title: Detection of clopidogrel hyporesponsiveness using a point-of-care assay and the impact of additional cilostazol administration after coronary stent implantation in diabetic patients.
abstract: OBJECTIVE
  Impaired responsiveness to clopidogrel is common in patients with type 2 diabetes mellitus (DM). The aim of this study was to evaluate the clinical application of a point-of-care assay to detect impaired responsiveness to clopidogrel after coronary stent implantation in patients with type 2 DM.
  
  
  METHODS
  We measured P2Y12 reaction units (PRU) with the VerifyNow point-of-care assay in 544 consecutive patients undergoing dual or triple (i.e., dual plus cilostazol) anti-platelet therapy after coronary stent implantation. High platelet reactivity (HPR) was defined as a PRU value ≥ 240.
  
  
  RESULTS
  The mean PRU values were 233.5 ± 83.2 and 190.3 ± 85.5 in patients undergoing dual or triple anti-platelet therapy, respectively (p < 0.001). Patients with DM manifested higher post treatment PRU values (238.3 ± 82.4 vs. 210.8 ± 86.8, p = 0.001) and a higher frequency of HPR (44.8% vs. 31.0%, p = 0.003) as compared to patients without DM. We also found that higher PRU values and a higher frequency of HPR were present in patients with DM who were undergoing both triple and dual anti-platelet therapy. However, the higher post-treatment PRU values observed in patients with DM decreased with triple anti-platelet therapy (219.4 ± 82.5 vs. 247.9 ± 81.1, p = 0.044).
  
  
  CONCLUSIONS
  A point-of-care assay can detect elevated platelet reactivity and impaired responsiveness to clopidogrel in patients with type 2 DM. The addition of cilostazol to dual anti-platelet therapy may decrease post-treatment PRU values in patients with type 2 DM.
authors.affiliation: Department of Internal Medicine & Cardiovascular Research Institute, Inje University College of Medicine, Busan, Korea.
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yang
authors.forename: Doo-Il
authors.initials: DI
authors.lastname: Kim
authors.forename: Dong-Kie
authors.initials: DK
authors.lastname: Kim
authors.forename: Jae-Sik
authors.initials: JS
authors.lastname: Jang
authors.forename: Ung
authors.initials: U
authors.lastname: Kim
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Seol
authors.forename: Dae-Kyeong
authors.initials: DK
authors.lastname: Kim
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.forename: Jong-Seon
authors.initials: JS
authors.lastname: Park
authors.forename: Dong-Gu
authors.initials: DG
authors.lastname: Shin
authors.forename: Young-Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Yun-Kyeong
authors.initials: YK
authors.lastname: Cho
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Kwon-Bae
authors.initials: KB
authors.lastname: Kim
authors.forename: Dong-Soo
authors.initials: DS
authors.lastname: Kim
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D001241:Aspirin / Q000008:administration & dosage; D016009:Chi-Square Distribution; D000077407:Cilostazol; D000077144:Clopidogrel; D003327:Coronary Disease / Q000097:blood / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D010979:Platelet Function Tests; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D012042:Registries; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013777:Tetrazoles / Q000008:administration & dosage* / Q000009:adverse effects; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin