Dual thienopyridine low-response to clopidogrel and prasugrel in a patient with STEMI, cardiogenic shock and early stent thrombosis is overcome by ticagrelor.
Little is known about the antiplatelet action of the thienopyridines, clopidogrel and prasugrel, as well as the non-thienopyridine, ticagrelor, in patients suffering from ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock since systematic comparisons of these antiplatelet agents in this devastating condition are limited so far. This is a report of a patient with STEMI undergoing urgent PCI in cardiogenic shock followed by repeated angioplasty after suffering early stent thrombosis (ST) who showed dual thienopyridine treatment failure of clopidogrel and prasugrel, which was successfully overcome by switching the patient to the non-thienopyridine derivative ticagrelor.
Deutsches Herzzentrum München & 1. Medizinische Klinik, Technische Universität München, Munich, Germany. MartinOrban@gmail.com
Martin
M
Orban
Julia
J
Riegger
Michael
M
Joner
Tomohisa
T
Tada
Rainer
R
Okrojek
Jörg
J
Hausleiter
Adnan
A
Kastrati
Steffen
S
Massberg
Dirk
D
Sibbing
D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D000077144:Clopidogrel; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D012770:Shock, Cardiogenic / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D015607:Stents / Q000009:adverse effects; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use*; D013927:Thrombosis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine