title: Pharmacodynamic effect of clopidogrel in patients undergoing transcatheter aortic valve implantation.
abstract: The aim of this study was to analyze periprocedural and mid-term effect of clopidogrel on platelet function using the VerifyNow P2Y12 point-of-care assay in patients undergoing TAVI. Platelet reactivity was measured at the beginning of the procedure after 300 mg clopidogrel bolus administration and during the follow-up (at 1 month after the procedure) in 52 patients undergoing TAVI using the Medtronic CoreValve prosthesis (Medtronic CoreValve). A cutoff value of 240 PRU was used to identify nonresponders to clopidogrel treatment with high residual platelet reactivity (HRPR). Baseline HRPR was identified in 80% of patients and in 72% of patients during 6-month follow-up. There was no significant difference in the pharmacodynamic effects of clopidogrel on platelet reactivity from baseline to 6-months follow-up (297 ± 57 vs. 275 ± 62; P = 0.058). Ischemic event occurred only in 3 patients (5.8%) from the study group. In conclusion, majority of patients undergoing TAVI had high residual platelet reactivity after pretreatment with 300 mg of clopidogrel and during the 6-month follow-up at dual antiplatelet treatment. The noneffectiveness of clopidogrel in the TAVI population raises the question of the routine use of dual antiplatelet treatment in this setting.
authors: Third Faculty of Medicine, Charles University, University Hospital Vinohrady, Cardiocenter, Srobarova 50, 100 34 Prague 10, Czech Republic. tousek@email.cz
authors: Petr
authors: P
authors: Tousek
authors: Viktor
authors: V
authors: Kocka
authors: Jakub
authors: J
authors: Sulzenko
authors: Frantisek
authors: F
authors: Bednar
authors: Hana
authors: H
authors: Linkova
authors: Petr
authors: P
authors: Widimsky
mesh_terms: D054058:Acute Coronary Syndrome / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001792:Blood Platelets / Q000378:metabolism; D001807:Blood Vessel Prosthesis; D000077144:Clopidogrel; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000473:pathology / Q000601:surgery*; D015539:Platelet Activation; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000077144:Clopidogrel; D013988:Ticlopidine
references: Eur Heart J. 2011 Jan;32(2):198-204
references: 20864486
references: Circulation. 2009 Jan 20;119(2):237-42
references: 19118249
references: N Engl J Med. 2012 May 3;366(18):1705-15
references: 22551129
references: Eur Heart J. 2008 Apr;29(8):992-1000
references: 18263931
references: J Am Coll Cardiol. 2013 Dec 24;62(25):2349-2359
references: 23583252
references: N Engl J Med. 2007 Nov 15;357(20):2001-15
references: 17982182
references: EuroIntervention. 2008 Aug;4(2):242-9
references: 19110790
references: JAMA. 2002 Nov 20;288(19):2411-20
references: 12435254
references: Lancet. 2001 Aug 18;358(9281):527-33
references: 11520521
references: Am J Cardiol. 2011 Dec 15;108(12):1772-6
references: 21907949
references: J Thromb Thrombolysis. 2013 May;35(4):476-82
references: 23420510
references: N Engl J Med. 2009 Sep 10;361(11):1045-57
references: 19717846
references: J Am Coll Cardiol. 2010 Mar 16;55(11):1080-90
references: 20096533