Korean J Intern Med.  2011 Jun;26(2):145-152. 10.3904/kjim.2011.26.2.145.

Detection of Clopidogrel Hyporesponsiveness Using a Point-of-Care Assay and the Impact of Additional Cilostazol Administration after Coronary Stent Implantation in Diabetic Patients

• Yang TH
• Kim DI
• Kim DK
• Jang JS
• Kim U
• Seol SH
• Kim DK
• Hong GR
• Park JS
• Shin DG
• Kim YJ
• Cho YK
• Nam CW
• Hur SH
• Kim KB
• Kim DS

• KMID: 1776586
• DOI: http://doi.org/10.3904/kjim.2011.26.2.145

Abstract

BACKGROUND/AIMS
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 > or = 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.

Keyword

Cilostazol; Clopidogrel; Diabetes mellitus; Platelet function tests; Point-of-care systems

MeSH Terms

Aged
Angioplasty, Balloon, Coronary/adverse effects/*instrumentation
Aspirin/administration & dosage
Chi-Square Distribution
Coronary Disease/blood/*therapy
Diabetes Mellitus, Type 2/*blood
Drug Therapy, Combination
Female
Humans
Logistic Models
Male
Middle Aged
Platelet Activation/*drug effects
Platelet Aggregation Inhibitors/*administration & dosage/adverse effects
*Platelet Function Tests
*Point-of-Care Systems
Predictive Value of Tests
Purinergic P2Y Receptor Antagonists/*administration & dosage/adverse effects
Registries
Republic of Korea
Risk Assessment
Risk Factors
*Stents
Tetrazoles/*administration & dosage/adverse effects
Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives
Treatment Outcome