Resistance to thienopyridines: clinical detection of coronary stent thrombosis by monitoring of vasodilator-stimulated phosphoprotein phosphorylation

Catheter Cardiovasc Interv. 2003 Jul;59(3):295-302. doi: 10.1002/ccd.10497.

Abstract

We carried out a prospective evaluation of a new vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay in order to detect patients with high-risk coronary subacute stent thrombosis (SAT) despite thienopyridine regimen. Twenty healthy donors (group 1) without any medication were compared to 16 stented patients (group 2) treated by ticlopidin or clopidogrel initiated 2 days before stenting and aspirin (250 mg/day). No difference in platelet reactivity was noted between group 1 and group 2 treated only with aspirin (72.00% +/- 4.17% vs. 69.73% +/- 5.62%, respectively; P = NS). Significant differences were found between patients of group 2 treated with aspirin alone (69.73% +/- 5.62%), after 2.0 days (60.14% +/- 9.60%; P < 0.05), and after 4.8 +/- 1.3 days (48.37% +/- 11.19%; P < 0.05) with thienopyridine-aspirin. Among 1,684 consecutive stented patients, 16 patients who presented an SAT (group 3) were compared with 30 other stented patients free of SAT (group 4). We found a significant difference between group 3 (63.28% +/- 9.56%) and group 4 (39.80% +/- 10.9%; P < 0.0001). VASP phosphorylation analysis may be useful for the detection of coronary SAT.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon, Coronary / adverse effects
  • Angioplasty, Balloon, Coronary / instrumentation
  • Aspirin / administration & dosage
  • Case-Control Studies
  • Cell Adhesion Molecules / analysis*
  • Chi-Square Distribution
  • Clopidogrel
  • Coronary Restenosis / diagnosis
  • Coronary Restenosis / prevention & control
  • Coronary Stenosis / therapy*
  • Coronary Thrombosis / diagnosis*
  • Coronary Thrombosis / prevention & control*
  • Drug Resistance
  • Female
  • Flow Cytometry
  • Humans
  • Male
  • Microfilament Proteins
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Phosphoproteins / analysis*
  • Pilot Projects
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Premedication
  • Probability
  • Prospective Studies
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Stents / adverse effects*
  • Ticlopidine / administration & dosage
  • Ticlopidine / analogs & derivatives*
  • Treatment Outcome

Substances

  • Cell Adhesion Molecules
  • Microfilament Proteins
  • Phosphoproteins
  • Platelet Aggregation Inhibitors
  • vasodilator-stimulated phosphoprotein
  • Clopidogrel
  • Ticlopidine
  • Aspirin