Prevalence of clOpidogrel 'resIstaNce' in a selected population of patients undergoing elective percutaneous coronary intervention at a tertiary cardiovascular centre in Trinidad: the POINT pilot study.

Authors:
Naveen Anand Seecheran
Naveen Anand Seecheran
The University of the West Indies
Kingston | Jamaica
Rajeev Seecheran
Rajeev Seecheran
The University of the West Indies
Dr Valmiki Seecheran, MBBS
Dr Valmiki Seecheran, MBBS
Eric Williams Medical Sciences Complex Compound
House Officer
Internal Medicine
Champ Fleurs, Tunapuna-Piarco | Trinidad and Tobago
Sangeeta Persad
Sangeeta Persad
North West Regional Health Authority
Boone | United States
Sherry Sandy
Sherry Sandy
University of Calgary

Open Heart 2019 27;6(1):e000841. Epub 2019 Feb 27.

Cardiology Unit, Universidad de Murcia, Murcia, Spain.

Objectives:  This novel, pilot study aimed to assess the estimated prevalence of high on-treatment platelet reactivity (HPR) in Trinidad and Tobago.

Methods: Patients (n=40) who were awaiting elective percutaneous coronary intervention on maintenance dual antiplatelet therapy (DAPT) with aspirin 81 mg daily and clopidogrel 75 mg or loaded at least 48 hours prior were recruited. Platelet reactivity with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, California, USA) was assessed prior to cardiac catheterisation.

Results: 60.7% (17/28) of the South Asian (Indo-Trinidadians) patients had HPR, whereas 14.3% (1/7) of Africans and 40% (2/5) of mixed ethnicity had HPR. There was a significant association between HPR (P2Y12 reaction units >208) and ethnicity with South Asians (Indo-Trinidadians) (OR 5.4; 95% CI 1.18 to 24.66, p=0.029).

Conclusions: This pilot study serves to introduce the preliminary observation that the estimated prevalence of HPR is considerably higher within the heterogeneous population in Trinidad at 50% as compared with predominantly Caucasian studies. Furthermore, the HPR is significantly higher in South Asians (Indo-Trinidadians) (>60% of patients) which has severe clinical repercussions considering the cardiovascular disease pandemic. Clopidogrel may not be a satisfactory or optimal antiplatelet agent in this subgroup, and therefore, another more potent antiplatelet such as ticagrelor should be used instead. Further large-scale studies are imperative to confirm these findings. (Funded by the University of the West Indies, St. Augustine; POINT ClinicalTrials.gov number, NCT03667066.).

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Source
http://dx.doi.org/10.1136/openhrt-2018-000841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443217PMC
February 2019

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