8 research outputs found
Elevated Plasma Fibrinogen and Diabetes Mellitus Are Associated With Lower Inhibition of Platelet Reactivity With Clopidogrel
Get PDFObjectivesThe goal of this study was to identify factors associated with lower platelet inhibition (PI) with clopidogrel in subjects with cardiovascular disease (CVD).BackgroundA heterogeneous platelet reactivity response to clopidogrel exists, and the clinical or biochemical predictors of suboptimal PI with clopidogrel remain unclear.MethodsThis study prospectively enrolled subjects with CVD requiring treatment with clopidogrel (75 mg daily for ≥7 days or 600-mg bolus ≥24 h before recruitment). A bedside rapid platelet function assay (VerifyNow, Acccumetrics, San Diego, California) to measure maximal and clopidogrel-mediated platelet reactivity was utilized, and factors associated with lower PI were identified.ResultsA heterogeneous, normally distributed PI (mean 40.8 ± 26.2%) response to clopidogrel was observed in 157 subjects (age 67.2 ± 12.2 years; 59.9% men). Multiple variable analysis of clinical and biochemical factors known to affect platelet reactivity revealed lower PI in patients with an elevated plasma fibrinogen level (≥375 mg/dl), diabetes mellitus, and increased body mass index (BMI) (≥25 kg/m2). On testing for interaction, elevated fibrinogen level was associated with diabetic status, resulting in lower PI in diabetic patients (23.9 ± 3.9% vs. 45.1 ± 4.5%, p < 0.001), but not nondiabetic patients (44.7 ± 4.4% vs. 46.3 ± 4.8%, p = 0.244). Increased BMI remained independently associated with lower PI after clopidogrel therapy regardless of diabetic status or fibrinogen level (36.8 ± 9.0% vs. 49.0 ± 7.0%, p < 0.001).ConclusionsElevated plasma fibrinogen (≥375 mg/dl) in the presence of diabetes mellitus and increased BMI (≥25 kg/m2) are associated with lower PI with clopidogrel in patients with CVD
Fase Piloto do Estudo SPECTRUM. Reserva de Fluxo Fracionada Versus Angiografia para Avaliação e Conduta em Pacientes com Lesões Obstrutivas Coronárias de Grau Moderado: Racional e Desenho do Estudo
No full textIntrodução: A despeito de suas reconhecidas limitações, a angiografia coronária invasiva é o método mais usado (muitas vezes único) para a adoção de estratégias terapêuticas em pacientes submetidos a cateterismo cardíaco diagnóstico. A mensuração de reserva de fluxo fracionada (FFR) tem sido empregada em diversos estudos, fundamentalmente no contexto de pacientes em que a avaliação angiográfica per se indica a necessidade de intervenção sobre as lesões coronárias. No entanto, o método praticamente não foi ainda testado em condições opostas, no cenário clínico em que as obstruções, angiograficamente, não indicariam intervenções. O propósito deste trabalho, a ser realizado de forma piloto em dois centros, é testar a hipótese de que também para lesões intermediárias, nas quais a angiografia não demonstra necessidade de intervenção coronária, a medida de FFR resultaria em alteração da conduta terapêutica baseada em angiografia. Métodos: Serão incluídos pacientes consecutivos e clinicamente estáveis, com doença coronária em segmento proximal e/ou médio de um ou mais vasos epicárdicos (diâmetro > 2,5 mm), apresentando obstruções entre 40 e 70%, por estimativa visual. Em seguida, a conduta terapêutica (clínica ou intervencionista) baseada em angiografia, relativamente a essas lesões, será definida de maneira independente por consenso de dois observadores. A partir daí, os pacientes, em ambos os grupos, serão randomizados para dois subgrupos: (1) manutenção de conduta baseada na angiografia; e (2) realização de FFR para decisão terapêutica. Os pacientes com lesões em que se obtiver FFR < 0,80 serão tratados com revascularização percutânea ou cirúrgica, enquanto os portadores de lesões com FFR ≥ 0,80 serão tratados clinicamente. Conclusões: O presente estudo visa avaliar se a medida de FFR em lesões intermediárias não consideradas necessárias de tratamento intervencionista pela angiografia resulta em mudança de conduta
Elevated Plasma Fibrinogen Level Predicts Suboptimal Response to Therapy With Both Single- and Double-Bolus Eptifibatide During Percutaneous Coronary Intervention
Get PDFObjectivesThis study sought to determine the factors associated with suboptimal platelet inhibition (PI) with single- and double-bolus eptifibatide during percutaneous coronary intervention (PCI).BackgroundAlthough PI ≥ 95% measured 10 min after glycoprotein IIb/IIIa inhibitor therapy is associated with improved outcomes following PCI, this level of PI often is not achieved.MethodsWe prospectively studied 150 patients undergoing PCI with single-bolus eptifibatide (180 μg/kg) (n = 100) and double-bolus eptifibatide (180 μg/kg administered 10 min apart) (n = 50) followed by standard infusion (2 μg/kg/min). Measuring platelet aggregation at baseline and at 10 min and 30 to 45 min after eptifibatide bolus, patients were classified as optimal responders (OPT) (≥95% PI) or suboptimal responders (sub-OPT) (<95% PI) based on 10-min PI after final bolus.ResultsSuboptimal PI was achieved in 61% of patients with single-bolus eptifibatide and in 36% with double-bolus eptifibatide. In the single-bolus group, sub-OPT had higher fibrinogen levels (324 ± 85 mg/dl vs. 259 ± 49 mg/dl, p = 0.0002), platelet counts (221 ± 70 vs. 186 ± 47, p = 0.008), and white blood cell counts (7.7 ± 2.3 vs. 6.6 ± 1.9, p = 0.02). In the double-bolus group, sub-OPT also had higher fibrinogen levels (324 ± 68 mg/dl vs. 278 ± 53 mg/dl, p = 0.01) and were more likely to be smokers (38.9% vs. 9.4%, p = 0.01). Multivariable analysis showed that fibrinogen level was the only independent predictor of suboptimal PI, with fibrinogen cutoffs at 375 and 325 mg/dl predicting suboptimal PI (single-bolus: 100% and 90.0%, respectively; double-bolus: 100% and 60%, respectively) with both doses.ConclusionsDuring PCI, both single- and double-bolus eptifibatide provide suboptimal PI in a substantial proportion of patients. A fibrinogen level >375 mg/dl is a strong predictor of suboptimal PI
Elevated Plasma Fibrinogen Level Predicts Suboptimal Response to Therapy With Both Single- and Double-Bolus Eptifibatide During Percutaneous Coronary Intervention
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