English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Tools annual

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Presents the access of premium content as premium feature

Premium Content

Global: Zendy Plus annual

Global: Zendy Free Plan

E-mail: miroslav.krpan@gmail.com Objectives: Platelet response to clopidogrel is not uniform. It is known that inadequate effect of clopidogrel on platelets increases the risk for new ischeamic events. We aimed to investigate whether repeated clopidogrel reloading regimen and increased maintenance dose in persistent low responders is an effective and a safe strategy. Patients and Methods: Patients with acute coronary syndrome who underwent coronary stenting were tested with impendance aggregometer — Multiplate function analyzer. This is a point of care instrument which measures residual platelet reactivity (RPR) in small quantities of the whole blood. Low clopidogrel responders received another loading dose and underwent aggregometry testing the following day. The remaining low responders on repeated aggregometry received the third loading dose followed by a maintenance dose of 150 mg/day. On day 7, we repeated aggregometry testing and patients who remained low responders were assigned to a clopidogrel maintenance dose of 300 mg/day. After one month follow-up we conducted control interview and Multiplate testing. Results: Persistent low response to clopidogrel was found in 12 patients out of 43 initially low responders (27.9%). After one month of follow-up no patient had a major bleeding event. Furthermore, three patients sustained a new ischaemic event: non fatal myocardial infarction, ischaemic (fatal) stroke and in-stent thrombosis. After 30 days, seven patients (63.6%) still had high RPR. Conclusion: Our study showed that repeated clopidogrel reloading doses and very high maintenance doses can be safe in persistent low responders in terms of bleeding complications. However, certain number of patients are still inadequately treated and sustain new ischaemic events. Changing clopidogrel by a new thienopyridine like ticagrelor or prasugrel should be considered for those patients, if available.

cardiologia croatica

Impact of repeated clopidogrel reloading doses and increased maintenance dose in patients with acute coronary syndrome and persistent low response to clopidogrel in 30-day follow-up