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
Naveen Anand Seecheran,
Aarti Maharaj,
Brent Boodhai,
Rajeev Seecheran,
Valmiki Seecheran,
Sangeeta Persad,
Koomatie Ramsaroop,
Sherry Sandy,
Stanley Giddings,
Sateesh Sakhamuri,
Ronan Ali,
Shastri Motilal,
Surujpal Teelucksingh,
Antonio Tello-Montoliu
Affiliations
Naveen Anand Seecheran
1 Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
Aarti Maharaj
2 Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
Brent Boodhai
2 Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
Rajeev Seecheran
Department of Medicine, University of Kansas Medical Center, Wichita, Kansas, USA
Valmiki Seecheran
Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
Sangeeta Persad
2 Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
Koomatie Ramsaroop
2 Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
Sherry Sandy
Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
Stanley Giddings
Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
Sateesh Sakhamuri
1 Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
Ronan Ali
1 Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
Shastri Motilal
1 Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
Surujpal Teelucksingh
1 Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
Antonio Tello-Montoliu
Cardiology Division, 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.)
