An Intra-procedural Stent Thrombosis in a Prasugrel Resistant Patient Treated with Ticagrelor

Stent thromboses due to multifactorial causes including hypercoagulable conditions and high on treatment platelet reactivity (HTPR), which means a low response to anti-platelet therapy, especially clopidogrel. Prasugrel is a third generation thienopyridine and inactive pro-drug requiring metabolic activation in vivo, which improves the rate of HTPR with clopidogrel. This drug is mostly effective, with a potent, fast, and consistent anti-platelet action, but rare cases of inadequate platelet inhibition with prasugrel have been reported. Here we describe the case of a 47-year-old man who presented with a recurrent acute myocardial infarction and ST during an intravascular ultrasound pullback and was resistant to prasugrel, was successfully treated with ticagrelor.

[1]  R. van Oerle,et al.  The hypercoagulable profile of patients with stent thrombosis , 2015, Heart.

[2]  A. Jaffe,et al.  2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2014, Circulation.

[3]  L. Leroux,et al.  First report of a subacute stent thrombosis in a prasugrel resistant patient successfully managed with ticagrelor , 2014, Platelets.

[4]  D. Trenk,et al.  Genetics of platelet inhibitor treatment. , 2014, British journal of clinical pharmacology.

[5]  A. Mügge,et al.  Cytochrome P450 2B6 and 2C9 genotype polymorphism – a possible cause of prasugrel low responsiveness , 2013, Thrombosis and Haemostasis.

[6]  I. Xanthopoulou,et al.  Resistance to high-maintenance dose of prasugrel treated by ticagrelor: A case report , 2013, Platelets.

[7]  Masafumi Ueno,et al.  Impact of prasugrel reload dosing regimens on high on-treatment platelet reactivity rates in patients on maintenance prasugrel therapy. , 2013, JACC. Cardiovascular interventions.

[8]  M. Joner,et al.  Dual thienopyridine low-response to clopidogrel and prasugrel in a patient with STEMI, cardiogenic shock and early stent thrombosis is overcome by ticagrelor , 2012, Platelets.

[9]  R. More,et al.  The Use of Ticagrelor in a Patient at Increased Risk of Stent Thrombosis Resistant to Multiple Thienopyridines , 2011, Cardiology.

[10]  L. Thuesen,et al.  Late coronary stent thrombosis. , 2010, Minerva medica.

[11]  V. Serebruany,et al.  Application of platelet function testing to the bedside , 2009, Thrombosis and Haemostasis.

[12]  F. Giordanetto,et al.  Ticagrelor binds to human P2Y12 independently from ADP but antagonizes ADP‐induced receptor signaling and platelet aggregation , 2009, Journal of thrombosis and haemostasis : JTH.

[13]  B. Ring,et al.  INTERACTIONS OF TWO MAJOR METABOLITES OF PRASUGREL, A THIENOPYRIDINE ANTIPLATELET AGENT, WITH THE CYTOCHROMES P450 , 2006, Drug Metabolism and Disposition.

[14]  J. Tardif,et al.  Long-term safety of intravascular ultrasound in nontransplant, nonintervened, atherosclerotic coronary arteries. , 2005, Journal of the American College of Cardiology.

[15]  C. Esmon.  The anticoagulant and anti-inflammatory roles of the protein C anticoagulant pathway. , 2000, Journal of autoimmunity.

[16]  G. Stone,et al.  Intra-procedural stent thrombosis: a new risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention for acute coronary syndromes. , 2013, JACC. Cardiovascular interventions.

[17]  D. Kosinski,et al.  International Medical Case Reports Journal Dovepress Recurrent Myocardial Infarctions in a Young Football Player Secondary to Thrombophilia, Associated with Elevated Factor Viii Activity , 2022 .