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Cardiology - Interventional
A 59-year-old man who smoked, with hypercholesterolaemia and a family history of premature coronary artery disease, underwent percutaneous coronary intervention (PCI) with two drug-eluting stents to the right coronary artery and left anterior descending artery for a non-ST-segment elevation myocardial infarction (NSTEMI). Six hundred and seventy-one days later, he presented with stent thrombosis while taking aspirin 150 mg once daily; both vessels showed acute thrombotic occlusion and required four additional drug-eluting stents. Short thromboelastography (sTEG) demonstrated an adequate aspirin response (% clotting inhibition [CI] 82%) but hyporesponsiveness to clopidogrel 75 mg once daily (%CI 8) after 19 days and prasugrel 10 mg once daily (%CI 9) after 56 days. Ticagrelor 90 mg twice daily was then initiated. After 21 days, %CI was 24, indicating an inadequate response, although this was numerically greater than with prasugrel. Given the relatively greater platelet inhibition observed with ticagrelor, the decision was made to continue ticagrelor for 12 months. No further ischaemic events were reported during follow-up.
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