January 27, 2009 - According to research findings from Interventional Cardiologist Paul A. Gurbel, M.D., director of the Sinai Center for Thrombosis Research based at Sinai Hospital of Baltimore, platelet aggregation or "stickiness" may be the single most important risk factor in patients treated with coronary stents.
"We currently measure the cholesterol level in everyone with vascular disease, yet the pivotal event that kills the patient - platelet aggregation isn't being assessed in any way," said Dr. Gurbel.
Dr. Gurbel's findings may explain why someone with no cardiac history could die suddenly of a massive heart attack, while an individual with high blood pressure, high cholesterol and plaque-filled arteries may never have a cardiac event because they had low platelet aggregation.
Dr. Gurbel and his team at Sinai Hospital demonstrated that patients with platelets most prone to aggregate had the highest prevalence of complications, including heart attack, after coronary artery stenting. Their work is helping to revolutionize the testing and treatment of patients with coronary artery disease, offering further evidence that a more personalized approach to anti-platelet therapy needs to be established.
Dr. Gurbel was one of the first researchers in the world to discover that up to 30 percent of patients taking clopidogrel, a drug designed to decrease platelet aggregation, do not respond to treatment.
"Of the millions of cardiac patients treated with clopidogrel, a significant percentage are non-responsive and remain at high risk for a major cardiac event," said Dr. Gurbel. "The platelet aggregation of each patient needs to be precisely measured to determine how well the drug is working. The blind administration of anti-platelet drugs without confirming a good response, in our opinion, will soon be reaching an end."
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