• Tae-Hyun Yang, Doo-Il Kim, Dong-Kie Kim, Jae-Sik Jang, Ung Kim, Sang-Hoon Seol, Dae-Kyeong Kim, Geu-Ru Hong, Jong-Seon Park, Dong-Gu Shin, Young-Jo Kim, Yun-Kyeong Cho, Chang-Wook Nam, Seung-Ho Hur, Kwon-Bae Kim, and Dong-Soo Kim.
• Department of Internal Medicine & Cardiovascular Research Institute, Inje University College of Medicine, Busan, Korea.
• Korean J. Intern. Med. 2011 Jun 1;26(2):145-52.

Background/AimsImpaired responsiveness to clopidogrel is common in patients with type 2 diabetes mellitus (DM). The aim of this study was to evaluate the clinical application of a point-of-care assay to detect impaired responsiveness to clopidogrel after coronary stent implantation in patients with type 2 DM.MethodsWe measured P2Y12 reaction units (PRU) with the VerifyNow point-of-care assay in 544 consecutive patients undergoing dual or triple (i.e., dual plus cilostazol) anti-platelet therapy after coronary stent implantation. High platelet reactivity (HPR) was defined as a PRU value ≥ 240.ResultsThe mean PRU values were 233.5 ± 83.2 and 190.3 ± 85.5 in patients undergoing dual or triple anti-platelet therapy, respectively (p < 0.001). Patients with DM manifested higher post treatment PRU values (238.3 ± 82.4 vs. 210.8 ± 86.8, p = 0.001) and a higher frequency of HPR (44.8% vs. 31.0%, p = 0.003) as compared to patients without DM. We also found that higher PRU values and a higher frequency of HPR were present in patients with DM who were undergoing both triple and dual anti-platelet therapy. However, the higher post-treatment PRU values observed in patients with DM decreased with triple anti-platelet therapy (219.4 ± 82.5 vs. 247.9 ± 81.1, p = 0.044).ConclusionsA point-of-care assay can detect elevated platelet reactivity and impaired responsiveness to clopidogrel in patients with type 2 DM. The addition of cilostazol to dual anti-platelet therapy may decrease post-treatment PRU values in patients with type 2 DM.

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