{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T11:37:56Z","timestamp":1788089876084,"version":"build-2803163510"},"reference-count":16,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,2,10]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>Stent thrombosis (ST) may occur due to variability in platelet response to P2Y12 inhibitors, particularly after excluding common causes such as mechanical complications or medication non-compliance. Although ticagrelor and prasugrel typically provide more potent and consistent platelet inhibition than clopidogrel, some individuals still demonstrate inadequate response due to drug resistance. We describe a healthy, non-smoking male in his mid-60s who developed subacute ST 4\u2009days after drug-eluting stent placement while on dual antiplatelet therapy with aspirin and ticagrelor. After excluding mechanical and clinical aetiologies, ticagrelor resistance was suspected. His regimen was switched to aspirin and prasugrel; however, thromboelastography (TEG) platelet mapping demonstrated persistently high on-treatment platelet reactivity to prasugrel, even after doubling the prasugrel dose. This case highlights rare resistance to newer P2Y12 inhibitors as a cause of unexplained ST and underscores the value of TEG platelet mapping to identify antiplatelet non-responsiveness and guide individualised therapy.<\/jats:p>","DOI":"10.1136\/bcr-2025-271188","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T14:05:37Z","timestamp":1771941937000},"page":"e271188","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Dual resistance to ticagrelor and prasugrel leading to subacute stent thrombosis: a diagnostic and therapeutic challenge"],"prefix":"10.1136","volume":"19","author":[{"given":"Abdelhadi","family":"Farouji","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Saint Michael\u2019s Medical Center, New York Medical College, Newark, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed","family":"Umer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Saint Michael\u2019s Medical Center, New York Medical College, Newark, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masara","family":"Touza","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Saint Michael\u2019s Medical Center, New York Medical College, Newark, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arwa","family":"Battah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Saint Michael\u2019s Medical Center, New York Medical College, Newark, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Abureesh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iyad","family":"Farouji","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Saint Michael\u2019s Medical Center, New York Medical College, Newark, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"2026022406051541000_19.2.e271188.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1908973"},{"key":"2026022406051541000_19.2.e271188.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"2026022406051541000_19.2.e271188.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"2026022406051541000_19.2.e271188.4","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1159\/000464404","article-title":"Acute Coronary Stent Thrombosis in Modern Era: Etiology, Treatment, and Prognosis","volume":"137","author":"Ge","year":"2017","journal-title":"Cardiology"},{"key":"2026022406051541000_19.2.e271188.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.17.2126"},{"key":"2026022406051541000_19.2.e271188.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.026788"},{"key":"2026022406051541000_19.2.e271188.7","first-page":"e264","article-title":"Mechanisms of stent thrombosis analysed by optical coherence tomography","volume":"12","author":"Souteyrand","year":"2016","journal-title":"EuroIntervention"},{"key":"2026022406051541000_19.2.e271188.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.01.094"},{"key":"2026022406051541000_19.2.e271188.9","doi-asserted-by":"crossref","unstructured":"Cheng D , Zhao S , Hao Y . Net platelet clot strength of thromboelastography platelet mapping assay for the identification of high on-treatment platelet reactivity in post-PCI patients. Biosci Rep 2020;40. doi:10.1042\/BSR20201346","DOI":"10.1042\/BSR20201346"},{"key":"2026022406051541000_19.2.e271188.10","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1111\/1755-5922.12083","article-title":"The \u201cdual-pathway\u201d strategy after acute coronary syndrome: rivaroxaban and antiplatelet agents in the ATLAS ACS 2-TIMI 51 trial","volume":"32","author":"Cohen","year":"2014","journal-title":"Cardiovasc Ther"},{"key":"2026022406051541000_19.2.e271188.11","doi-asserted-by":"crossref","first-page":"450","DOI":"10.2459\/JCM.0000000000000516","article-title":"Real-world use of ticagrelor and prasugrel in patients with NSTEMI undergoing percutaneous coronary intervention","volume":"18","author":"Sucato","year":"2017","journal-title":"J Cardiovasc Med (Hagerstown)"},{"key":"2026022406051541000_19.2.e271188.12","unstructured":"Sampat PJ , Prasugrel WR . StatPearls. Treasure Island (FL): StatPearls Publishing, 2024. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557427\/"},{"key":"2026022406051541000_19.2.e271188.13","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12031149","article-title":"Ticagrelor Resistance in Cardiovascular Disease and Ischemic Stroke","volume":"12","author":"He","year":"2023","journal-title":"J Clin Med"},{"key":"2026022406051541000_19.2.e271188.14","first-page":"3055","article-title":"Expert position paper on the role of platelet function testing in patients undergoing percutaneous coronary intervention","volume":"36","author":"Aradi","year":"2015","journal-title":"Eur Heart J"},{"key":"2026022406051541000_19.2.e271188.15","doi-asserted-by":"publisher","DOI":"10.3109\/09537104.2011.600478"},{"key":"2026022406051541000_19.2.e271188.16","first-page":"1019","article-title":"Efficacy and safety of cilostazol-based triple antiplatelet therapy after percutaneous coronary intervention: a meta-analysis","volume":"167","author":"Zhang","year":"2013","journal-title":"Int J Cardiol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271188","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T14:05:43Z","timestamp":1771941943000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,24]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bcr-2025-271188"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271188","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}