BackgroundPeriprocedural bleeding events are common after percutaneous coronary intervention. We evaluated the association of periprocedural bleeding events with thrombogenicity, which was measured quantitatively by the Total Thrombus‐formation Analysis System equipped with microchips and thrombogenic surfaces (collagen, platelet chip [PL]; collagen plus tissue factor, atheroma chip [AR]).Methods and ResultsBetween August 2013 and March 2016, 313 consecutive patients with coronary artery disease undergoing elective percutaneous coronary intervention were enrolled. They were divided into those with or without periprocedural bleeding events. We determined the bleeding events as composites of major bleeding events defined by the International Society on Thrombosis and Hemostasis and minor bleeding events (eg, minor hematoma, arteriovenous shunt and pseudoaneurysm). Blood samples obtained at percutaneous coronary intervention were analyzed for thrombus formation area under the curve (PL24‐AUC10 for PL chip; AR10‐AUC30 for AR chip) by the Total Thrombus‐formation Analysis System and P2Y12 reaction unit by the VerifyNow system. Periprocedural bleeding events occurred in 37 patients. PL24‐AUC10 levels were significantly lower in patients with such events than those without (P=0.002). Multiple logistic regression analyses showed association between low PL24‐AUC10 levels and periprocedural bleeding events (odds ratio, 2.71 [1.22–5.99]; P=0.01) and association between PL24‐AUC10 and periprocedural bleeding events in 176 patients of the femoral approach group (odds ratio, 2.88 [1.11–7.49]; P=0.03). However, PL24‐AUC10 levels in 127 patients of the radial approach group were not significantly different in patients with or without periprocedural bleeding events.ConclusionsPL24‐AUC10 measured by the Total Thrombus‐formation Analysis System is a potentially useful predictor of periprocedural bleeding events in coronary artery disease patients undergoing elective percutaneous coronary intervention.
The assessment of bleeding risk in patients with coronary artery disease (CAD) is clinically important. We recently developed the Total Thrombus-Formation Analysis System (T-TAS) for the quantitative analysis of thrombus formation using microchips with thrombogenic surfaces. Here, we assessed the utility of T-TAS parameters in predicting 1-year bleeding events in patients with CAD. Methods: The study subjects were 561 consecutive patients who underwent coronary angiography (CAG) between August 2013 and September 2016 for suspected CAD. Blood samples collected at the time of CAG were used for T-TAS to compute the area under the curve (AUC) (AR10-AUC30) in the AR chip. Patients were divided into three groups according to AR10-AUC30 (low: ≤ 1603, intermediate, and high: 1765, n 187 each). Oneyear bleeding events were defined by the Platelet Inhibition and Patient Outcomes criteria. Results: Bleeding occurred in 21 (3.7%) patients and was classified as major (8 [1.4%]) and minor (13 [2.3%]). The AR10-AUC30 levels were significantly lower in the bleeding group than the non-bleeding group (median [interquartile range] 1590 [1442-1734] vs. 1687 [1546-1797], p 0.04). Univariate Cox regression analysis demonstrated that low AR10-AUC30 , high prothrombin time-international normalized ratio levels, and diabetes correlated with bleeding events. Multivariate Cox regression analysis identified low AR10-AUC30 levels as a significant determinant of bleeding events. Kaplan-Meier survival curves showed a higher rate of bleeding events in the low than the high AR10-AUC30 group (p 0.007). Conclusions: The results highlight the potential usefulness of the AR10-AUC30 levels in the prediction of 1-year bleeding events in patients with CAD treated with various antithrombotic therapies. (AF) and venous thromboembolism. However, there is no adequate monitoring system that can evaluate antithrombotic drugs. Bleeding events are one of the major concerns in patients treated with these drugs. Bleeding events after PCI are associated with early and late mortality 1-4). The reported incidence of major bleeding events in patients with stable coronary artery disease (CAD) is 0.6%/year, and major bleeding events are significantly associated with mortality 5). Furthermore, approximately 5%-8% of patients who Copyright©2019 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.
It has been reported that combination therapies that include low-dose rivaroxaban seem to be effective in secondary prevention of acute coronary syndrome, 11 which suggests that rivaroxaban is effective not only for atrial fibrillation and venous thrombosis but also for coronary artery thrombosis. However, there is insufficient evidence about the cardioprotective effects of rivaroxaban on cardiac remodeling after MI. Rivaroxaban also exhibits anti-inflammatory properties, acting through amelioration of protease-activated receptor (PAR)-1 and-2 in arteriosclerosis models. 12-17 In addition, basic in vivo and in vitro research work has examined in detail the relationship between PARs and cardiac remod-C ardiac remodeling is an important prognostic factor in heart failure (HF). 1 Myocardial infarction (MI) is the most common cause of HF 2 and our understanding of the effect of cardiac remodeling in HF is based on MI studies. 3 The pathology of MI suggests that the inflammatory changes in the infarcted tissue correlate closely with cardiac function and prognosis after MI. 4,5 These findings suggest that modulation of the inflammatory response in the infarcted myocardium could potentially improve cardiac remodeling after MI. Rivaroxaban, an oral anticoagulant, is used to prevent and treat atrial fibrillation and venous thrombosis, because it exerts its anticoagulant properties by inhibiting activated
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