Characterization of the Antiplatelet Effect of Aspirin at Enrollment and After 2-Year Follow-up in a Real Clinical Setting in Japan

Ikeda, Tomoyuki; Taniguchi, Ryoji; Watanabe, Shin; Kawato, Mitsunori; Kondo, Hirokazu; Shirakawa, Ryutaro; Yamane, Keiichiro; Toma, Masanao; Tamura, Toshihiro; Takahashi, Kanako; Watanabe, Hiroshi; Yoshikawa, Yoshiaki; Tabuchi, Arata; Kita, Toru; Kimura, Takeshi; Horiuchi, Hisanori

doi:10.1253/circj.cj-09-0927

Cited by 6 publications

(10 citation statements)

References 27 publications

(20 reference statements)

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“…In that study, we previously reported that 28.0% of enrolled patients were aspirin low responders and they were associated with female gender and non-use of calcium-channel blockers (CCB) 8) .…”

Section: Study Endpoints and Definitionsmentioning

confidence: 99%

“…The method for determination of platelet reactivity for finding low responders to aspirin was described previously 8) . Briefly, platelet-rich plasma (PRP) was prepared from fasting blood and the aggregability was measured using an optical aggregometer with 0.1, 0.4, 1.6, 6.4, and 25.6 mg/L collagen as stimuli.…”

Section: Measurement Of Prp Aggregationmentioning

confidence: 99%

“…It is known that the antiplatelet effect of aspirin varies among patients and may be insufficient in some patients, known as aspirin low responders. Although the definition of aspirin low responders has not been established yet, its prevalence in patients is reported to be between 0.4 and 35% [6][7][8] . Notably, some studies who participated in the study.…”

Section: Introductionmentioning

confidence: 99%

“…Between May 2005 and May 2007, patients with high cardiovascular risk under antiplatelet therapy with aspirin, ticlopidine, clopidogrel, cilostazol, sarpogrelate, beraprost sodium, dipyridamole, or ethyl icosapentate for more than 60 days were enrolled in the APTEST database, and their clinical courses were followed. Their residual platelet reactivity (aggregability) and other blood laboratory values were examined at enrollment and after 2 years, as shown previously 8) . Compliance was evaluated by face-to-face interviews when their platelet aggregability was examined.…”

Section: Introductionmentioning

confidence: 99%

“…The definitions of hypertension, hyperlipidemia, and diabetes mellitus were also described in our previous report 8) . Coronary artery disease (CAD) was defined as a history of documented myocardial infarction, prior coronary revascularization intervention (coronary artery bypass graft surgery or percutaneous coronary intervention), or as the presence of ≥ 50% stenosis in one or more coronary arteries identified during cardiac catheterization.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Platelet Reactivity on Long-term Clinical Outcomes and Bleeding Events in Japanese Patients Receiving Antiplatelet Therapy with Aspirin

Yamane¹,

Ikeda²,

Taniguchi³

et al. 2012

JAT

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Aim:Aspirin is an antiplatelet drug widely used for the prevention of cardiovascular disease; however, it is known to increase bleeding events. A low response to aspirin was reported to correlate with poor prognosis in patients undergoing antiplatelet therapy with aspirin. The aim of this study was to evaluate the impact of the antiplatelet activity of aspirin on cardiovascular and bleeding events in Japanese patients. Methods: We analyzed the clinical course of 239 Japanese patients undergoing antiplatelet therapy with aspirin for a median of 64 months in this study. Their residual platelet reactivity was examined at enrollment and after 2 years. The co-primary endpoints were the occurrence of major adverse cardiac and cerebrovascular events (MACCEs) and bleeding events. Results: The annual incidence of MACCEs and major bleeding events was 3.7% and 0.48%, respectively. With defined criteria, 67 patients (28%) were classified as low responders based on the platelet aggregability measured at enrollment. Low response to aspirin was not associated with increased MACCEs, while it clearly increased MACCEs in patients less than 70 years old (low responders 36.9% vs. responders 14.8%, log rank p=0.008). Five major types of bleeding occurred in the responders, but not in low responders, although the difference was not statistically significant (p = 0.07). Conclusion: Low response to aspirin was not associated with the increase of long-term MACCEs, while it increased MACCEs in patients less than 70 years old; however, it tended to decrease major bleeding events in Japanese patients.

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Section: Study Endpoints and Definitionsmentioning

confidence: 99%

Section: Measurement Of Prp Aggregationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Platelet Reactivity on Long-term Clinical Outcomes and Bleeding Events in Japanese Patients Receiving Antiplatelet Therapy with Aspirin

Yamane¹,

Ikeda²,

Taniguchi³

et al. 2012

JAT

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Efficacy of dual antiplatelet therapy for preventing recurrence of arterial thrombosis in patients with antiphospholipid syndrome

et al. 2018

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OBJECTIVE: Warfarin is regarded as the standard treatment for preventing thrombotic events in antiphospholipid syndrome (APS), but the recurrence rate is still high. Dual antiplatelet therapy (DAPT) has been shown to be effective for the prevention of acute coronary syndrome or stroke. The objective of this study was to evaluate the efficacy of DAPT for the prevention of thrombosis recurrence in APS patients with history of arterial thrombosis. METHODS: This retrospective cohort study of APS patients was conducted at Hokkaido University Hospital between 1990 and 2016. The secondary prophylactic effects and safety of warfarin monotherapy (Wf), antiplatelet monotherapy (AP), warfarin and antiplatelet combination therapy (Wf + AP) and DAPT were evaluated. The primary endpoints were set as thrombosis-free and adverse events-free survival period. Adverse events were defined as severe bleeding and death. RESULTS: A total of 90 APS patients were enrolled. Thrombotic recurrence was found in 40 patients (35 arterial and 5 venous thromboses) and serious adverse events in 20 patients (9 severe bleeding events and 14 deaths). Kaplan-Meier analysis demonstrated a 10-year recurrence-free survival rate of 62%. The recurrence rate per 100 patient-years were as follows: Wf: 11.6, AP: 5.5, Wf: + AP: 3.7, DAPT: 1.8. We demonstrated that DAPT significantly reduced the rate of recurrence compared with Wf (Log-rank p = 0.001). There 4 were no significant differences in the rate of serious adverse events among the groups. CONCLUSION: DAPT might be considered as an effective and safe option for the prophylaxis of recurrent arterial thrombosis in APS. Keywords Antiphospholipid syndrome (APS), dual antiplatelet therapy (DAPT), arterial thrombosis, venous thrombosis, prophylaxis, safety Rheumatology key messages ・ This is the first study exploring dual antiplatelet therapy (DAPT) for APS patients. ・ DAPT might be considered as an effective and safe option for APS patients.

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Platelet Reactivity With Prolonged Aspirin Treatment

Frelinger

2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp latelets play a critical role in ischemic heart disease, the cause of 10% of all deaths in Japan. 1 Aspirin is the most commonly used antiplatelet agent for secondary prevention of ischemic heart disease, providing an estimated 20-25% reduction in the risk for serious vascular events in high-risk patients. 2,3 Recurrent thrombotic events, however, have been reported in 10-20% of aspirin-treated patients 3 and several studies have found an association between less-than-expected inhibition of in vitro aspirin-sensitive platelet function tests and the occurrence of adverse clinical outcomes. 4-7 Adding complexity to the problem, conflicting results have been obtained with respect to whether aspirin's antiplatelet effect is maintained 8 or attenuated 9 over time. Therefore, the extent to which platelets in Japanese patients are inhibited by aspirin, and the consistency of this inhibition over time, are of great interest. Article p 1227In this issue of the Journal, Ikeda et al have reported on the antiplatelet effect of aspirin and its 2-year change in high cardiovascular risk Japanese patients. 10 Important strengths of that study include the relatively large group of subjects studied (239 at enrollment) over this time interval and that the study addressed the issue of platelet reactivity under reallife conditions in a Japanese population. As was the case with the aspirin-sensitive tests that were found to be associated with poor clinical outcomes, 4-7 the aspirin-sensitive tests evaluated by Ikeda et al, that is, collagen-stimulated light transmission aggregometry and whole blood aggregation measured by screen filtration pressure, measure endpoints many steps removed from aspirin inhibition of platelet cyclooxygenase-1 (COX-1) and must be interpreted in that context. 10 For example, the authors reported that at baseline 27% of aspirin-treated patients produced a threshold platelet aggregation response to 1 mg/L collagen, while only 10% of healthy aspirin-treated donors responded to this dose of collagen. Such patients with high on-treatment platelet reactivity may be at increased risk for poor clinical outcomes. But because many factors other than aspirin inhibition of platelet COX-1 contribute to collagen-stimulated platelet aggregation, not the least of which is the platelet collagen receptor Ia -IIa, 11 it would be more correct to refer to this as platelet hyperreactivity rather than poor response to aspirin. In studies in which platelet COX-1 activity was evaluated by measuring serum thromboxane B2 (TxB2), the most direct measure of platelet COX-1 activity, poor aspirin inhibition of platelet COX-1 was infrequent (<2% of aspirin-treated patients undergoing cardiac catheterization). 12 Nevertheless, high residual serum TxB2 has been associated with adverse clinical outcomes. 13 In the same study, platelet hyperreactivity as measured using a COX-1-independent platelet function assay was also associated with subsequen...

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Characterization of the Antiplatelet Effect of Aspirin at Enrollment and After 2-Year Follow-up in a Real Clinical Setting in Japan

Cited by 6 publications

References 27 publications

Impact of Platelet Reactivity on Long-term Clinical Outcomes and Bleeding Events in Japanese Patients Receiving Antiplatelet Therapy with Aspirin

Impact of Platelet Reactivity on Long-term Clinical Outcomes and Bleeding Events in Japanese Patients Receiving Antiplatelet Therapy with Aspirin

Efficacy of dual antiplatelet therapy for preventing recurrence of arterial thrombosis in patients with antiphospholipid syndrome

Platelet Reactivity With Prolonged Aspirin Treatment

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