Clinical and Prognostic Implications of the Initial Response to Aspirin in Patients With Acute Coronary Syndrome

Spectre, Galia; Mosseri, Morris; Abdel-Rahman, Nader; Briskin, Elinor; Bulut, Atilla; Loncar, Sasa; Varon, David; Alcalai, Ronny

doi:10.1016/j.amjcard.2011.06.013

Cited by 7 publications

(21 citation statements)

References 23 publications

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“…NIHR Journals Library www.journalslibrary.nihr.ac.uk ) and miscellaneous tests (9%, 7 studies 76,93,125,146,152,154,163,196,198 ). The corresponding proportions for dual-therapy studies were: LTA (25%, 14 ), thromboxane metabolites measurement (0%), WBA (18%, 10 studies 97,100,106,114,158,165,167,[175][176][177]179,180,183,184,191 ), TEG (5%, 3 studies 156,197,199 ) and miscellaneous tests (5%, 3 studies 98,101,134,157,192 ).…”

Section: Results Of Prognostic Utility Reviewmentioning

confidence: 99%

“…Of the 108 included studies with test data linked to clinical outcome data, 57 studies reported on a patient group solely or predominantly receiving aspirin as monotherapy at the time of testing, 46,76,86,88,90,92,93,95,99,105,[108][109][110]112,113,[115][116][117][118]121,123,125,127,128,132,133,135,137,138,142,[144][145][146][147][148][149][150][151][152][153][154][155]159,[162][163][164]166,168,169,171,174,186,187,189,193,195,196,…”

Section: Study Mappingmentioning

confidence: 99%

“…Nineteen studies 88,90,93,95,112,113,121,125,142,147,149,155,159,162,164,169,174,187,201 were identified in this category, four of which were reported in abstract form only, 162,164,169,174 and one as a letter. 88 Populations had CAD (six studies In 12 studies 88,90,95,112,121,142,147,155,159,162,164,174 it appeared that patients were exclusively on monotherapy both at the time of the PFT and during follow-up.…”

Section: Population and Test Characteristicsmentioning

confidence: 99%

“…In the study where patients underwent PPCI, 93 patients were on monotherapy at the time of the PFT and all were on dual therapy (aspirin + clopidogrel) during follow-up. This study has been listed separately, as the addition of clopidogrel therapy in all patients may affect the rate of events, and may also be a reflection of underlying population differences compared with the other studies.…”

Section: Population and Test Characteristicsmentioning

confidence: 99%

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The prognostic utility of tests of platelet function for the detection of ‘aspirin resistance’ in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation

Dretzke

Riley

Lordkipanidzé

et al. 2015

Health Technology Assessment

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BackgroundThe use of aspirin is well established for secondary prevention of cardiovascular disease. However, a proportion of patients suffer repeat cardiovascular events despite being prescribed aspirin treatment. It is uncertain whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity. This report aims to investigate whether or not insufficient platelet function inhibition by aspirin (‘aspirin resistance‘), as defined using platelet function tests (PFTs), is linked to the occurrence of adverse clinical outcomes, and further, whether or not patients at risk of future adverse clinical events can be identified through PFTs.ObjectivesTo review systematically the clinical effectiveness and cost-effectiveness evidence regarding the association between PFT designation of ‘aspirin resistance’ and the risk of adverse clinical outcome(s) in patients prescribed aspirin therapy. To undertake exploratory model-based cost-effectiveness analysis on the use of PFTs.Data sourcesBibliographic databases (e.g. MEDLINE from inception and EMBASE from 1980), conference proceedings and ongoing trial registries up to April 2012.MethodsStandard systematic review methods were used for identifying clinical and cost studies. A risk-of-bias assessment tool was adapted from checklists for prognostic and diagnostic studies. (Un)adjusted odds and hazard ratios for the association between ‘aspirin resistance’, for different PFTs, and clinical outcomes are presented; however, heterogeneity between studies precluded pooling of results. A speculative economic model of a PFT and change of therapy strategy was developed.ResultsOne hundred and eight relevant studies using a variety of PFTs, 58 in patients on aspirin monotherapy, were analysed in detail. Results indicated that some PFTs may have some prognostic utility, i.e. a trend for more clinical events to be associated with groups classified as ‘aspirin resistant’. Methodological and clinical heterogeneity prevented a quantitative summary of prognostic effect. Study-level effect sizes were generally small and absolute outcome risk was not substantially different between ‘aspirin resistant’ and ‘aspirin sensitive’ designations.No studies on the cost-effectiveness of PFTs for ‘aspirin resistance’ were identified. Based on assumptions of PFTs being able to accurately identify patients at high risk of clinical events and such patients benefiting from treatment modification, the economic model found that a test–treat strategy was likely to be cost-effective. However, neither assumption is currently evidence based.LimitationsPoor or incomplete reporting of studies suggests a potentially large volume of inaccessible data. Analyses were confined to studies on patients prescribed aspirin as sole antiplatelet therapy at the time of PFT. Clinical and methodological heterogeneity across studies precluded meta-analysis. Given the lack of robust data the economic modelling was speculative.ConclusionsAlthough evidence indicates that some PFTs may have some prognostic value, methodological and clinical heterogeneity between studies and different approaches to analyses create confusion and inconsistency in prognostic results, and prevented a quantitative summary of their prognostic effect. Protocol-driven and adequately powered primary studies are needed, using standardised methods of measurements to evaluate the prognostic ability of each test in the same population(s), and ideally presenting individual patient data. For any PFT to inform individual risk prediction, it will likely need to be considered in combination with other prognostic factors, within a prognostic model.Study registrationThis study is registered as PROSPERO 2012:CRD42012002151.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Results Of Prognostic Utility Reviewmentioning

confidence: 99%

Section: Study Mappingmentioning

confidence: 99%

Section: Population and Test Characteristicsmentioning

confidence: 99%

Section: Population and Test Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

The prognostic utility of tests of platelet function for the detection of ‘aspirin resistance’ in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation

Dretzke

Riley

Lordkipanidzé

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

show abstract

“…Data linking the results obtained from the Impact-R with clinical outcomes are scarce and conflicting. While Spectre et al revealed a significantly lower rate of major adverse cardiovascular events (MACEs) six months after PCI in patients showing a good response to aspirin in the Impact-R 38) , the Impact-R was not able to discriminate between patients who did and did not experience atherothrombotic events one year post-PCI in a study by Breet et al 26) . In our study, the hsCRP level was found to be an independent predictor of platelet reactivity measured using the Impact-R.…”

Section: Supplementary Tablementioning

confidence: 99%

Differential Impact of Inflammation on Six Laboratory Assays Measuring Residual Arachidonic Acid-Inducible Platelet Reactivity During Dual Antiplatelet Therapy

Gremmel

Perkmann

Seidinger

et al. 2013

JAT

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Aims: Inflammation has been postulated to modify the platelet response to aspirin treatment, thereby causing high on-treatment residual platelet reactivity (HRPR). Both high levels of inflammatory markers and HRPR have been linked to adverse cardiovascular events. We aimed to study the impact of inflammation on residual arachidonic acid (AA)-inducible platelet reactivity. Methods: In 288 patients receiving dual antiplatelet therapy, residual AA-inducible platelet reactivity was assessed using light transmission aggregometry (LTA), the VerifyNow assay, multiple electrode aggregometry (MEA) and the Impact-R. The levels of urinary 11-dehydro-thromboxane B2 (D-TXB2), serum thromboxane B2 (TXB2), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) were determined using immunoassays. Results: The IL-6 level was found to be an independent predictor of platelet reactivity as determined according to LTA and D-TXB2 using a multiple linear regression analysis. Accordingly, patients with supramedian IL-6 levels exhibited significantly higher platelet reactivity than patients with inframedian IL-6 levels when determined according to LTA and D-TXB2 (both p ≤ 0.02). High IL-6 levels were associated with a 3.6-fold (95%CI 2.1-6.4) increased risk of HRPR, as defined according to D-TXB2, and a 3.4-fold (95%CI 1.4-8.3) increased risk of HRPR, as defined according to MEA. The HsCRP level was found to be an independent predictor of platelet reactivity when determined according to LTA, D-TXB2, the Impact-R and TXB2 using a multiple linear regression analysis. High hsCRP levels were associated with a 3.6-fold (95%CI 1.3-10) increased risk of HRPR, as defined according to LTA, and a 2.5-fold (95%CI 1.3-4.6) increased risk of HRPR, as defined according to TXB2. Conclusions: Increased levels of inflammatory markers are independently associated with residual AA-inducible platelet reactivity in patients receiving dual antiplatelet treatment.

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Shear Stress‐Based Platelet Function Tests

Breet

Berg

2014

Antiplatelet Therapy in Cardiovascular Disease

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Clinical and Prognostic Implications of the Initial Response to Aspirin in Patients With Acute Coronary Syndrome

Cited by 7 publications

References 23 publications

The prognostic utility of tests of platelet function for the detection of ‘aspirin resistance’ in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation

The prognostic utility of tests of platelet function for the detection of ‘aspirin resistance’ in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation

Differential Impact of Inflammation on Six Laboratory Assays Measuring Residual Arachidonic Acid-Inducible Platelet Reactivity During Dual Antiplatelet Therapy

Shear Stress‐Based Platelet Function Tests

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