Low On‐Treatment Platelet Reactivity Predicts Long‐Term Risk of Bleeding After Elective PCI

Colic, Mirko; Čalija, Branko; Milosavljevic, Bratislav; Grdinić, Aleksandra; Angelkov, Lazar; Sagić, Dragan; Kružliak, Peter; Marinković, Jelena; Babic, Rade; Mrdović, Igor

doi:10.1111/joic.12251

Cited by 4 publications

(7 citation statements)

References 55 publications

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“…Platelet reactivity varies in percutaneous coronary intervention (PCI) patients treated with clopidogrel ( 1 ), and platelet participates in thrombosis and bleeding events. Previous studies have established in patients with coronary heart disease (CHD) that high on-treatment platelet reactivity (HTPR) is an independent risk factor for thrombotic events ( 2 – 4 ), while low on-treatment platelet reactivity (LTPR) is an independent risk factor for bleeding events ( 5 – 8 ). Therefore, platelet reactivity controlled within normal range might contribute to the reduction of thrombosis and bleeding events in patients with CHD.…”

Section: Introductionmentioning

confidence: 99%

Similar Inflammatory Biomarkers Reflect Different Platelet Reactivity in Percutaneous Coronary Intervention Patients Treated With Clopidogrel: A Large-Sample Study From China

Yuan

Jiang

et al. 2021

Front. Cardiovasc. Med.

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Background: Platelet reactivity is closely associated with adverse events in percutaneous coronary intervention (PCI) patients. Inflammation plays a crucial role in the development of coronary heart disease (CHD).Aim: To investigate the association of inflammatory biomarkers such as leukocyte count and high-sensitivity C reactive proteins (hs-CRP) with platelet reactivity in PCI patients treated with clopidogrel.Method: We examined 10,724 consecutive PCI patients in Fuwai hospital from January 2013 to December 2013. High on-treatment platelet reactivity (HTPR) was defined as adenosine diphosphate (ADP)-induced platelet maximum amplitude [MA(ADP)] of thromboelastogram (TEG) > 47 mm, and low on-treatment platelet reactivity (LTPR) MA(ADP) < 31 mm.Results: Finally, 6,772 PCI patients treated with clopidogrel who had the results of postoperative TEG were enrolled. Among them, 2,070 (30.57%) presented HTPR and 2,568 (37.92%) presented LTPR. As for LTPR, multivariate logistic regression showed that leukocyte count (OR: 1.153, 95% CI 1.117–1.191) and hs-CRP (OR: 0.920, 95% CI 0.905–0.936) were independent predictors, along with diabetes mellites, hemoglobin, platelet count and glucose. As for HTPR, multivariate logistic regression showed that leukocyte count (OR: 0.885, 95% CI 0.854–0.917) and hs-CRP (OR: 1.094, 95% CI 1.077–1.112) were independent predictors, along with sex, hemoglobin, platelet count and glucose.Conclusions: This was the first large real-world study reporting that both leukocyte count and hs-CRP were the independent factors for platelet reactivity in PCI populations treated with clopidogrel, among which higher leukocyte count was associated with more LTPR while higher hs-CRP was associated with more HTPR, providing new insights on individualized antiplatelet therapy.

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Section: Introductionmentioning

confidence: 99%

Similar Inflammatory Biomarkers Reflect Different Platelet Reactivity in Percutaneous Coronary Intervention Patients Treated With Clopidogrel: A Large-Sample Study From China

Yuan

Jiang

et al. 2021

Front. Cardiovasc. Med.

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“…ORs for bleeding or transfusion with impaired platelet aggregation were moderate or had wide confidence intervals. 83,88,92,94 However, two studies, which are not presented in ►Table 6 due to low rating, reported somewhat different results. Preisman et al investigated patients on clopidogrel undergoing cardiac surgery and reported AUC 0.81 for preoperative Multiplate ADP-induced aggregation.…”

Section: Resultsmentioning

confidence: 99%

“…Fully described, treatment standardized or randomized Each point is either "fulfilled" (1) or "not fulfilled" (0) Notes: A3: "Fulfilled" when patient inclusion was described as "consecutive" or when it was explicitly described that all eligible patients were approached for inclusion in the study C: The follow-up time for blood loss/transfusion should be explicitly stated (e.g., "for 24 h," "until discharge") and in accordance with the objective of the study, e.g., sufficient time for follow-up if postoperative blood loss was investigated G: "Treatment" is here defined as treatment of bleeding, e.g., transfusion, antifibrinolytic agents, etc. patients on antiplatelet or anticoagulant medication and are grouped separately, [80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96] while the remaining 18 studies investigated only standard coagulation tests. [97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114] We considered a rating of 14 or above to be of good quality.…”

Section: Resultsmentioning

confidence: 99%

“…51,[53][54][55][56][57]60,62,63,[68][69][70][71]75 However, their results were generally in accordance with Antithrombotic Treatment ►Table 6 summarizes 13 studies which investigated prediction of bleeding in patients on antithrombotic medication. Eleven of these included patients undergoing cardiac surgery, 80,81,83,[85][86][87][88]91,92,94,96 and two were on orthopedic surgery. 90,95 Twelve of the studies investigated antiplatelet medication (acetylsalicylic acid [ASA] and/or ADP inhibitors), while Thaler et al investigated COX inhibitors other than ASA.…”

Section: Resultsmentioning

confidence: 99%

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Predictive Value of Whole Blood and Plasma Coagulation Tests for Intra- and Postoperative Bleeding Risk: A Systematic Review

Larsen

Hvas

2017

Semin Thromb Hemost

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Excessive perioperative bleeding is associated with increased morbidity and mortality as well as increased economic costs. A range of whole blood laboratory tests for hemostatic monitoring has emerged, but their ability to predict perioperative bleeding is still debated. We conducted a systematic review of the existing literature assessing the ability of whole blood coagulation (thromboelastography [TEG]/thromboelastometry [ROTEM]/Sonoclot), platelet function tests, and standard plasma-based coagulation tests to predict bleeding in the perioperative setting. We searched PubMed and Embase, covering the period from 1966 to November 2016. In total, 99 original studies were included. The included studies assessed TEG/ROTEM/Sonoclot (n = 29), platelet function tests (n = 27), both test types (n = 8), and standard coagulation tests only (n = 18), and some (n = 17) investigated the predictive value of testing in patients receiving antithrombotic medication. In general, studies reported low positive predictive values for perioperative testing, whereas negative predictive values were high. The studies yielded moderate areas under receiver operator characteristics (ROC) curve (for the majority, 0.60–0.80). In conclusion, while useful in the diagnosis and management of patients with overt bleeding, whole blood coagulation and platelet function tests as well as standard coagulation tests demonstrated limited ability to predict perioperative bleeding in unselected patients. Therefore, we recommend that both whole blood and plasma-based coagulation tests are primarily used in case of bleeding and not for screening in unselected patients prior to surgery.

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“…Recent studies indicated that LTPR, measured by some PFTs is also an independent risk factor for bleeding. 3,18,66,[74][75][76][77][78] LTPR is associated with a higher incidence of thrombolysis in myocardial infarction major bleeding (2.2 vs. 0.8%; p ¼ 0.005). 76 Sibbing and colleagues studied 2,533 patients undergoing PCI using multiplate assay and found that 38% of patients with LTPR to clopidogrel had significantly higher incidence of bleeding (adjusted OR, 3.5; 95% CI, 1.6-7.3; p ¼ 0.001).…”

Section: Assessment Of Effects Of Antiplatelet Therapy In High-risk Pmentioning

confidence: 99%

Practical Aspects of Monitoring of Antiplatelet Therapy

Jovanović¹,

Antonijević

Novakovic

et al. 2016

Semin Thromb Hemost

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Despite the application of new antiplatelet drugs (prasugrel and ticagrelor), dual antiplatelet therapy with clopidogrel and aspirin remains the standard for patients with acute coronary syndrome undergoing percutaneous coronary intervention, especially in countries of low socioeconomic status. Regardless of the proven benefits, numerous studies have shown that certain groups of patients who receive standard doses of clopidogrel and aspirin do not respond adequately, and many of them also exhibit adverse cardiovascular events. Studies have shown that the risk of stent thrombosis and ischemic complications is higher in patients with: acute coronary syndrome, diabetes mellitus, thrombocytosis, reduced systolic function of the left ventricle with ejection fraction less than 30%, presence of multiple stents, longer and thinner stents, and renal failure. In these patients it is particularly important to assess the response to clopidogrel and selecting adequate antiplatelet therapy; this provides an impetus for platelet function tests. The second especially significant group to target for laboratory evaluation includes patients with increased risk of bleeding, such as elderly patients, patients with low body weight, anemia, thrombocytopenia, renal failure, past or current ventricular or duodenal ulcer, coagulopathy, or liver disease. The third important application of platelet function tests entails the preparation and evaluation of the time for surgical interventions or invasive diagnostic procedures in patients on antiplatelet therapy. These tests can also be helpful for monitoring the effects of therapy of bleeding due to platelet dysfunction. For high-risk patients the careful selection of optimal antiplatelet drug(s) on the basis of estimated individual risk of thrombosis and bleeding, pharmacodynamic characteristics of each drug, and patient̀s comorbidity remains essential.

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Low On‐Treatment Platelet Reactivity Predicts Long‐Term Risk of Bleeding After Elective PCI

Abstract: MAE ADP test before and after PCI, was associated with any, and BARC ≤ 2 bleeding after elective PCI.

Cited by 4 publications

References 55 publications

Similar Inflammatory Biomarkers Reflect Different Platelet Reactivity in Percutaneous Coronary Intervention Patients Treated With Clopidogrel: A Large-Sample Study From China

Similar Inflammatory Biomarkers Reflect Different Platelet Reactivity in Percutaneous Coronary Intervention Patients Treated With Clopidogrel: A Large-Sample Study From China

Predictive Value of Whole Blood and Plasma Coagulation Tests for Intra- and Postoperative Bleeding Risk: A Systematic Review

Practical Aspects of Monitoring of Antiplatelet Therapy

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