Platelet-to-lymphocyte ratio but not neutrophil-to-lymphocyte ratio predicts high on-treatment platelet reactivity in clopidogrel-treated patients with acute coronary syndrome

Abstract

Objectives:Dual antiplatelet therapy (DAPT), consisting of clopidogrel and aspirin, is the main-stay treatment of acute coronary syndromes (ACS). However, major adverse cardiovascular events may occur even in patients undergoing DAPT, and this has been related to the variable pharmacodynamic efficacy of these drugs, especially clopidogrel. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are novel inflammatory markers for cardiovascular risk stratification, which may reflect an inflammatory state and thus high on-treatment platelet reactivity (HPR).Methods:We investigated the usefulness of PLR and NLR in predicting HPR in clopidogrel-treated patients with ACS. A total of 244 patients were enrolled in this study, and 43 of them were nonresponsive to clopidogrel.Results:Logistic regression analysis indicated that PLR was significantly associated with HPR (P < 0.001). Using a cutoff level of 331, PLR predicted HPR with a sensitivity of 73% and a specificity of 69% (odds ratio: 376.15, 95% confidence interval = 37.813–3741.728 P < 0.001, receiver operating characteristic curve: 0.885).Conclusions:We suggest that more attention should be paid to the PLR values of these patients on admission to identify individuals who may not benefit from clopidogrel during the course of ACS.

Novel Predictors of Future Vascular Events in Post-stroke Patients—A Pilot Study

“…In summary, while AUC upper indicates more precise definition of HTPR, NAR rather reflects the inflammatory state in poststroke patients (18). Based on this small, single-center pilot study, these novel markers may provide a better prediction of recurrent ischemic events leading to a better selection of patients at risk and providing an individually tailored vascular therapy including antiplatelet and anti-inflammatory regimens (17,19).…”

Platelet-to-Lymphocyte Ratio as Marker of Platelet Activation in Patients on Potent P2Y12 Inhibitors

“…38,39 This fact might explain the lack of association of PLR with ADP-inducible platelet aggregation in our cohort, contrary to a previous report demonstrating a significant association of PLR with high residual platelet reactivity (defined as change in maximal aggregation ≤20% from baseline aggregation in response to ADP) in patients treated with clopidogrel. 40 However, platelet activation via other surface receptors remains largely unaffected. Thrombin acts as a strong endogenous platelet agonist activating platelets predominantly via PAR-1.…”

The Prognostic Significance of Neutrophil to Lymphocyte Ratio (NLR), Monocyte to Lymphocyte Ratio (MLR) and Platelet to Lymphocyte Ratio (PLR) on Long-Term Survival in Off-Pump Coronary Artery Bypass Grafting (OPCAB) Procedures

“…Subsequently it gathered growing interest in patients with coronary artery disease since both platelets and lymphocytes, as mentioned above, are included in inflammatory reaction. Elevated platelet count is by itself associated with worse cardiovascular outcomes [ 78 , 79 ] and high on-treatment platelet reactivity and resistance to antiplatelet therapy [ 80 ]. This may result from more advanced inflammatory response.…”