Relationship between thromboelastography and long-term ischemic events as gauged by the response to clopidogrel in patients undergoing elective percutaneous coronary intervention

Hou, Xiaolin; Han, Wenzheng; Gan, Qian; Liu, Yuan; Fang, Wei-Yi

doi:10.5582/bst.2016.01233

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…In line with previous studies [ 10 , 17 , 18 ], our study showed that MA ADP was significantly associated with post-PCI clinical endpoints and could be used as an important indicator of ischemic events occurrence. Our optimal diagnostic cutoff value of 47 mm for MA ADP , obtained in patients with ACS and with a 6-month follow-up, is consistent with that reported in a previous report [ 10 ].…”

Section: Discussionsupporting

confidence: 91%

Residual platelet reactivity is preferred over platelet inhibition rate in monitoring antiplatelet efficacy: insights using thrombelastography

Zhang

Zhao

et al. 2019

Acta Pharmacol Sin

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Although thrombelastography (TEG) has been widely implemented in the clinical setting of endovascular intervention, consensus on the optimal parameter for defining high ischemic risk patients is lacking due to the limited data about the relationship between various TEG parameters and clinical outcomes. In this article, we report a post hoc analysis of a prospective, single-center cohort study, including 447 patients with acute coronary syndrome (ACS). Arachidonic acid (AA)- or adenosine diphosphate (ADP)-induced platelet-fibrin clot strength (MA AA or MA ADP ) was indicative of the net residual platelet reactivity after the treatment with aspirin or clopidogrel, respectively. AA% or ADP% was indices of the relative platelet inhibition rate on AA or ADP pathway. We found that each parameter alone was predictive of the risk of 6-month ischemic event, even after adjusting for confounding factors. However, the association between AA% and clinical outcome disappeared when further adjusted for MA AA . Likewise, inclusion of MA ADP changed the significant relation between ADP% and clinical outcome. MA ADP > 47.0 mm and MA AA > 15.1 mm were identified as the optimal cutoffs by receiver operating characteristic analysis. High MA AA (HR = 3.963; 95% CI: 1.152–13.632; P = 0.029) and high MA ADP (HR = 5.185; 95% CI: 2.228–12.062; P < 0.001) were independent predictors when both were included in multivariable Cox regression hazards model. Interestingly, an even higher risk was found for the coexisting high MA AA and high MA ADP (HR = 7.870; 95% CI: 3.462–17.899; P < 0.001). We conclude that when performing TEG to predict clinical efficacy, residual platelet reactivity has superiority over platelet inhibition rate as a measure of thrombotic risk in patients treated with aspirin and clopidogrel after ACS.

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Section: Discussionsupporting

confidence: 91%

Residual platelet reactivity is preferred over platelet inhibition rate in monitoring antiplatelet efficacy: insights using thrombelastography

Zhang

Zhao

et al. 2019

Acta Pharmacol Sin

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“…Full text of the remaining 51 articles was retrieved for further evaluation, and 25 of these articles were excluded for the following reasons: insufficient data (n = 17), reporting other outcome (n = 4), reporting the same study population (n = 3) and retrospective study (n = 1). The final data analysis included 26 articles 4,8,9,27‐49 . No additional eligible study was detected on a manual search.…”

Section: Resultsmentioning

confidence: 99%

Predicting ischaemic events using platelet reactivity in patients receiving clopidogrel: Indirect meta‐comparison among VerifyNow, light transmission aggregometry and thromboelastography

Xiang

Wang

Zhang

et al. 2020

Basic Clin Pharma Tox

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The present study compared performances of the three major methods used for assessing platelet reactivity (PR)—VerifyNow, light transmission aggregometry (LTA) and thromboelastography (TEG)—to predict ischaemic events in patients receiving clopidogrel. PubMed, EMBASE and the Cochrane Library were searched from their inception to April 2019 for prospective studies that examined PR using VerifyNow, LTA or TEG and the incidence of ischaemic events. The investigated diagnostic indices include sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), diagnostic odds ratio and area under the receiver operating characteristic curves (AUC) of VerifyNow, LTA and TEG, respectively. A total of 26 prospective studies involving 22 185 patients were included in the analysis. The pooled AUC was 0.71 (95% CI: 0.67‐0.75) for VerifyNow, 0.60 (95% CI: 0.55‐0.64) for LTA and 0.81 (95% CI: 0.77‐0.84) for TEG. Results of indirect comparisons indicated the AUC of VerifyNow was higher than that of LTA (1.18, 95% CI: 1.08‐1.30) and lower than that of TEG (0.88, 95% CI: 0.82‐0.94). TEG outperformed the other two methods for assessing PR in all predictive measures, including sensitivity, specificity, PLR and NLR. Despite a lack of studies that directly compared the three methods, our findings suggest that TEG should be recommended.

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“…69 Results from two prospective studies have affirmed that increased platelet-rich fibrin clot strength measured by TEG predicts recurrent ischemic events within 2 years in patient with stable CAD (►Table 2). 70,71 However, the effect of prolonged clot lysis time on the increased risk of cardiovascular events seems to be less profound than in ACS. The study by Neergaard-Petersen and colleagues followed up 786 patients with stable CAD (90% had previous MI) over 3.1 years, and found that only area under the curve (AUC) of clot formation and lysis predicted composite cardiovascular outcomes, but not maximum turbidity or lysis time alone (►Table 2).…”

Section: Stable Coronary Artery Diseasementioning

confidence: 99%

Fibrinolysis in Acute and Chronic Cardiovascular Disease

Kietsiriroje

Ariëns

Ajjan

2021

Semin Thromb Hemost

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The formation of an obstructive thrombus within an artery remains a major cause of mortality and morbidity worldwide. Despite effective inhibition of platelet function by modern antiplatelet therapies, these agents fail to fully eliminate atherothrombotic risk. This may well be related to extensive vascular disease, beyond the protective abilities of the treatment agents used. However, recent evidence suggests that residual vascular risk in those treated with modern antiplatelet therapies is related, at least in part, to impaired fibrin clot lysis. In this review, we attempt to shed more light on the role of hypofibrinolysis in predisposition to arterial vascular events. We provide a brief overview of the coagulation system followed by addressing the role of impaired fibrin clot lysis in acute and chronic vascular conditions, including coronary artery, cerebrovascular, and peripheral vascular disease. We also discuss the role of combined anticoagulant and antiplatelet therapies to reduce the risk of arterial thrombotic events, addressing both efficacy and safety of such an approach. We conclude that impaired fibrin clot lysis appears to contribute to residual thrombosis risk in individuals with arterial disease on antiplatelet therapy, and targeting proteins in the fibrinolytic system represents a viable strategy to improve outcome in this population. Future work is required to refine the antithrombotic approach by modulating pathological abnormalities in the fibrinolytic system and tailoring therapy according to the need of each individual.

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Relationship between thromboelastography and long-term ischemic events as gauged by the response to clopidogrel in patients undergoing elective percutaneous coronary intervention

Cited by 9 publications

References 16 publications

Residual platelet reactivity is preferred over platelet inhibition rate in monitoring antiplatelet efficacy: insights using thrombelastography

Residual platelet reactivity is preferred over platelet inhibition rate in monitoring antiplatelet efficacy: insights using thrombelastography

Predicting ischaemic events using platelet reactivity in patients receiving clopidogrel: Indirect meta‐comparison among VerifyNow, light transmission aggregometry and thromboelastography

Fibrinolysis in Acute and Chronic Cardiovascular Disease

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