Usefulness of thrombelastography platelet mapping assay to measure the antiplatelet effect of P2Y<sub>12</sub>receptor inhibitors and high on-treatment platelet reactivity

Jeong, Young Hoon; Bliden, Kevin P.; Antonino, Mark J.; Tantry, Udaya S.; Gurbel, Paul A.

doi:10.3109/09537104.2012.675108

Cited by 15 publications

(11 citation statements)

References 8 publications

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“…Recently, TEG has been widely used in the assessment of platelet function 21 22. However, few studies have investigated TEG parameters in patients undergoing extracranial or intracranial artery stenting for ischemic cerebrovascular disease.…”

Section: Discussionmentioning

confidence: 99%

Association of thrombelastographic parameters with post-stenting ischemic events

Wang¹,

Li²,

Ma³

et al. 2015

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 99%

Association of thrombelastographic parameters with post-stenting ischemic events

Wang¹,

Li²,

Ma³

et al. 2015

J NeuroIntervent Surg

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“…Previous results have suggested the predictive utility of measuring whole blood maximal clot strength in assessing risk for ischaemic events after coronary stenting, with significantly increased risk observed in patients within the highest quartiles of whole blood clot strength [2,7]. Although no direct comparison has been published between the positive predictive value of whole blood TEG and platelet reactivity testing, which has been well established in the identification of clopidogrel nonresponse after coronary stenting, the data available suggest similar utility [2,7–9]. Whole blood TEG-maximal clot strength comprises simultaneous contribution of plasma fibrin generation and platelet aggregation in the generation of a stable thrombus.…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein and fibrin clot strength measured by thrombelastography after coronary stenting

Kreutz

Owens

Breall

et al. 2013

Blood Coagulation &Amp; Fibrinolysis

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Inflammation is implicated in the progression of coronary artery disease and the molecular processes of inflammation and thrombosis are closely intertwined. Elevated levels of C-reactive protein (CRP) have been associated with an elevated risk of adverse ischaemic events after coronary stenting and hypercoagulability. Heightened whole blood clot strength measured by thrombelastography (TEG) has been associated with adverse ischaemic events after stenting. We intended to examine the relationship of CRP to plasma fibrin clot strength in patients after coronary stenting. Plasma fibrin clot strength was measured by TEG in 54 patients 16–24 h after undergoing elective percutaneous coronary intervention (PCI). Coagulation was induced in citrated plasma by addition of kaolin and CaCl2. Plasma levels of CRP and fibrinogen were measured by enzyme-linked immunoassay. Increasing quartiles of CRP were associated with increasing levels of maximal plasma fibrin clot strength measured by TEG (P < 0.001) and increasing BMI (P =0.04). Patients in the highest quartile of CRP had significantly higher maximal fibrin clot strength (G) than the patients in the lowest quartile (G: 3438 ± 623 vs. 2184 ± 576 dyn/cm2, P < 0.0001). Fibrinogen concentration was not significantly different across quartiles of CRP (P =0.97). Patients with established coronary artery disease undergoing coronary stenting who have elevated CRP after PCI exhibit heightened maximal plasma fibrin clot strength as compared with those with low CRP. Thrombotic risk associated with elevated CRP may be linked to procoagulant changes and high tensile fibrin clot strength independent of fibrinogen concentration.

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“…However, Jeong et al demonstrated a significant correlation between TEG and LTA in 730 patients treated by percutaneous coronary intervention. 18 Gurbel et al reported that the TEG MA parameters might be better than LTA in an in vivo situation because LTA ignored the important contribution of platelet-fibrin interactions to both thrombosis and hemorrhage. 15 We used TEG to test the effects of antiplatelet agents, and the proportion of resistance to clopidogrel (34.5%) in our series was lower than that reported by Lee et al (42.9%) in patients tested using VerifyNow.…”

Section: Discussionmentioning

confidence: 99%

Insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysms after stent placement

Yang¹,

Li²,

Jiang³

2016

JNS

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C erebral infarction is one of the major disabling complications of neurovascular stent treatment. During the last decades, many studies have evaluated the safety and efficacy of the technique of stent placement for intracranial aneurysms, which demonstrated a range of 3.7%-21% thromboembolic complications. 4,10,11,29 Dual antiplatelet therapy (aspirin and clopidogrel) has been used as the standard protocol to decrease the incidence of thromboembolic complications in patients with intracranial aneurysms undergoing stent treatment. However, many patients still experience thromboembolic complications after neurovascular intervention, despite being compliant with the standard antiplatelet medication protocol.Previous studies have demonstrated that a low response to antiplatelet medication was associated with the abbreviatioNs AA = arachidonic acid; ADP = adenosine diphosphate; DWI = diffusion-weighted imaging; ICA = internal carotid artery; MA = maximum amplitude; mRS = modified Rankin Scale; TEG = thromboelastography. obJective Insufficient platelet inhibition has been associated with an increased incidence of thromboembolic complications in cardiology patients undergoing percutaneous coronary intervention. Data regarding the relationship between insufficient platelet inhibition and thromboembolic complications in patients undergoing neurovascular procedures remain controversial. The purpose of this study was to assess the relationship of insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysm undergoing stent treatment. methods The authors prospectively recruited patients with intracranial aneurysms undergoing stent treatment and maintained the data in a database. MRI with diffusion-weighted sequences was performed within 24 hours of stent insertion to identify acute ischemic lesions. The authors used thromboelastography to assess the degree of platelet inhibition in response to clopidogrel and aspirin. Univariate and multivariate logistic regression analysis was used to identify potential risk factors of thromboembolic complications. results One hundred sixty-eight patients with 193 aneurysms were enrolled in this study. Ninety-one of 168 (54.2%) patients with acute cerebral ischemic lesions were identified by diffusion-weighted MRI. In 9 (5.4%) patients with ischemic lesions, transient ischemic attack or stroke was found at discharge, and these complications were found in 11 (6.5%) patients during the follow-up period. The incidence of periprocedural thromboembolic complications increased with resistance to antiplatelet agents, hypertension, hyperlipidemia, complete occlusion, and aneurysm of the anterior circulation. The multivariate regression analysis demonstrated that the anterior circulation and adenosine diphosphate (ADP) inhibition percentage were independent risk factors of perioperative thromboembolic complications. The maximum amplitude and ADP inhibition percentage were independent risk factors for thromboembolic complications during the follow-up peri...

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Usefulness of thrombelastography platelet mapping assay to measure the antiplatelet effect of P2Y₁₂receptor inhibitors and high on-treatment platelet reactivity

Abstract: (2013) Usefulness of thrombelastography platelet mapping assay to measure the antiplatelet effect of P2Y 12 receptor inhibitors and high on-treatment platelet reactivity, Platelets, 24:2, 166-169,

Cited by 15 publications

References 8 publications

Association of thrombelastographic parameters with post-stenting ischemic events

Association of thrombelastographic parameters with post-stenting ischemic events

C-reactive protein and fibrin clot strength measured by thrombelastography after coronary stenting

Insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysms after stent placement

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Usefulness of thrombelastography platelet mapping assay to measure the antiplatelet effect of P2Y12receptor inhibitors and high on-treatment platelet reactivity

Abstract: (2013) Usefulness of thrombelastography platelet mapping assay to measure the antiplatelet effect of P2Y 12 receptor inhibitors and high on-treatment platelet reactivity, Platelets, 24:2, 166-169,

Cited by 15 publications

References 8 publications

Association of thrombelastographic parameters with post-stenting ischemic events

Association of thrombelastographic parameters with post-stenting ischemic events

C-reactive protein and fibrin clot strength measured by thrombelastography after coronary stenting

Insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysms after stent placement

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Usefulness of thrombelastography platelet mapping assay to measure the antiplatelet effect of P2Y₁₂receptor inhibitors and high on-treatment platelet reactivity