4178Cerebral microbleeds and acute coronary syndrome: screening and progression under dual anti-platelet therapy: proof of concept study

SummaryIntracranial haemorrhage (ICH) accounts for ~35% of all strokes in Chinese. Anti-platelet agent is often avoided after an index event due to the possibility of recurrent ICH. This single-centered observational study included 440 consecutive Chinese patients with a first spontaneous ICH surviving the first month performed during 1996–2010. The subjects were identified, and their clinical characteristics, anti-platelet therapy after ICH, and outcomes including recurrent ICH, ischaemic stroke, and acute coronary syndrome were checked from hospital records. Of these 440 patients, 56 patients (12.7%) were prescribed aspirin (312 patient-aspirin years). After a follow-up of 62.2 ± 1.8 months, 47 patients had recurrent ICH (10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have a higher risk of recurrent ICH compared with those not prescribed aspirin (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years (hazard ratio [HR]: 2.0, 95% confidence interval [CI]: 1.07–3.85, p=0.03) and hypertension (HR: 2.0, 95% CI: 1.06–3.75, p=0.03) as independent predictors for recurrent ICH. In a subgroup analysis including 127 patients with standard indications for aspirin of whom 56 were prescribed aspirin, the incidence of combined vascular events including recurrent ICH, ischaemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than those not prescribed aspirin (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). In conclusion, we observed in a cohort of Chinese post-ICH patients that aspirin use was not associated with an increased risk for a recurrent ICH.

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Evaluation of triple anti-platelet therapy by modified throm-belastography in patients with acute coronary syndrome

Chinese Medical Journal ◽

10.1097/00029330-200805010-00018 ◽

2008 ◽

Vol 121 (9) ◽

pp. 850-852

Author(s):

Yi-hong REN ◽

Ting-shu YANG ◽

Yu WANG ◽

Lu-yue GAI ◽

Hong-bin LIU ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Syndrome ◽

Anti Platelet Therapy

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Adherence to dual anti-platelet therapy after acute coronary syndrome and its impact on patient outcome

European Heart Journal ◽

10.1093/ehjci/ehaa946.3383 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Sulzgruber ◽

H Sinkovec ◽

N Kazem ◽

F Hofer ◽

A Hammer ◽

...

Keyword(s):

Patient Outcome ◽

Acute Coronary Syndrome ◽

Study Endpoint ◽

Primary Study ◽

Index Event ◽

Coronary Syndrome ◽

Anti Platelet Therapy ◽

The Impact ◽

Observation Period

Abstract Background Secondary prevention after acute coronary syndrome (ACS) mirrors a key position in the reduction of morbidity and mortality in this highly vulnerable patient population. Especially dual anti-platelet therapy (DAPT) – including aspirin plus a P2Y12 inhibitor – proved to be one of the most beneficial therapeutic approaches for the reduction of re-events and stent thrombosis. However, profound epidemiological measures on adherence to DAPT intake after ACS remain scare, but seem of major importance in terms of preventing fatal cardiac adverse events. Therefore, we aimed to investigate adherence to DAPT after ACS and its impact on patient outcome from an Austrian nationwide perspective. Methods Within this population-based national observation all patients presenting with ACS between 04/2011 and 8/2015 in Austria were enrolled. Patient characteristics and co-morbidities were assessed via the Austrian national health insurance system and elucidated according to ICD10 definitions. Adherence to DAPT was investigated according to handing in prescriptions for aspirin and P2Y12 inhibitors at local pharmacies. Patients were followed prospectively until the primary study endpoint (=mortality) was reached. Cox Regression hazard analysis was used to investigate the impact of non-adherence to DAPT on patient outcome and was adjusted for a comprehensive subset of confounders within the multivariate model. Results During the observation period a total of 22.331 patients (median age: 65 years [55–75]; male: 69.7% [n=15.176]) met the inclusion criteria. Patients presenting with the indication for oral anticoagulation (n=2165; 9.7%), individuals that died during the index event (n=151; 0.7%), patients that presented with a re-ACS (n=396; 1.7%) or those who were lost during follow-up (n=96; 0.4%) were not included within the final analysis. Of alarming importance 70.7% (n=15.792) of all patients presenting with ACS did not take DAPT as recommended by current guidelines. The highest rate of drug interruption/end of therapy was observed within the first month after the index event with almost 50% of all cases. During patient follow-up until 14 months after the index event 513 individuals died. Non-adherence to DAPT proved a strong an independent association with mortality with an adjusted hazard ratio of 1.25 (95% CI: 1.09–1.41; p<0.001). (see Figure 1) Conclusion The present nationwide investigation highlighted an overall low adherence to DAPT after ACS, with the highest interruption/end of therapy rate within the first month after the index event. Since the intake of DAPT after ACS was associated with a 20% risk reduction for fatal cardiovascular events during the observation period, awareness in terms of drug-adherence and intensified patient follow-up should be promoted, in order to prevent fatal atherothrombotic events. Figure 1. Cumulative Mortality Funding Acknowledgement Type of funding source: None

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Association of Platelet Parameters in Acute Coronary Syndrome before and after Anti-platelet Therapy

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v43i2.35181 ◽

2018 ◽

Vol 43 (2) ◽

pp. 52-57

Author(s):

Silpi Pervin ◽

Mosharaf Hossain ◽

Tuhin Sultana ◽

Debatosh Paul ◽

Choudhury Meshkat Ahmed ◽

...

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Negative Predictive Value ◽

Predictive Value ◽

Distribution Width ◽

Blood Samples ◽

Platelet Counts ◽

Coronary Syndrome ◽

Anti Platelet Therapy ◽

Sensitivity Specificity

Identification of risk factors for acute coronary syndrome (ACS) is important for both diagnostic and prognostic purposes. Among the platelet parameters- mean platelet volume (MPV) and platelet distribution width (PDW) are thought to be risk factors of ACS. This quasi- experimental study was conducted from September 2011 to August 2012 in the Department of Clinical Pathology, in collaboration with Departments of Cardiology, Bangbandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) . It was enrolled 79 patients with ACS, diagnosed based on clinical history, electrocardiographic changes and increased cardiac markers especially troponin I, and 63 subjects were enrolled as control. For determination of platelet parameters, the blood samples were obtained from all patients of ACS before anti-platelet therapy when patient attended in the cardiac emergency and after 5th day of ongoing anti-platelet therapy; and from control group on the 1st day and 5th day at outpatient department. The blood samples were taken properly and processed in haematology autoanalyser. In this study, the baseline characteristics of study patients were measured. Platelet counts were 273.1±50.15 x 109/L in patients with ACS and 290.78±74.86 x 109/L in control subjects in 1st sample and 284.56±41.93 x 109/L in patients with ACS in 2nd sample. In 1st samples, platelet counts were slightly low in patients with ACS compared to controls and 2nd samples. There were no statistical significant differences between the groups and the samples. MPV was 12.48±1.17 fl and 10.45±0.66 fl in patients with ACS and controls and 11.55±1.08 fl in 2nd sample in ACS cases. PDW was 16.23±2.56 fl, 11.89±1.42 fl and 14.29±2.11 fl in patients with ACS, controls and 2nd sample of ACS cases respectively. Both MPV and PDW were statistically significant between the groups and the samples (p<0.001). The sensitivity, specificity, positive and negative predictive value of platelet parameters of ACS cases were obtained from ROC curve and compared with controls. The best cut off value of platelet count, MPV and PDW were >225 x 109/L, > 10.7 fl and >12.7 fl respectively. The sensitivity, specificity, accuracy, positive and negative predictive value of platelet counts, MPV and PDW were 83%, 28.1%, 42.3%, 37.6%, 64%; 90.6%, 49.4%, 64.8%, 51.6%, 89.8%; and 94.3%,52.8%, 69%,54.9%, 94.1% respectively. The study showed that PDW had higher sensitivity and specificity in contrast to MPV. Platelet parameters were increased in patients with ACS before anti-platelet therapy and gradually decreased after anti-platelet therapy. These two markers may used as predictor for early detection of ACS and risk stratification, when other cardiac biomarkers are negative.

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