High post-treatment platelet reactivity identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascular events after stenting for acute coronary syndrome

2006 ◽  
Vol 4 (3) ◽  
pp. 542-549 ◽  
Author(s):  
T. CUISSET ◽  
C. FRERE ◽  
J. QUILICI ◽  
F. BARBOU ◽  
P. E. MORANGE ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Dual Antiplatelet Therapy ◽  
Platelet Reactivity ◽  
Post Treatment ◽  
Coronary Syndrome ◽  
Low Responders ◽  
Increased Risk

Prognostic impact of severe anemia (hemoglobin <10g/dL) during treatment with dual antiplatelet therapy after hospital discharge for acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Campos ◽  
C Oliveira ◽  
C Pires ◽  
P Medeiros ◽  
R Flores ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Multivariate Analysis ◽  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Dual Antiplatelet Therapy ◽  
Severe Anemia ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Group 2 ◽  
Group 1

Abstract Introduction In recent years, the use of invasive strategies has become the generalized approach in the management of patients with acute coronary syndrome (ACS), justified by the associated prognostic benefit due to reduced mortality and the evolution of percutaneous coronary intervention (PCI). However, the benefits of an invasive approach in ACS are unclear in the population with significant anemia, as anemia is strongly associated with increased risk of morbidity and mortality in these patients. Aim To determine the ischaemic vs. bleeding risks from patients with severe anemia (hemoglobin &lt;10 g/dL) during treatment with Dual Antiplatelet Therapy (DAPT) after an ACS undergoing PCI. Methods From a national multicentre registry, we analyzed 17 370 ACS pts. Pts were divided into two groups: group 1 - pts with severe anemia (hemoglobin &lt;10g/dL) (n=557, 3.2%); group 2 - pts without severe anemia (hemoglobin 10g/dL) (n=16813, 96.8%). Primary endpoint was the occurrence of a composite of death and adverse cardiovascular events (stroke, reinfarction, and rehospitalization of cardiovascular etiology) at 1 year. Results The sample consisted in 73.4% men and 26.6% women, with mean age of 66±14 years. The incidence of severe anemia was 3.2%. Group 1 pts were older (75±12 vs 66±14, p&lt;0.001), had a higher proportion of women (47.6% vs 25.9%, p&lt;0.001), diabetes (55% vs 30.6%, p&lt;0.001), hypertension (81.8% vs 68.2%, p&lt;0.001) and chronic kidney disease (29.2% vs 5.2%, p&lt;0.001). During hospitalization, group 1 had more heart failure (35.3% vs 15.1%, p&lt;0.001), worst LVEF (27.3% vs 17.3%, p&lt;0,001), bleeding (7.6%% vs 1.3%, p&lt;0.001) and transfusion (23.4% vs 1%, p&lt;0.001). During hospitalization, group 2 pts were more likely to undergo revascularization (82.9% vs 89.4%, p&lt;0.001) and double antiaggregation (82.5% vs 95%, p&lt;0.001). A multivariate analysis identified age [OR 1.48, 95% CI 1.32 to 1.89; p&lt;0.001] and feminine sex [OR 2.21, 95% CI 1.89 to 3.61; p&lt;0.001] as independent predictors of severe anemia during hospitalization. Patients with severe anemia had longer hospital stay (9 days vs 6 days; p&lt;0.001), and higher 6-month mortality (8.7% vs. 2.9%; p&lt;0.001). In multivariate analysis and after adjusting for different baseline characteristics, pts with severe anemia had higher occurrence of a composite of death and adverse cardiovascular events at 1-year compared to those without severe anemia [OR 3.04, 95% CI 1.21 to 5.04; p=0.029]. Conclusion We objected a low prevalence of ACS patients with severe anemia undergoing PCI (52.2%) but the incidence of ICP in these complex patients has increased in recent years, mainly due to the evolution of PCI over the last 40 years. Severe anemia was strongly associated with increased risk of morbidity and mortality in ACS pts. Funding Acknowledgement Type of funding source: None

scholarly journals Cessation of dual antiplatelet therapy and cardiovascular events following acute coronary syndrome

Heart ◽  
2018 ◽  
Vol 105 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Wardati Mazlan-Kepli ◽  
Jesse Dawson ◽  
Colin Berry ◽  
Matthew Walters
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Dual Antiplatelet Therapy ◽  
Early Period ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Long Term Follow Up

ObjectiveTo assess whether cardiovascular events are increased after cessation of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) and to explore predictors for recurrent events after DAPT cessation during long-term follow-up.MethodsWe did a retrospective observational cohort study. We included consecutive people with ACS who were discharged from Scottish hospitals between January 2008 and December 2013 and who received DAPT after discharge followed by antiplatelet monotherapy. The rates of cardiovascular events were assessed during each 90-day period of DAPT treatment and 90-day period after stopping DAPT. Cardiovascular events were defined as a composite of death, ACS, transient ischaemic attack or stroke. Cox regression was used to identify predictors of cardiovascular events following DAPT cessation.Results1340 patients were included (62% male, mean age 64.9 (13.0) years). Cardiovascular events occurred in 15.7% (n=211) during the DAPT period (mean DAPT duration 175.1 (155.3) days) and in 16.7% (n=188) following DAPT cessation (mean of 2.7 years follow-up). Independent predictors for a cardiovascular event following DAPT cessation were age (HR 1.07; 95% CI 1.05 to 1.08; p<0.001), DAPT duration (HR 0.997; 95% CI 0.995 to 0.998; p<0.001) and having revascularisation therapy during the index admission (HR 0.58; 95% CI 0.39 to 0.85; p=0.005).ConclusionsThe rate of cardiovascular events was not significantly increased in the early period post-DAPT cessation compared with later periods in this ACS population. Increasing age, DAPT duration and lack of revascularisation therapy were associated with increased risk of cardiovascular events during long-term follow-up after DAPT cessation.

scholarly journals Impact of Diabetes Mellitus on Antithrombotic Management Patterns and Long‐Term Clinical Outcomes in Patients With Acute Coronary Syndrome: Insights From the EPICOR Asia Study

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Shaoyi Guan ◽  
Xiaoming Xu ◽  
Yi Li ◽  
Jing Li ◽  
Mingzi Guan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Antiplatelet Agents ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Antithrombotic Management

Background Long‐term use of antiplatelet agents after acute coronary syndrome in diabetic patients is not well known. Here, we describe antiplatelet use and outcomes in such patients enrolled in the EPICOR Asia (Long‐Term Follow‐up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia) registry. Methods and Results EPICOR Asia is a prospective, observational study of 12 922 patients with acute coronary syndrome surviving to discharge, from 8 countries/regions in Asia. The present analysis included 3162 patients with diabetes mellitus (DM) and 9602 patients without DM. The impact of DM on use of antiplatelet agents and events (composite of death, myocardial infarction, and stroke, with or without any revascularization; individual components, and bleeding) was evaluated. Significant baseline differences were seen between patients with DM and patients without DM for age, sex, body mass index, cardiovascular history, angiographic findings, and use of percutaneous coronary intervention. At discharge, ≈90% of patients in each group received dual antiplatelet therapy. At 2‐year follow‐up, more patients with DM tended to still receive dual antiplatelet therapy (60% versus 56%). DM was associated with increased risk from ischemic but not major bleeding events. Independent predictors of the composite end point of death, myocardial infarction, and stroke in patients with DM were age ≥65 years and use of diuretics at discharge. Conclusions Antiplatelet agent use is broadly comparable in patients with DM and patients without DM, although patients with DM are more likely to be on dual antiplatelet therapy at 2 years. Patients with DM are at increased risk of ischemic events, suggesting an unmet need for improved antithrombotic treatment. Registration URL: https://www.clini​caltr​ials.gov ; Unique identifier: NCT01361386.

Adrenergic receptor polymorphisms and platelet reactivity after treatment with dual antiplatelet therapy with aspirin and clopidogrel in acute coronary syndrome

2010 ◽  
Vol 103 (04) ◽  
pp. 774-779 ◽  
Author(s):  
Thomas Cuisset ◽  
Michalis Hamilos ◽  
Leen Delrue ◽  
Corinne Frere ◽  
Katia Verhamme ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Platelet Aggregation ◽  
Antiplatelet Therapy ◽  
Adrenergic Receptor ◽  
Dual Antiplatelet Therapy ◽  
Platelet Reactivity ◽  
Individual Variability ◽  
Platelet Response ◽  
Coronary Syndrome ◽  
Β2 Adrenergic Receptor

SummaryPlatelet response to clopidogrel shows inter-individual variability that is partially explained by genetic polymorphisms. This variability affects clinical outcome when clopidogrel is administered in patients with acute coronary syndrome (ACS). Catecholamines, released during ACS, contribute to platelet aggregation through platelet α2A- (α2A-AR) and β2-adrenergic receptor (β2-AR) stimulation. It was the objective of this study to assess the potential influence of α2A-AR and β2-AR gene polymorphisms on platelet reactivity after dual antiplatelet therapy with aspirin and clopidogrel in ACS. We screened 641 ACS patients for 6.3/6.7 kb α2A-AR polymorphism, and for Arg16Gly and Gln27Glu β2-AR polymorphism. After 600 mg clopidogrel, we assessed ADP 10 μmol-induced platelet aggregation (ADP-Ag) and vasoactive stimulated phosphoprotein (VASP). All single nucleotide polymorphisms were in Hardy-Weinberg equilibrium. A slight though negligible association was found between 6.3 kb allele of α2A-AR with platelet reactivity ADPAg induced (beta: –2.91 [-5.68;-0.14], p=0.04). A borderline not significant reduction in PRI VASP was observed in 6.3 kb α2A-AR carriers (beta: –3.81 [-0.09;7.72], p=0.06). No significant effect on platelet parameters was observed for the other tested polymorphisms. Common α2A- and β2-adrenergic receptor polymorphisms do not show any major impact on residual platelet reactivity in non-ST-elevation ACS when a dual antiplatelet therapy with 250 mg aspirin and 600 mg clopidogrel is administered.

A time course study of high on treatment platelet reactivity in acute coronary syndrome male patients on dual antiplatelet therapy

2015 ◽  
Vol 136 (3) ◽  
pp. 613-619 ◽  
Author(s):  
Alessia Fabbri ◽  
Rossella Marcucci ◽  
Anna Maria Gori ◽  
Betti Giusti ◽  
Rita Paniccia ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Time Course ◽  
Dual Antiplatelet Therapy ◽  
Platelet Reactivity ◽  
Coronary Syndrome ◽  
Male Patients ◽  
Time Course Study

High post-treatment platelet reactivity is associated with a high incidence of myonecrosis after stenting for non-ST elevation acute coronary syndromes

2007 ◽  
Vol 97 (02) ◽  
pp. 282-287 ◽  
Author(s):  
Corinne Frere ◽  
Jacques Quilici ◽  
Pierre-Emmanuel Morange ◽  
Lyassine Nait-Saidi ◽  
Christopher Mielot ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Antiplatelet Therapy ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Dual Antiplatelet Therapy ◽  
Platelet Reactivity ◽  
Post Treatment ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
St Elevation

SummaryHigh post-treatment platelet reactivity (HPPR= adenosine diphosphate [ADP] 10 µM-induced platelet aggregation > 70%) identifies low responders to dual antiplatelet therapy with increased risk of recurrent cardiovascular (CV) events after stenting for non-ST elevation acute coronary syndromes (NSTEACS). This study was designed to compare the incidence of periprocedural myocardial infarction (MI) after stenting for NSTEACS patients between non-responders to dual antiplatelet therapy defined by HPPR and normo-responders. One hundred ninety NSTE-ACS consecutive patients undergoing coronary stenting were included in this prospective study. They received 250 mg aspirin and a 600 mg loading dose of clopidogrel at least 12 hours (h) before percutaneous coronary intervention (PCI). A single post-treatment blood sample was obtained before PCI to analyze maximal intensity of ADP-induced platelet aggregation, and troponin levels were analyzed before PCI, and 12 and 24 h after PCI. Troponin I was considered elevated if > 0.4 ng/ ml. HPPR was present in 22% of patients (n=42). Periprocedural MI occurred significantly more frequently in patients with HPPR than in the normo-responders (43% vs. 24%, p=0.014). After being correlated with recurrent ischemic events after stenting for NSTE-ACS, the HPPR seems to be also a marker of increased risk of periprocedural MI for NSTE-ACS patients.

scholarly journals The Safety and Efficacy of Aspirin Discontinuation on a Background of a P2Y 12 Inhibitor in Patients After Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (6) ◽  
pp. 538-545 ◽  
Author(s):  
Michelle L. O’Donoghue ◽  
Sabina A. Murphy ◽  
Marc S. Sabatine
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Percutaneous Coronary

Background: Dual antiplatelet therapy with aspirin and a P2Y 12 inhibitor has been shown to reduce the risk of major adverse cardiovascular events (MACE) compared with aspirin alone after percutaneous coronary intervention (PCI) or acute coronary syndrome but with increased risk of bleeding. The safety of discontinuing aspirin in favor of P2Y 12 inhibitor monotherapy remains disputed. Methods: A meta-analysis was conducted from randomized trials (2001–2020) that studied discontinuation of aspirin 1 to 3 months after PCI with continued P2Y 12 inhibitor monotherapy compared with traditional dual antiplatelet therapy. Five trials were included; follow-up duration ranged from 12 to 15 months after PCI. Primary bleeding and MACE outcomes were the prespecified definitions in each trial. Results: The study population included 32 145 patients: 14 095 (43.8%) with stable coronary artery disease and 18 046 (56.1%) with acute coronary syndrome. In the experimental arm, background use of a P2Y 12 inhibitor included clopidogrel in 2649 (16.5%) and prasugrel or ticagrelor in 13 408 (83.5%) patients. In total, 820 patients experienced a primary bleeding outcome and 937 experienced MACE. Discontinuation of aspirin therapy 1 to 3 months after PCI significantly reduced the risk of major bleeding by 40% compared with dual antiplatelet therapy (1.97% versus 3.13%; hazard ratio [HR], 0.60 [95% CI, 0.45–0.79]), with no increase observed in the risk of MACE (2.73% versus 3.11%; HR, 0.88 [95% CI, 0.77–1.02]), myocardial infarction (1.08% versus 1.27%; HR, 0.85 [95% CI, 0.69–1.06]), or death (1.25% versus 1.47%; HR, 0.85 [95% CI, 0.70–1.03]). Findings were consistent among patients who underwent PCI for an acute coronary syndrome, in whom discontinuation of aspirin after 1 to 3 months reduced bleeding by 50% (1.78% versus 3.58%; HR, 0.50 [95% CI, 0.41–0.61]) and did not appear to increase the risk of MACE (2.51% versus 2.98%; HR, 0.85 [95% CI, 0.70–1.03]). Conclusions: Discontinuation of aspirin with continued P2Y 12 inhibitor monotherapy reduces risk of bleeding when stopped 1 to 3 months after PCI. An increased risk of MACE was not observed after discontinuation of aspirin, including in patients with acute coronary syndrome.

Sign in / Sign up

Export Citation Format

Share Document