scholarly journals An optimal window of platelet reactivity by LTA assay for patients undergoing percutaneous coronary intervention

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jing Wang ◽  
Jing Wang ◽  
Zhou Dong ◽  
Jiazheng Ma ◽  
Jianzhen Teng ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Trial Registration ◽  
Therapeutic Window ◽  
Bleeding Events ◽  
Link Type ◽  
Coronary Stent Implantation ◽  
Percutaneous Coronary

Abstract Objective This study was aimed to determine how platelet reactivity (PR) on dual antiplatelet therapy predicts ischemic and bleeding events in patients underwent percutaneous coronary intervention (PCI). Design A total of 2768 patients who had received coronary stent implantation and had taken aspirin 100 mg in combination with clopidogrel 75 mg daily for > 5 days were consecutively screened and 1885 were enrolled. The recruited patients were followed-up for 12 months. The primary end-point was the net adverse clinical events (NACE) of cardiovascular death, nonfatal myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST) and any bleeding. Result 1709 patients completed the clinical follow-up. By using the receiver operating characteristic (ROC) curve analysis, the optimal cut-off values were found to be 37.5 and 25.5% respectively in predicting ischemic and bleeding events. Patients were classified into 2 groups according to PR: inside the window group (IW) [adenosine diphosphate (ADP) induced platelet aggregation (PLADP) 25.5–37.4%)] and outside the window group (OW) (PLADP < 25.5% or ≥ 37.5%). The incidence of NACE was 16.8 and 23.1% respectively in the IW and OW group. The hazard ratio of NACE in IW group was significantly lower [0.69 (95% CI, 0.54–0.89, P = 0.004)] than that in the OW group during 12-month follow-up. Conclusion An optimal therapeutic window of 25.5–37.4% for PLADP predicts the lowest risk of NACE, which could be referred for tailored antiplatelet treatment while using LTA assay. Trial registration Trial registration number: ClinicalTrials.govNCT01968499. Registered 18 October 2013 - Retrospectively registered.

scholarly journals An Optimal Window of Platelet Reactivity by LTA Assay for Patients Undergoing Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Jing Wang ◽  
Jiazheng Ma ◽  
Jianzhen Teng ◽  
Xiaofeng Zhang ◽  
Jing Wang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Light Transmittance ◽  
Receiver Operating Curve ◽  
Therapeutic Window ◽  
Bleeding Events ◽  
Clinical Registry ◽  
Coronary Stent Implantation ◽  
Percutaneous Coronary

Abstract Objective This study was aimed to investigate an optimal therapeutic window for platelet reactivity (PR) to predict the lowest ischemic and bleeding events in patients underwent percutaneous coronary intervention (PCI) and treated with dual antiplatelet agents. Design A total of 1709 patients who had received coronary stent implantation and had taken aspirin 100 mg in combination with clopidogrel 75 mg daily for >5 days were consecutively recruited and their platelet reactivity was determined by light transmittance aggregometry (LTA). All patients were followed up for 12 months. The primary end-point was the net adverse clinical events (NACE) of cardiovascular death, nonfatal myocardial infarction (MI), target vessel revascularization (TVR) , stent thrombosis (ST) and any bleeding.Result By using the receiver-operating curve (ROC) analysis, the optimal cutoff values were found to be 37.5% and 25.5% respectively in predicting ischemic and bleeding events. Patients were classified into 2 groups according to PR: inside the window group (IW) [adenosine diphosphate (ADP) induced platelet aggregation (PLADP) 25.5%-37.4%)] and outside the window group (OW) (PLADP <25.5% or ≥37.5%). The incidence of NACE was 16.8% and 23.1% respectively in the IW and OW group. The hazard ratio of NACE in IW-group was significantly lower [0.69 (95% CI: 0.54–0.89; P = 0.004)] than that in the OW-group during 12 month follow-up. Conclusion An optimal therapeutic window of 25.5%-37.4% for PLADP predicts the lowest risk of NACE, which could be referred for tailored antiplatelet treatment while using LTA assay. Trial and clinical registry Trial registration number: ClinicalTrials.gov NCT01968499. Registered 18 October 2013 - Retrospectively registered.

Comparing prasugrel to twice daily clopidogrel post percutaneous coronary intervention in a Veterans Affairs population

2015 ◽  
Vol 72 (17_Supplement_2) ◽  
pp. S98-S103 ◽  
Author(s):  
Samreen Khatri ◽  
Tamra Pierce
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Platelet Reactivity ◽  
Medical Center ◽  
Coronary Intervention ◽  
Veterans Affairs ◽  
Cardiovascular Outcomes ◽  
Bleeding Events ◽  
Daily Group ◽  
Percutaneous Coronary ◽  
Study Results

Abstract Objective The purpose of this study was to compare various antiplatelet regimens in patients who experienced increased platelet reactivity on clopidogrel therapy with regards to cardiovascular outcomes, including need for revascularization, myocardial infarction (MI), stroke, and cardiovascular (CV) death. Methods A retrospective chart review was conducted on patients who received percutaneous coronary intervention (PCI) at the Richard L. Roudebush Veterans Affairs Medical Center and were subsequently prescribed either clopidogrel 75 mg twice daily, prasugrel 10 mg daily, or clopidogrel 75 mg daily with high platelet reactivity between October 1, 2009 and November 30, 2010. Correlations between antiplatelet regimens and prevention of cardiovascular outcomes and bleeding events were evaluated. Groups were evaluated statistically as two separate comparisons; the first comparison being clopidogrel twice daily versus prasugrel and the second comparison being clopidogrel twice daily versus clopidogrel daily in those patients with a P2Y12 test result of less than 50%. Results A total of 108 patients were included in the study. Eight events occurred in the clopidogrel twice daily group (n = 26), including five revascularizations and three MIs. Seven events occurred in the prasugrel group (n = 64), including two revascularizations, two MIs, two strokes, and one CV death. The difference between these groups was statistically significant (p = 0.031), with patients in the prasugrel group experiencing fewer events. Five events occurred in the clopidogrel daily group (n = 18), including one need for revascularization, two MIs, and two instances of CV death. There were no statistically significant differences in CV events between the clopidogrel twice daily group and clopidogrel daily group (p &gt; 0.999). There were also no statistically significant differences in bleeding incidents for either of the comparisons; p &gt; 0.999 and p = 0.676 respectively for the first and second comparisons. Conclusion Patients on prasugrel had fewer cardiovascular events as compared to patients on clopidogrel twice daily with no difference in bleeding events. No difference was seen with regards to cardiovascular or bleeding events when comparing clopidogrel twice daily to clopidogrel daily in patients with increased platelet reactivity. Study results suggest that there is no benefit to dosing clopidogrel twice daily when compared to either prasugrel or once daily clopidogrel dosing.

Abstract 16929: Propensity-matched Analysis of Triple Oral Antithrombotic Therapy versus Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Daniel B Spoon ◽  
Ryan J Lennon ◽  
Joshua P Slusser ◽  
David R Holmes ◽  
Kent R Bailey ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Primary Endpoint ◽  
Antithrombotic Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Percutaneous Coronary

Introduction: Triple oral antithrombotic therapy (TOAT) (aspirin, clopidogrel, and warfarin) is associated with an increased risk of bleeding. Despite this, the optimal management of patients with indications for warfarin following percutaneous coronary intervention (PCI) has not been established. We sought to compare long-term clinical outcomes between patients receiving TOAT with those receiving dual antiplatelet therapy (DAPT) (aspirin and clopidogrel) after PCI. Hypothesis: Patients with clinical indications for warfarin have higher baseline risk which is largely responsible for the observed differences in outcomes between patients receiving TOAT vs. DAPT. Methods: Retrospective analysis of prospectively collected data from 9,009 patients. The primary outcome was a composite of all-cause mortality, ischemic or embolic events (myocardial infarction or stroke), or bleeding. Secondary outcomes were death plus ischemic or embolic events, death plus bleeding, death, MI, stroke, and bleeding. A 2:1 propensity matched analysis was also performed. Results: In 9,009 patients, 812 received TOAT and 8,197 received DAPT. Median follow-up was 61 months. The primary end point occurred in 2,749 patients. At 1 year, 22% of patients treated with TOAT had the primary endpoint versus 11% of DAPT patients (p<0.001). At 1 year, secondary end points of death or ischemic or embolic events (19% vs. 10%, p<0.001), and death or bleeding events (15% vs. 5%, p<0.001) also occurred with a higher frequency with TOAT. After propensity matched analysis the above differences were no longer significant with 1 year primary endpoint rates of 19% vs. 17% respectively (HR 1.95%, CI 0.88, 1.47; p = 0.33). Following propensity matching the only significant difference between TOAT and DAPT groups was minor bleeding (5% vs. 2%; HR 2.65, 95% CI 1.39, 5.03; p=0.003). Conclusions: In a large single center registry with comprehensive follow up, patients treated with TOAT had higher rates of ischemic and bleeding events. However, when baseline risks are accounted for event rates are similar, other than minor bleeding, indicating patient risk characteristics are largely responsible for the observed differences in outcomes.

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