scholarly journals Total Thrombus-Formation Analysis System can Predict 1-Year Bleeding Events in Patients with Coronary Artery Disease

2020 ◽  
Vol 27 (3) ◽  
pp. 215-225 ◽  
Author(s):  
Tatsuro Mitsuse ◽  
Koichi Kaikita ◽  
Masanobu Ishii ◽  
Yu Oimatsu ◽  
Nobuhiro Nakanishi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Thrombus Formation ◽  
Bleeding Events ◽  
Artery Disease ◽  
Analysis System

scholarly journals The usefulness of total thrombus-formation analysis system for predicting high bleeding risk in coronary artery disease patients taking anticoagulants who underwent percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Nakanishi ◽  
K Kaikita ◽  
T Mitsuse ◽  
K Tsujita
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Thrombus Formation ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Analysis System ◽  
High Bleeding Risk

Abstract Background Although anticoagulants are widely used for prevention of cerebral infarction in patients with atrial fibrillation (AF), venous thrombosis, and valvular disease, it is possible that anticoagulants increase bleeding events in daily medical practices. Recently, we reported that the total thrombus-formation analysis system (T-TAS) was useful for evaluating bleeding risk in coronary artery disease (CAD) patients. Aim We examined whether T-TAS was practical for predicting bleeding risk in CAD patients taking anticoagulants who underwent percutaneous coronary intervention (PCI). Methods This study was the retrospective analysis of the 500 consecutive CAD patients who underwent PCI. Blood samples obtained on the day of PCI were used in T-TAS to compute the thrombus formation area under the curve (AUC) (AR10-AUC30, AUC for AR chip). We divided the total number of study patients into two groups according to the presence of anticoagulants; 53 CAD patients with triple therapy (TT) and 447 CAD patients with dual antiplatelet therapy (DAPT). We compared clinical characteristics and prognosis between the two groups. The primary endpoint was 1-year bleeding events that were defined by ISTH bleeding criteria. We excluded the CAD patients who underwent emergency PCI, and who were treated for hemodialysis. Results All patients took aspirin and clopidogrel, or aspirin and prasugrel at baseline. Compared to the patients with DAPT, the patients with TT had atrial fibrillation and history of stroke. The AR10-AUC30 levels were significantly lower in the patients with TT than the patients with DAPT (median [interquartile range] 1402.6 [1095.1–1609.8] vs. 1679.8 [1526.4–1783.3], p<0.001). Thirty-five patients (7%) had bleeding events during follow-up [11 cases (20.8%) in the patients with TT, 24 cases (5.4%) in the patients with DAPT]. Kaplan-Meier curve analysis showed a worse 1-year bleeding event-free survival rate in the patients with TT compared with the patients with DAPT (p<0.001). Receiver operating characteristic analysis showed that AR10-AUC30 levels significantly predicted bleeding events (AUC 0.653, 95% CI 0.555–0.751; p=0.003) and the cut-off point was 1586.4 by Youden index in the present study. In multivariate Cox hazards analysis, low AR10-AUC30 level (≤1586.4) (hazard ratio 2.99; 95% CI 1.46–6.11; p=0.003) and taking warfarin (hazard ratio 3.02; 95% CI 1.24–7.34; p=0.015) were significant predictors for 1-year bleeding events. Conclusions The present findings suggested that the AR10-AUC30 level determined by T-TAS could be a useful marker for predicting high bleeding risk in CAD patients taking anticoagulants who underwent PCI. Funding Acknowledgement Type of funding source: None

Clopidogrel Use as Single Antiplatelet Therapy in Outpatients with Stable Coronary Artery Disease: Prevalence, Correlates and Association with Prognosis (from the CORONOR Study)

Cardiology ◽  
2016 ◽  
Vol 134 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Gilles Lemesle ◽  
Guillaume Schurtz ◽  
Thibaud Meurice ◽  
Olivier Tricot ◽  
Nestor Lemaire ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Stable Coronary Artery Disease ◽  
Significant Proportion ◽  
Cardiovascular Death ◽  
Drug Eluting Stent ◽  
Bleeding Events ◽  
Therapy Regimen ◽  
Artery Disease

Background: Clopidogrel use as single antiplatelet therapy (SAPT) has never been evaluated in stable coronary artery disease (CAD) outpatients either as compared to placebo or aspirin. Methods: We therefore studied 2,823 outpatients included in a prospective registry. The patients were divided into 2 groups according to their antiplatelet therapy regimen: patients treated with clopidogrel were compared with those treated with aspirin alone. Results: The mean time since CAD diagnosis was 7.9 years. Altogether, 776 (27.5%) patients received clopidogrel as SAPT. Factors independently associated with clopidogrel use were prior aortic or peripheral intervention, drug-eluting stent implantation, stroke, carotid endarterectomy and time since CAD diagnosis. Clopidogrel tended to be used in higher-risk patients: composite of cardiovascular death, myocardial infarction or stroke at 5.8 versus 4.2% (p = 0.056). However, after propensity score matching, similar event rates were observed between the groups: 5.9% when treated with clopidogrel versus 4.4% with aspirin (p = 0.207). The rate of bleeding was also similar between the groups. Conclusions: Our study shows that a significant proportion of stable CAD patients are treated with clopidogrel as SAPT in modern practice. Several correlates of such an attitude were identified. Our results suggest that this strategy is not beneficial as compared to aspirin alone in terms of ischaemic or bleeding events.

The role of microRNAs in prethrombotic status associated with coronary artery disease

2017 ◽  
Vol 117 (03) ◽  
pp. 429-436 ◽  
Author(s):  
Jie Gao ◽  
Xiaojuan Ma ◽  
Ying Zhang ◽  
Ming Guo ◽  
Dazhuo Shi
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Thrombus Formation ◽  
Underlying Mechanism ◽  
Fine Tuning ◽  
Diagnostic Biomarkers ◽  
Golden Standard ◽  
Artery Disease

SummaryThe acute cardiovascular events following thrombus formation is a primary cause of morbidity and mortality of patients with coronary artery disease (CAD). Numerous studies have shown that a prethrombotic status, which can be defined as an imbalance between the procoagulant and anticoagulant conditions, would exist for a period of time before thrombogenesis. Therefore, early diagnosis and intervention of prethrombotic status are important for reducing acute cardiovascular events. However, none of prethrombotic indicators have been identified as golden standard for diagnosis of prethrombotic status to date. MicroRNAs (miRNAs), a class of short non-coding RNAs, have been shown to be involved in pathophysiologic processes related to prethrombotic status, such as endothelial dysfunction, platelet activation, impaired fibrinolysis and elevated procoagulant factors, etc. Owing to their multiple and fine-tuning impacts on gene expression, miRNAs raise a novel understanding in the underlying mechanism of prethrombotic status. This review aims to discuss the role of miRNAs in prethrombotic status, especially the differently expressed miRNAs in CAD, which may be meaningful for developing promising diagnostic biomarkers and therapeutic strategies for CAD patients in future.

Abstract 1521: Platelet RNA Content is Increased in Patients with Acute Coronary Syndromes Compared to Patients with stable Coronary Artery Disease and Healthy Individuals

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Erik L Grove ◽  
Anne-Mette Hvas ◽  
Steen D Kristensen
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Thrombus Formation ◽  
Stable Coronary Artery Disease ◽  
Healthy Individuals ◽  
Coronary Thrombus ◽  
Coronary Syndromes ◽  
Immature Platelets ◽  
Artery Disease

Background: Platelets newly released from the bone marrow are characterized by large cell volumes and, contrary to mature platelets, contain RNA, which might reflect an increased capacity of producing proaggregatory proteins. We hypothesized that the fraction of RNA-containing, immature platelets (Immature Platelet Fraction = IPF) is a marker for acute coronary thrombus formation. Methods: Flow cytometric determination of immature platelets was conducted using a RNA fluorescent dye and an automated analyzer (Sysmex XE-2100). Measurements were performed in a total of 426 individuals (365 patients with acute coronary syndromes (ACS), 39 patients with stable coronary artery disease (CAD) and 22 healthy individuals). Results: Geometric mean IPF was 2.5 (CV = 0.37) in the control group, 2.9 (0.43) in patients with stable CAD, 3.0 (0.55) in the non-STEMI/Unstable Angina group and 3.7 (0.56) in patients with STEMI. IPF was significantly increased in STEMI patients compared to all other groups (t-test for log-transformed data: p < 0.004), and the overall difference between groups was significant (ANOVA: p < 0.0001). IPF was increased in active smokers among patients with ACS (3.2 vs 3.6, p=0.02), whereas no relation with age, sex, body mass index or CRP levels was observed. Conclusion: The fraction of RNA-containing platelets is increased in ACS, especially in the acute phase of STEMI. Immature platelets with an increased haemostatic potential may contribute to coronary thrombus formation and may partly explain previous findings of temporary resistance to anti-platelet therapy.

scholarly journals Intracoronary thrombus formation causes focal vasoconstriction of epicardial arteries in patients with coronary artery disease.

Circulation ◽  
1991 ◽  
Vol 83 (5) ◽  
pp. 1519-1525 ◽  
Author(s):  
A M Zeiher ◽  
V Schächinger ◽  
S H Weitzel ◽  
H Wollschläger ◽  
H Just
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Thrombus Formation ◽  
Artery Disease
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