high platelet reactivity
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2021 ◽  
Author(s):  
Raisuke Iijima ◽  
Kazushige Kadota ◽  
Koichi Nakao ◽  
Yoshihisa Nakagawa ◽  
Junya Shite ◽  
...  

2021 ◽  
Vol 17 (11) ◽  
pp. e888-e897
Author(s):  
Seung Hun Lee ◽  
Sang Yeub Lee ◽  
Woo Jung Chun ◽  
Young Bin Song ◽  
Seung-Hyuk Choi ◽  
...  

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Fabio Mangiacapra ◽  
Luca Paolucci ◽  
Michele Mattia Viscusi ◽  
Roberto Mangiacapra ◽  
Pietro Manuel Ferraro ◽  
...  

Abstract Aims High platelet reactivity (HPR) on clopidogrel and chronic kidney disease (CKD) are recognized as potent risk factors for adverse outcomes in patients suffering coronary artery disease (CAD) and undergoing percutaneous coronary intervention (PCI). However, conclusive evidence regarding their reciprocal interaction and the consequent impact on clinical events is still lacking. We performed a meta-analysis with the aim to evaluate the prevalence of HPR in patients with and without CKD and the incidence of major adverse cardiovascular events (MACE) according to the renal and platelet function status in current literature (co-primary endpoints). Secondary endpoints were myocardial infarction (MI), all cause death and definite/probable stent thrombosis (ST). Methods and results We searched on PubMed, EMBASE, and Cochrane Library studies investigating CKD and HPR on clopidogrel in patients suffering CAD who underwent PCI and their related outcomes. Overall, 13 studies including 22.464 patients were selected. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects model with the Mantel–Haenszel method. Patients with CKD presented significantly higher odds of HPR compared with those without CKD [OR: 1.51 (95% CI: 1.29–1.76)]. In patients without CKD, HPR was associated with increased odds of MACE [OR: 1.31 (95% CI: 1.01–1.72)], MI [OR: 1.48 (95% CI: 1.17–1.86)] and definite/probable ST [OR: 2.45 (95% CI: 1.08–5.60)]. In patients with CKD, HPR was associated with higher odds of both MACE [OR: 1.61 (95% CI: 1.14–2.27)] and MI [OR: 1.69 (95% CI: 1.11–2.59)], compared to those without HPR. Conclusions Our analysis shows that HPR on clopidogrel is more frequent in patients with CKD treated with PCI. Patients with HPR are exposed to a high risk of MACE after PCI, regardless of the renal function status.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M E Canonico ◽  
G D Sanna ◽  
R Siciliano ◽  
S Guarino ◽  
B Bellandi ◽  
...  

Abstract Background Platelet reactivity (PR) has been indicated as a pathophysiological key element for ST-Elevation Myocardial Infarction (STEMI) development. In STEMI patients, PR following pharmacological treatment has been extensively studied with focus on patients with on-treatment high platelet reactivity (HPR). Patients with before-treatment not-high platelet reactivity (NHPR) have been poorly studied so far. Purpose Aim of the study is to investigate the prevalence, clinical characteristics, response to therapy and outcomes of baseline prior to treatment NHPR among patients with STEMI undergoing primary PCI. Methods We analysed the data from 358 STEMI patients with assessment of PR by VerifyNowbefore P2Y12 inhibitor loading dose (LD). All patients received a P2Y12 inhibitor (ticagrelor or prasugrel) LDafter baseline PR assessment. Blood samples were obtained at baseline (T0), and after 1 hour (T1), 2 hours (T2), 4–6 hours (T3) and 8–12 hours (T4) after LD. HPR was defined as Platelet Reactivity Unit values ≥208, while patients with values <208 at baseline were defined as having NHPR. Results Overall, 20% patients had NHPR. Patients with before-treatment NHPR values were more frequently young, of male gender and more frequently smokers (p=0.005), overweight or obese (p=0.009), affected by dyslipidemia (p=0.03) and with a family history of coronary artery disease (p=0.04). Age and male gender resulted both independent predictors of NHPR, even after propensity score adjustment. The percentage of inhibition of PR after ticagrelor or prasugrel LD was similar between HPR and NHPR patients at each time point (figure 1) and residual PR was constantly lower in patients with before-treatment PRU <208 from baseline to 8–12 hours from LD (figure 2). However, patients with HPR showed worse in-hospital clinical outcomes, and the composite adverse outcome endpoint of death, reinfarction, stroke, acute kidney injury or heart failure was significantly higher (10.0% vs 1.4%; p=0.017) as compared with the NHPR group. Conclusions A significant proportion of patients presenting with STEMI has a baseline NHPR; they are predominantly young males with a high-risk cardiovascular profile. NHPR is associated with better in-hospital outcomes as compare with patients with HPR. Further studies are needed to better understand the underlying pathophysiology in order to find out potential personalized treatments in this setting. FUNDunding Acknowledgement Type of funding sources: None.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254067
Author(s):  
Koji Tanaka ◽  
Shoji Matsumoto ◽  
Gulibahaer Ainiding ◽  
Ichiro Nakahara ◽  
Hidehisa Nishi ◽  
...  

Background and purpose The impact of the paraoxonase-1 (PON1) polymorphism, Q192R, on platelet inhibition in response to clopidogrel remains controversial. We aimed to investigate the association between carrier status of PON1 Q192R and high platelet reactivity (HPR) with clopidogrel in patients undergoing elective neurointervention. Methods Post-clopidogrel platelet reactivity was measured using a VerifyNow® P2Y12 assay in P2Y12 reaction units (PRU) for consecutive patients before the treatment. Genotype testing was performed for PON1 Q192R and CYP2C19*2 and *3 (no function alleles), and *17. PRU was corrected on the basis of hematocrit. We investigated associations between factors including carrying ≥1 PON1 192R allele and HPR defined as original and corrected PRU ≥208. Results Of 475 patients (232 men, median age, 68 years), HPR by original and corrected PRU was observed in 259 and 199 patients (54.5% and 41.9%), respectively. Carriers of ≥1 PON1 192R allele more frequently had HPR by original and corrected PRU compared with non-carriers (91.5% vs 85.2%, P = 0.031 and 92.5% vs 85.9%, P = 0.026, respectively). In multivariate analyses, carrying ≥1 PON1 192R allele was associated with HPR by original (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.03–3.76) and corrected PRU (OR 2.34, 95% CI 1.21–4.74) after adjustment for age, sex, treatment with antihypertensive medications, hematocrit, platelet count, total cholesterol, and carrying ≥1 CYP2C19 no function allele. Conclusions Carrying ≥1 PON1 192R allele is associated with HPR by original and corrected PRU with clopidogrel in patients undergoing elective neurointervention, although alternative results related to other genetic polymorphisms cannot be excluded.


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