Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Impact of Platelet Function Test on Platelet Responsiveness and Clinical Outcome After Coronary Stent Implantation: Platelet Responsiveness and Clinical Outcome

  • Yu, Long-Hao (Department of Cardiology, College of Medicine, Dong-A University) ;
  • Kim, Moo-Hyun (Department of Cardiology, College of Medicine, Dong-A University) ;
  • Zhang, Hong-Zhe (Department of Cardiology, College of Medicine, Dong-A University) ;
  • Park, Jong-Seong (Department of Cardiology, College of Medicine, Dong-A University) ;
  • Park, Tae-Ho (Department of Cardiology, College of Medicine, Dong-A University) ;
  • Kim, Young-Dae (Department of Cardiology, College of Medicine, Dong-A University) ;
  • Cha, Kwang-Soo (Department of Cardiology, Pusan National University College of Medicine) ;
  • Han, Jin-Yeong (Department of Laboratory Medicine, College of Medicine, Dong-A University)
  • Published : 2012.06.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: The aim of this study was to confirm the predictive cut-off values for P2Y12 reaction units (PRU) and aspirin reaction units (ARU) and to evaluate the clinical impact of $VerifyNow^{(R)}$ assays. Subjects and Methods: From November 2007 to October 2009, 186 eligible patients were prospectively recruited. Post-treatment platelet reactivity was measured by $VerifyNow^{(R)}$ assays within 12 to 24 hours after intervention, followed by standard dual maintenance dose therapy for 1 year. All patients had scheduled clinical follow-ups at 1, 3, 6, and 12 months. Results: The rate of low responders to clopidogrel, aspirin, and both drugs were 41.4%, 10.2%, and 3.8%, respectively. The predictive factors for low responsiveness to clopidogrel (PRU ${\geq}$240) were female sex, age, and non-use of cilostazol medication in our univariate analysis and age ${\geq}$65 years and non-use cilostazol in the multivariate analysis. The predictors of low responsiveness to aspirin (ARU ${\geq}$550) were male sex and age in both univariate and multivariate analyses. There was no significant difference in the clinical event rate with a cut-off value of PRU ${\geq}$240 or ARU ${\geq}$550 for 30 days and 1-year (p>0.05). Conclusion: Hyporesponsiveness to antiplatelet agents (namely aspirin and clopidogrel) was identified in about half of the patients. The cut-off point of PRU ${\geq}$240 or ARU ${\geq}$550 did not confer predictive value for 30-day or 1-year clinical event rates in patients who had undergone coronary intervention with drug-eluting stents.

Keywords

References

  1. Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, et al. Variability in individual responsiveness to clopidogrel: clinical implications, management, and future perspectives. J Am Coll Cardiol 2007;49:1505-16. https://doi.org/10.1016/j.jacc.2006.11.044
  2. Angiolillo DJ. Variability in responsiveness to oral antiplatelet therapy. Am J Cardiol 2009;103(3 Suppl):A27-34. https://doi.org/10.1016/j.amjcard.2008.11.020
  3. Ferreiro JL, Angiolillo DJ. Clopidogrel response variability: current status and future directions. Thromb Haemost 2009;102:7-14.
  4. Angiolillo DJ. Platelet function testing in clinical practice: are we ready for prime time? Rev Esp Cardiol 2009;62:113-6. https://doi.org/10.1016/S0300-8932(09)70151-4
  5. Capodanno D, Angiolillo DJ. Platelet monitoring for PCI: which test is the one to choose? Hamostaseologie 2009;29:376-80.
  6. Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 357:2001-15. https://doi.org/10.1056/NEJMoa0706482
  7. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009;361: 1045-57. https://doi.org/10.1056/NEJMoa0904327
  8. Tantry US, Gurbel PA. Platelet monitoring for PCI: is it really necessary? Hamostaseologie 2009;29:368-75.
  9. Campo G, Fileti L, Valgimigli M, et al. Poor response to clopidogrel: current and future options for its management. J Thromb Thrombolysis 2010;30:319-31. https://doi.org/10.1007/s11239-010-0457-5
  10. Marcucci R, Gori AM, Paniccia R, et al. Cardiovascular death and nonfatal myocardial infarction in acute coronary syndrome patients receiving coronary stenting are predicted by residual platelet reactivity to ADP detected by a point-of-care assay: a 12-month follow-up. Circulation 2009;119:237-42. https://doi.org/10.1161/CIRCULATIONAHA.108.812636
  11. Gum PA, Kottke-Marchant K, Poggio ED, et al. Profile and prevalence of aspirin resistance in patients with cardiovascular disease. Am J Cardiol 2001;88:230-5. https://doi.org/10.1016/S0002-9149(01)01631-9
  12. Aradi D, Komócsi A, Vorobcsuk A, et al. Prognostic significance of high on-clopidogrel platelet reactivity after percutaneous coronary intervention: systematic review and meta-analysis. Am Heart J 2010;160: 543-51. https://doi.org/10.1016/j.ahj.2010.06.004
  13. Patti G, Nusca A, Mangiacapra F, Gatto L, D'Ambrosio A, Di Sciascio G. Point-of-care measurement of clopidogrel responsiveness predicts clinical outcome in patients undergoing percutaneous coronary intervention results of the ARMYDA-PRO (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Platelet Reactivity Predicts Outcome) Study. J Am Coll Cardiol 2008;52:1128-33. https://doi.org/10.1016/j.jacc.2008.06.038
  14. Woo KS, Kim BR, Kim JE, et al. Determination of the prevalence of aspirin and clopidogrel resistances in patients with coronary artery disease by using various platelet-function tests. Korean J Lab Med 2010;30: 460-8. https://doi.org/10.3343/kjlm.2010.30.5.460
  15. Gremmel T, Panzer S. Clinical, genetic and confounding factors determine the dynamics of the in vitro response/non response to clopidogrel. Thromb Haemost 2011;106:211-8. https://doi.org/10.1160/TH11-03-0137
  16. Gremmel T, Steiner S, Seidinger D, Koppensteiner R, Panzer S, Kopp CW. Adenosine diphosphate-inducible platelet reactivity shows a pronounced age dependency in the initial phase of antiplatelet therapy with clopidogrel. J Thromb Haemost 2010;8:37-42. https://doi.org/10.1111/j.1538-7836.2009.03644.x
  17. Geisler T, Grass D, Bigalke B, et al. The residual platelet aggregation after deployment of intracoronary stent (PREDICT) score. J Thromb Haemost 2008;6:54-61.
  18. Price MJ, Endemann S, Gollapudi RR, et al. Prognostic significance of post-clopidogrel platelet reactivity assessed by a point-of-care assay on thrombotic events after drug-eluting stent implantation. Eur Heart J 2008;29:992-1000. https://doi.org/10.1093/eurheartj/ehn046
  19. Price MJ, Nayak KR, Barker CM, Kandzari DE, Teirstein PS. Predictors of heightened platelet reactivity despite dual-antiplatelet therapy in patients undergoing percutaneous coronary intervention. Am J Cardiol 2009;103:1339-43. https://doi.org/10.1016/j.amjcard.2009.01.341
  20. Hochholzer W, Trenk D, Bestehorn HP, et al. Impact of the degree of peri-interventional platelet inhibition after loading with clopidogrel on early clinical outcome of elective coronary stent placement. J Am Coll Cardiol 2006;48:1742-50. https://doi.org/10.1016/j.jacc.2006.06.065
  21. Suh JW, Lee SP, Park KW, et al. Multicenter randomized trial evaluating the efficacy of cilostazol on ischemic vascular complications after drug-eluting stent implantation for coronary heart disease: results of the CILON-T (influence of CILostazol-based triple antiplatelet therapy ON ischemic complication after drug-eluting stenT implantation) trial. J Am Coll Cardiol 2011;57:280-9. https://doi.org/10.1016/j.jacc.2010.08.631
  22. Ko YG, Suh JW, Kim BH, et al. Comparison of 2 point-of-care platelet function tests, VerifyNow Assay and Multiple Electrode Platelet Aggregometry, for predicting early clinical outcomes in patients undergoing percutaneous coronary intervention. Am Heart J 2011;161:383-90. https://doi.org/10.1016/j.ahj.2010.10.036
  23. Price MJ, Berger PB, Teirstein PS, et al. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA 2011;305:1097-105. https://doi.org/10.1001/jama.2011.290
  24. Bliden KP, DiChiara J, Tantry US, Bassi AK, Chaganti SK, Gurbel PA. Increased risk in patients with high platelet aggregation receiving chronic clopidogrel therapy undergoing percutaneous coronary intervention: is the current antiplatelet therapy adequate? J Am Coll Cardiol 2007; 49:657-66. https://doi.org/10.1016/j.jacc.2006.10.050
  25. Geisler T, Langer H, Wydymus M, et al. Low response to clopidogrel is associated with cardiovascular outcome after coronary stent implantation. Eur Heart J 2006;27:2420-5. https://doi.org/10.1093/eurheartj/ehl275
  26. Pinto Slottow TL, Bonello L, Gavini R, et al. Prevalence of aspirin and clopidogrel resistance among patients with and without drug-eluting stent thrombosis. Am J Cardiol 2009;104:525-30. https://doi.org/10.1016/j.amjcard.2009.04.015
  27. Lee SP, Park KW, Shin DH, et al. Efficacy of predicting thrombotic events with combination of dual point-of-care testing (POCT) after drug eluting stent implantation for coronary heart study: result from the CILON-T randomized trial POCT substudy. J Atheroscler Thromb 2011;18:914-23. https://doi.org/10.5551/jat.9290

Cited by

  1. Comparison of Antiplatelet Effect and Safety of Clopidogrel Napadisilate with Clopidogrel Bisulfate in Coronary Artery Disease Patients: Multi-center, Randomized, Double-blind, Phase IV, Non-inferiori vol.13, pp.6, 2013, https://doi.org/10.1007/s40256-013-0039-y
  2. Impact of platelet reactivity on long-term prognosis in Korean patients receiving percutaneous coronary intervention vol.30, pp.8, 2012, https://doi.org/10.1080/09537104.2018.1562172