Relation Between Platelet Count and Platelet Reactivity to Thrombotic and Bleeding Risk: From the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Study

Autor: Christopher Metzger, Gennaro Giustino, Peter L. Duffy, Ernest L. Mazzaferri, Ajay J. Kirtane, George Dangas, Giora Weisz, Franz-Josef Neumann, Philippe Généreux, Bruce R. Brodie, Usman Baber, Claire Litherland, Akiko Maehara, Roxana Mehran, Dominic P. Francese, Michael J. Rinaldi, David A. Cox, Gregg W. Stone, Thomas Stuckey, Bernhard Witzenbichler, Timothy D. Henry
Rok vydání: 2016
Předmět:
Blood Platelets
Male
medicine.medical_specialty
medicine.medical_treatment
Postoperative Hemorrhage
030204 cardiovascular system & hematology
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Coronary thrombosis
Risk Factors
Cause of Death
Internal medicine
medicine
Humans
Platelet
Prospective Studies
030212 general & internal medicine
Myocardial infarction
Prospective cohort study
Aged
Aspirin
Dose-Response Relationship
Drug
Platelet Count
business.industry
Coronary Thrombosis
Incidence
Percutaneous coronary intervention
Drug-Eluting Stents
Middle Aged
medicine.disease
Clopidogrel
United States
Survival Rate
Treatment Outcome
Cardiology
Platelet aggregation inhibitor
Drug Therapy
Combination
Female
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Follow-Up Studies
medicine.drug
Zdroj: The American Journal of Cardiology. 117:1703-1713
ISSN: 0002-9149
DOI: 10.1016/j.amjcard.2016.03.001
Popis: Whether the association between platelet count (PC) and thrombotic and bleeding risk is independent of or varies by residual platelet reactivity to antiplatelet therapies is unclear. We sought to investigate the independent and combined effects of PC and platelet reactivity on thrombotic and bleeding risk after coronary artery implantation of drug-eluting stents (DES). Patients enrolled in the prospective, multicenter Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents study were stratified by PC tertiles. The study cohort comprised 8,402 patients. By linear regression analysis, lower PC was strongly and independently associated with higher platelet reactive units (PRUs) on clopidogrel. After multivariable adjustment (including PRU and aspirin reactive units), high, but not low, PC tertile was independently associated with higher risk of thrombotic complications, including spontaneous myocardial infarction and stent thrombosis. Although no independent association was observed between PC tertiles and hemorrhagic risk, both high and low PC tertiles were associated with increased risk for all-cause mortality. After stratification of PC tertiles by tertiles of PRUs, the crude risk of thrombotic complications was highest in patients in the high PC and high PRU tertiles. By multivariable adjustment, PRU increases were uniformly associated with higher risk of thrombotic events across PC tertiles, without evidence of interaction. In conclusion, higher PCs and higher PRUs act independently and synergistically in determining thrombotic risk. Alongside PRU, PCs could be a simple hematological parameter to consider for risk stratification and in tailoring duration and potency of pharmacologic platelet inhibition after DES implantation.
Databáze: OpenAIRE
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