OBJECTIVES: This study aimed to assess the clinical implications and optimal cutoff value of high platelet reactivity (HPR) in patients receiving clopidogrel for peripheral endovascular procedures. BACKGROUND: As noted in coronary studies, HPR could be related to increased adverse events. METHODS: This prospective trial included patients receiving clopidogrel 75 mg daily, before and after infrainguinal angioplasty or stenting. Platelet inhibition was assessed with the VerifyNow P2Y12 point-of-care test. Primary endpoints were 1-year clinical events rate (composite endpoint of death, major stroke, major amputation, target vessel revascularization, and bypass) according to the P2Y12 reaction units (PRU)-based quartile distribution, the estimation of the optimal PRU cutoff value for predicting clinical outcome, and the identification of independent predictors influencing event-free survival. RESULTS: In total, 100 consecutive patients were enrolled. The 1-year cumulative events rate was 4% in the first quartile, 12% in the second, 52% in the third, and 84% in the fourth. Pairwise comparisons demonstrated a significant difference in the composite endpoint between successive quartiles (all p < 0.05 except for the first vs. second quartile). According to receiver-operating characteristic curve analysis, the optimal cutoff value for the composite endpoint was PRU ≥234 (area under the curve: 0.883; 95% confidence interval [CI]: 0.811 to 0.954; p < 0.0001; sensitivity: 92.1%; specificity: 84.2%). Cox multivariate regression analysis identified HPR (PRU ≥234) as the only independent predictor of an increased number of adverse events (hazard ratio: 16.9; 95% CI: 5 to 55; p < 0.0001). CONCLUSIONS: On-treatment HPR is associated with markedly increased adverse clinical events in patients undergoing peripheral endovascular procedures. Point-of-care clopidogrel assessment might be useful in individualizing antiplatelet therapy to attain superior clinical results. (High On-Treatment Platelet Reactivity Following Peripheral Endovascular Procedures [PRECLOP]; NCT01744613).
OBJECTIVES: This study aimed to assess the clinical implications and optimal cutoff value of high platelet reactivity (HPR) in patients receiving clopidogrel for peripheral endovascular procedures. BACKGROUND: As noted in coronary studies, HPR could be related to increased adverse events. METHODS: This prospective trial included patients receiving clopidogrel 75 mg daily, before and after infrainguinal angioplasty or stenting. Platelet inhibition was assessed with the VerifyNow P2Y12 point-of-care test. Primary endpoints were 1-year clinical events rate (composite endpoint of death, major stroke, major amputation, target vessel revascularization, and bypass) according to the P2Y12 reaction units (PRU)-based quartile distribution, the estimation of the optimal PRU cutoff value for predicting clinical outcome, and the identification of independent predictors influencing event-free survival. RESULTS: In total, 100 consecutive patients were enrolled. The 1-year cumulative events rate was 4% in the first quartile, 12% in the second, 52% in the third, and 84% in the fourth. Pairwise comparisons demonstrated a significant difference in the composite endpoint between successive quartiles (all p < 0.05 except for the first vs. second quartile). According to receiver-operating characteristic curve analysis, the optimal cutoff value for the composite endpoint was PRU ≥234 (area under the curve: 0.883; 95% confidence interval [CI]: 0.811 to 0.954; p < 0.0001; sensitivity: 92.1%; specificity: 84.2%). Cox multivariate regression analysis identified HPR (PRU ≥234) as the only independent predictor of an increased number of adverse events (hazard ratio: 16.9; 95% CI: 5 to 55; p < 0.0001). CONCLUSIONS: On-treatment HPR is associated with markedly increased adverse clinical events in patients undergoing peripheral endovascular procedures. Point-of-care clopidogrel assessment might be useful in individualizing antiplatelet therapy to attain superior clinical results. (High On-Treatment Platelet Reactivity Following Peripheral Endovascular Procedures [PRECLOP]; NCT01744613).
Authors: Khung-Keong Yeo; Ehrin J Armstrong; Javier E López; Debbie C Chen; Gregory G Westin; Chin-Shang Li; David Anderson; Amy Hua; Anil Singapuri; Ezra A Amsterdam; Nipavan Chiamvimonvat; John R Laird Journal: Catheter Cardiovasc Interv Date: 2018-02-07 Impact factor: 2.692
Authors: Michal Droppa; Dimitri Tschernow; Karin A L Müller; Elli Tavlaki; Athanasios Karathanos; Fabian Stimpfle; Elke Schaeffeler; Matthias Schwab; Alexander Tolios; Jolanta M Siller-Matula; Meinrad Gawaz; Tobias Geisler Journal: PLoS One Date: 2015-03-23 Impact factor: 3.240