Lijun Jin1, Huimin Yu2, Taiming Dong2, Bin Zhang2, Hong Yan2, Hongtao Liao2, Xia Zou3. 1. Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong Cardiovascular Institute, 510080, Guangzhou, China. Electronic address: lijun_jin2000@126.com. 2. Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong Cardiovascular Institute, 510080, Guangzhou, China. 3. Department of Medical Statistical Record, Guangzhou Oncology Hospital, Guangzhou Medical College, Guangzhou, 510095, China.
Abstract
BACKGROUND: Platelet aggregation may predict the bleeding outcomes after percutaneous coronary intervention (PCI). METHODS: Consecutive patients with non-high risk acute coronary syndrome and indication for PCI were enrolled. Maximum adenosine diphosphate-induced platelet aggregation (ADP-PGmax) was assessed by light transmission aggregometry. Study endpoints were the incidence of haemorrhage, categorised by Thrombolysis in Myocardial Infarction criteria, and significant entry-site complications during hospitalisation and six-month follow-up period. Platelet aggregation test was organised at 24h after PCI and 1 month after discharge respectively. The optimal platelet aggregation was detected defining enhanced clopidogrel response, and associations of measurements with endpoints were assessed. RESULTS: A total of 278 patients were included in analyses. Study endpoints were observed in 24 (8.6%) patients [major bleeding, n=4 (1.4%); minor bleeding, n=11 (4.0%); significant entry-site complication, n=9 (3.2%)]. In multivariate analysis, follow-up ADP-PGmax[odds ratio (OR)=0.96;95% confidence interval (CI),0.93-0.99;p=0.008) and renal insufficiency (OR=3.29; 95%CI, 1.23-8.85; p=0.018) were predictors of bleeding events. The optimal cutoff value for follow-up ADP-PGmax was 24.5% (area under the curve=0.72; 95% CI, 0.59-0.85; p<0.001). Bleeding occurred in 26.2% (16/61) of patients with enhanced clopidogrel response and 3.7% (8/217) of other patients (OR=9.26; p<0.001). CONCLUSION: Enhanced clopidogrel responsiveness was associated with an increased risk of bleeding and entry-site complication. Platelet function testing at an appropriate time after clopidogrel administration helps to identify patients at high risk of bleeding.
BACKGROUND:Platelet aggregation may predict the bleeding outcomes after percutaneous coronary intervention (PCI). METHODS: Consecutive patients with non-high risk acute coronary syndrome and indication for PCI were enrolled. Maximum adenosine diphosphate-induced platelet aggregation (ADP-PGmax) was assessed by light transmission aggregometry. Study endpoints were the incidence of haemorrhage, categorised by Thrombolysis in Myocardial Infarction criteria, and significant entry-site complications during hospitalisation and six-month follow-up period. Platelet aggregation test was organised at 24h after PCI and 1 month after discharge respectively. The optimal platelet aggregation was detected defining enhanced clopidogrel response, and associations of measurements with endpoints were assessed. RESULTS: A total of 278 patients were included in analyses. Study endpoints were observed in 24 (8.6%) patients [major bleeding, n=4 (1.4%); minor bleeding, n=11 (4.0%); significant entry-site complication, n=9 (3.2%)]. In multivariate analysis, follow-up ADP-PGmax[odds ratio (OR)=0.96;95% confidence interval (CI),0.93-0.99;p=0.008) and renal insufficiency (OR=3.29; 95%CI, 1.23-8.85; p=0.018) were predictors of bleeding events. The optimal cutoff value for follow-up ADP-PGmax was 24.5% (area under the curve=0.72; 95% CI, 0.59-0.85; p<0.001). Bleeding occurred in 26.2% (16/61) of patients with enhanced clopidogrel response and 3.7% (8/217) of other patients (OR=9.26; p<0.001). CONCLUSION: Enhanced clopidogrel responsiveness was associated with an increased risk of bleeding and entry-site complication. Platelet function testing at an appropriate time after clopidogrel administration helps to identify patients at high risk of bleeding.