Leonardo C Clavijo1, Noor Al-Asady2, Ashwat Dhillon3, Ray V Matthews4, Jorge Caro5, Han Tun6, Vincent Rowe7, David M Shavelle8. 1. Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. Electronic address: Leonardo.Clavijo@med.usc.edu. 2. Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. Electronic address: Noor.Al-Asady@med.usc.edu. 3. Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. Electronic address: Ashwat.Dhillon@med.usc.edu. 4. Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. Electronic address: Ray.Matthews@med.usc.edu. 5. Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. Electronic address: Jorge.Caro@med.usc.edu. 6. Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. Electronic address: Han.Tun@med.usc.edu. 7. Division of Vascular Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. Electronic address: Vincent.Rowe@med.usc.edu. 8. Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. Electronic address: David.Shavelle@med.usc.edu.
Abstract
OBJECTIVES: The goal of this study is to establish the prevalence of high on-treatment platelet reactivity to aspirin (HPRA) and clopidogrel (HPRC) in patients with critical limb ischemia (CLI). BACKGROUND: CLI is associated with an increased risk of death and cardiovascular events. Unlike other patient populations with atherosclerotic cardiovascular disease, previous studies failed to demonstrate a benefit of antiplatelet therapy in patients with CLI. METHODS: From June 2014 to November 2016, we performed platelet reactivity studies for P2Y12 and thromboxane A2 (TXA2) inhibition in 100 CLI patients receiving daily treatment with aspirin and clopidogrel. P2Y12 inhibition was measured by two assays: vasodilator-stimulated phosphoprotein (VASP) and VerifyNow P2Y12 assays. HPRC was defined as VerifyNow P2Y12 reactive units (PRU) >208 and VASP-platelet reactivity index (VASP-PRI) >50%. TXA2 inhibition was measured with the VerifyNow aspirin test and HPRA was defined as aspirin reaction units (ARU) >550. RESULTS: Mean age was 67±11 years, 50% were male, 80% had diabetes mellitus, and 26% had chronic renal insufficiency. Thirty-three percent of patients had a PRU >208 and 46% a VASP-PRI >50%. HPRC was present in 26% of patients based on the criteria of both a PRU >208 and VASP-PRI >50%. HPRA was present in 25% of patients. The overall prevalence of HPR to ASA or clopidogrel was 35% and HPR to both drugs was present in 8% of patients. Clinical characteristics were similar between groups. CONCLUSIONS: HPR to aspirin or clopidogrel is highly prevalent in patients with CLI. Nearly one in ten patients with CLI is a hyporesponder to both aspirin and clopidogrel.
OBJECTIVES: The goal of this study is to establish the prevalence of high on-treatment platelet reactivity to aspirin (HPRA) and clopidogrel (HPRC) in patients with critical limb ischemia (CLI). BACKGROUND: CLI is associated with an increased risk of death and cardiovascular events. Unlike other patient populations with atherosclerotic cardiovascular disease, previous studies failed to demonstrate a benefit of antiplatelet therapy in patients with CLI. METHODS: From June 2014 to November 2016, we performed platelet reactivity studies for P2Y12 and thromboxane A2 (TXA2) inhibition in 100 CLI patients receiving daily treatment with aspirin and clopidogrel. P2Y12 inhibition was measured by two assays: vasodilator-stimulated phosphoprotein (VASP) and VerifyNow P2Y12 assays. HPRC was defined as VerifyNow P2Y12 reactive units (PRU) >208 and VASP-platelet reactivity index (VASP-PRI) >50%. TXA2 inhibition was measured with the VerifyNow aspirin test and HPRA was defined as aspirin reaction units (ARU) >550. RESULTS: Mean age was 67±11 years, 50% were male, 80% had diabetes mellitus, and 26% had chronic renal insufficiency. Thirty-three percent of patients had a PRU >208 and 46% a VASP-PRI >50%. HPRC was present in 26% of patients based on the criteria of both a PRU >208 and VASP-PRI >50%. HPRA was present in 25% of patients. The overall prevalence of HPR to ASA or clopidogrel was 35% and HPR to both drugs was present in 8% of patients. Clinical characteristics were similar between groups. CONCLUSIONS: HPR to aspirin or clopidogrel is highly prevalent in patients with CLI. Nearly one in ten patients with CLI is a hyporesponder to both aspirin and clopidogrel.
Authors: Hamzah Khan; Mariya Popkov; Shubha Jain; Niousha Djahanpour; Muzammil H Syed; Margaret L Rand; John Eikelboom; C David Mazer; Mohammed Al-Omran; Rawand Abdin; Mohammad Qadura Journal: Front Cardiovasc Med Date: 2022-08-11
Authors: Hamzah Khan; Reid Gallant; Shubha Jain; Mohammed Al-Omran; Charles De Mestral; Elisa Greco; Mark Wheatcroft; Ashraf Alazonni; Rawand Abdin; Margaret L Rand; Heyu Ni; Mohammad Qadura Journal: Medicina (Kaunas) Date: 2020-10-02 Impact factor: 2.430