Platelet aggregation at discharge: A useful tool in acute coronary syndromes?

Inhibition of platelet aggregation appears two hours after the first dose of clopidogrel, becomes significant after the second dose, and progresses to a steady-state value of 55% by day seven. Low response to clopidogrel has been associated with increased risk of stent thrombosis and ischemic events...

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Bibliographic Details
Published in:Revista portuguesa de cardiologia 2012-09, Vol.31 (9), p.545-554
Main Authors: Teixeira, Rogério, Monteiro, Pedro, Marques, Gilberto, Pego, João Mariano, Lourenço, Margarida, Tavares, Carlos, Reboredo, Alda, Monteiro, Sílvia, Gonçalves, Francisco, Ferreira, Maria J., Freitas, Mário, Ribeiro, Graça, Providência, Luís A.
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - blood
Acute Coronary Syndrome - drug therapy
Acute coronary syndromes
Agregação plaquetar
Female
Humans
Longitudinal Studies
Male
Middle Aged
Patient Discharge
Platelet aggregation
Platelet Aggregation - drug effects
Platelet Aggregation Inhibitors - therapeutic use
Platelet Function Tests
Prognosis
Prognóstico
Prospective Studies
Síndromes coronárias agudas
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
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Summary:Inhibition of platelet aggregation appears two hours after the first dose of clopidogrel, becomes significant after the second dose, and progresses to a steady-state value of 55% by day seven. Low response to clopidogrel has been associated with increased risk of stent thrombosis and ischemic events, particularly in the context of stable heart disease treated by percutaneous coronary intervention. To stratify medium-term prognosis of an acute coronary syndrome (ACS) population by platelet aggregation. We performed a prospective longitudinal study of 70 patients admitted for an ACS between May and August 2009. Platelet function was assessed by ADP-induced platelet aggregation using a commercially available kit (Multiplate® analyzer) at discharge. The primary endpoint was a combined outcome of mortality, non-fatal myocardial infarction, or unstable angina, with a median follow-up of 136.0 (79.0–188.0) days. The median value of platelet aggregation was 16.0U (11.0–22.5U) with a maximum of 41.0U and a minimum of 4.0U (normal value according to the manufacturer: 53–122U). After ROC curve analysis with respect to the combined endpoint (AUC 0.72), we concluded that a value of 18.5U conferred a sensitivity of 75.0% and a specificity of 68% to that result. We therefore created two groups based on that level: group A – platelet aggregation
ISSN:0870-2551
2174-2030
DOI:10.1016/j.repc.2012.06.005