High platelet reactivity on aspirin in patients with acute ST elevation myocardial infarction

• Published in: Thrombosis research 2016-08, Vol.144, p.56-61
• Main Authors: Dillinger, Jean-Guillaume, Saeed, Alaa, Spagnoli, Vincent, Sollier, Claire Bal dit, Sideris, Georgios, Silberman, Stephane Manzo, Voicu, Sebastian, Drouet, Ludovic, Henry, Patrick
• Format: Article
• Language: English
• Subjects: Acute Disease; Adenosine - analogs & derivatives; Adenosine - therapeutic use; Aspirin; Aspirin - therapeutic use; Blood Platelets - drug effects; Blood Platelets - pathology; Brain Ischemia - etiology; Cardiovascular Diseases - etiology; Female; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; Myocardial infarction; P2Y12 inhibitors; Platelet Aggregation - drug effects; Platelet Aggregation Inhibitors - therapeutic use; Platelet Function Tests; Platelet reactivity; Prasugrel Hydrochloride - therapeutic use; Prospective Studies; Purinergic P2Y Receptor Antagonists - therapeutic use; ST Elevation Myocardial Infarction - blood; ST Elevation Myocardial Infarction - complications; ST Elevation Myocardial Infarction - drug therapy; ST Elevation Myocardial Infarction - pathology; Survival Analysis; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2016.05.002

Abstract Background Despite dual antiplatelet treatment, major ischemic events are common following ST elevation myocardial infarction (STEMI). We aimed to assess high platelet reactivity on aspirin (HPR-aspirin) and its association with P2Y12i (HPR-P2Y12i) during the acute phase of STEMI. Methods We included all consecutive patients admitted for STEMI treated by primary angioplasty in our center for 1 year. All patients received a loading dose followed by a maintenance dose of aspirin (75 mg/day) and prasugrel (ticagrelor or clopidogrel if contraindicated). Platelet reactivity was assessed 4 ± 1 days and 75 ± 15 days after admission using light transmission aggregometry with arachidonic acid (LTA-AA–HPR-aspirin) and VASP (HPR-P2Y12i) to define HPR as well as serum Thromboxane-B2 and LTA-ADP. Major cardiac and cerebrovascular events were recorded for 1 year. Results We included 106 patients – mean age was 61 y.o., 76% were male and 20% had diabetes. STEMI was anterior in 52% and LV ejection fraction at discharge was 51 ± 9%. 50% of patients were treated with prasugrel and 34% with ticagrelor. At day 4 after STEMI, HPR-aspirin was found in 26% patients and HPR-P2Y12i in 7%. HPR- both aspirin and P2Y12i was found in 4%. Diabetes and age were predictors of HPR-aspirin. HPR-aspirin was persistent 75 days later in 36% patients. At 1 year, 7.9% patients had experienced major adverse cardiovascular and cerebrovascular events (MACCE). HPR-aspirin and HPR on both aspirin and P2Y12i were significantly associated with MACCE. Conclusion HPR-aspirin is frequent just after STEMI and associated with MACCE especially when associated with HPR-P2Y12i.