The Prognostic Value of ADP-Induced Platelet Aggregation for Bleeding Complications in Low – Intermediate Risk Patients With Acute Coronary Syndrome Taking Clopidogrel After Percutaneous Coronary Intervention

• Published in: Heart, lung & circulation lung & circulation, 2017-01, Vol.26 (1), p.49-57
• Main Authors: Jin, Lijun, MD, Yu, Huimin, MD, PhD, Dong, Taiming, MD, Zhang, Bin, MD, Yan, Hong, MD, Liao, Hongtao, MD, Zou, Xia, MSPH
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - therapy; Adenosine Diphosphate - pharmacology; Aged; Cardiovascular; Clopidogrel; Female; Follow-Up Studies; Haemorrhage; Hemorrhage - blood; Hemorrhage - diagnosis; Hemorrhage - etiology; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Percutaneous Coronary Intervention - adverse effects; Platelet aggregation; Platelet Aggregation - drug effects; Prognosis; Risk Factors; Ticlopidine - administration & dosage; Ticlopidine - analogs & derivatives
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2016.05.113

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 24 h 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