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Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
High platelet reactivity is associated with vascular function in patients after percutaneous coronary intervention
Gerasimos Siasos1, Evangelos Oikonomou2, Marina Zaromitidou2
11st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece; Department of Biological Chemistry, University of Athens Medical School, Athens, Greece.
Insights
High platelet reactivity in patients post-percutaneous coronary intervention on clopidogrel is linked to stiffer arteries and worse cardiovascular outcomes. This highlights the importance of monitoring individual platelet response to antiplatelet therapy.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Trials
Background:
- Assessing the relationship between platelet reactivity and vascular function in patients undergoing percutaneous coronary intervention (PCI) is crucial for optimizing antiplatelet therapy.
- Clopidogrel is a commonly prescribed antiplatelet medication, but individual responses can vary, leading to high on-treatment platelet reactivity (HPR).
Purpose of the Study:
- To investigate the association between high on-treatment platelet reactivity (HPR) and vascular function, specifically aortic stiffness and arterial wave reflections, in patients treated with clopidogrel after PCI.
- To determine if HPR is a predictor of adverse cardiovascular outcomes in this patient population.
Main Methods:
- A prospective study of 150 patients with stable coronary artery disease (CAD) receiving clopidogrel (75 mg/d) one month post-PCI.
- Vascular function was assessed using carotid-femoral pulse wave velocity (PWV) for aortic stiffness and augmentation index (AIx) for arterial wave reflections.
- High on-treatment platelet reactivity (HPR) was determined using the VerifyNow Assay, with a cutoff of 230 P2Y12 reaction units (PRU).
- Patients were followed for up to 24 months for a composite primary endpoint of cardiovascular death, major cardiovascular events, or cardiovascular hospitalizations.
Main Results:
- Patients with HPR (PRU > 230) exhibited significantly increased PWV (8.81 ± 2.25 m/s vs. 7.69 ± 1.95 m/s, p=0.001) and AIx (25.27 ± 8.67% vs. 20.87 ± 10.57%, p=0.04) compared to those with lower reactivity.
- Platelet reactivity, measured by PRU, showed a positive correlation with PWV (r=0.23, p=0.02).
- HPR was significantly associated with an increased risk of the primary endpoint (Hazard Ratio = 5.38, 95% CI: 1.15-26.04, p=0.03).
Conclusions:
- Elevated platelet reactivity is linked to impaired arterial stiffness in patients on clopidogrel post-PCI.
- HPR represents a significant clinical factor associated with adverse cardiovascular outcomes in patients undergoing PCI and treated with clopidogrel.
- These findings underscore the clinical relevance of monitoring individual platelet response to antiplatelet therapy.
Background:
In the present study, we evaluated the association of platelet reactivity with vascular function in patients after percutaneous coronary intervention receiving clopidogrel treatment.
Methods:
We enrolled 150 patients with stable CAD receiving clopidogrel regimen (75 mg/d), 1 month after percutaneous coronary intervention. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as an index of arterial wave reflections. High on treatment platelet reactivity (HPR) was evaluated using VerifyNow Assay. VerifyNow reports its results in P2Y12 reaction units (PRU), and the diagnostic cutoff value is 230 PRU. Patients were evaluated prospectively up to 24 months. The primary end point was a composite of death from cardiovascular causes, nonfatal major cardiovascular events and hospitalization for cardiovascular causes.
Results:
There was no difference in the basic clinical and demographic characteristics between subjects with HPR and non-HPR. Subjects with high on treatment platelet reactivity and PRU>230 had significantly increased PWV (8.81 ± 2.25 m/s vs. 7.69 ± 1.95 m/s, p = 0.001) and AIx (25.27 ± 8.67% vs. 20.87 ± 10.57%, p = 0.04) compared to subjects with PRU≤230. PWV was also associated with PRU (r = 0.23, p = 0.02). HPR was associated with significantly increased risk of primary end point [HR = 5.38, 95%CI:(1.15, 26.04), p = 0.03].
Conclusions:
Increased platelet reactivity is associated with impaired arterial stiffness in patients after percutaneous coronary intervention receiving clopidogrel treatment, highlighting another clinical factor implicated in individual platelet response to antiplatelet therapy. Moreover, increased platelet reactivity is associated with adverse outcome in these patients.
