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Platelet reactivity in MitraClip patients
Amin Polzin1, Shazia Afzal1, Jan Balzer1
1Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany.
Vascular Pharmacology
|August 5, 2015
Summary
High on-treatment platelet reactivity (HTPR) to clopidogrel is common in MitraClip patients, yet ischemic events remain rare. Bleeding complications were more frequent, suggesting a need for optimized antithrombotic strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- MitraClip procedures carry risks of bleeding and ischemic events.
- Optimal antiplatelet strategies are unclear, especially with concurrent oral anticoagulation.
- Patient response to antiplatelet drugs varies significantly.
Purpose of the Study:
- To determine the incidence of high- and low on-treatment platelet reactivity (HTPR, LTPR) in MitraClip patients.
- To investigate the occurrence of clinical complications during the follow-up period.
Main Methods:
- Observational single-center cohort study of 73 MitraClip patients.
- Assessed clopidogrel effects using vasodilator-stimulated protein phosphorylation (VASP) assay.
- Measured aspirin effects via light-transmission aggregometry (LTA).
Main Results:
- High on-treatment platelet reactivity (HTPR) to clopidogrel was observed in 60% of patients (44/73).
- 16 patients (22%) showed HTPR to aspirin; 6 (8%) had LTPR to clopidogrel.
- 12 patients experienced major complications, 27 had bleeding, and 2 had ischemic events.
Conclusions:
- The high incidence of HTPR to clopidogrel suggests suboptimal antiplatelet effects in MitraClip patients.
- Despite HTPR, ischemic events were infrequent, but bleeding complications were common.
- Further large-scale trials are needed to define optimal antithrombotic regimens for these patients.
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