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Low On-Treatment Platelet Reactivity Predicts Long-Term Risk of Bleeding After Elective PCI
Mirko D Čolić1, Branko M Čalija1, Bratislav M Milosavljević1
1Dedinje Cardiovascular Institute, Belgrade, Serbia.
Insights
Enhanced platelet responsiveness to adenosine diphosphate (ADP) predicts bleeding events after percutaneous coronary interventions (PCI). Lower ADP-induced platelet aggregation after PCI is linked to increased bleeding risk, highlighting its predictive value.
Area of Science:
- Cardiology
- Hematology
- Interventional Cardiology
Background:
- Bleeding is a significant complication following percutaneous coronary interventions (PCI).
- This complication negatively impacts patient prognosis.
- Understanding predictors of bleeding is crucial for patient management.
Purpose of the Study:
- To assess the predictive capability of platelet responsiveness to dual antiplatelet therapy (aspirin and clopidogrel) for bleeding events.
- To identify key factors associated with bleeding post-elective PCI.
Main Methods:
- Multiple electrode aggregometry (MAE) was used to measure platelet function (ASPI and ADP).
- Tests were conducted before and 24 hours after PCI in 481 patients.
- Patients were followed for an average of 15.34 months, monitoring bleeding (BARC classification) and ischemic events.
Main Results:
- The incidence of any bleeding, BARC ≤2, and BARC ≥3 bleeding was 19%, 18%, and 1%, respectively.
- Lower MAE ADP test values 24 hours post-PCI were associated with increased bleeding (any and BARC ≤2).
- Independent predictors for bleeding included female gender, prior myocardial infarction, lower body mass, and MAE ADP test results.
Conclusions:
- The MAE ADP test, performed before and after PCI, is a valuable predictor of bleeding events.
- Enhanced platelet responsiveness to ADP is associated with a higher risk of bleeding after elective PCI.
- These findings can aid in risk stratification and personalized antiplatelet therapy management.
Background:
Bleeding after percutaneous coronary interventions (PCI) is an important complication with impact on prognosis.
Aim:
To evaluate the predictive value of enhanced platelet responsiveness to dual antiplatelet therapy with aspirin and clopidogrel, for bleeding, after elective PCI.
Methods And Results:
We performed multiple electrode aggregometry (MAE) platelet functional tests induced by arachidonic acid (ASPI) and adenosine-diphosphate (ADP) before PCI, and 24 hours after PCI, in 481 elective PCI patients who were followed-up for an average of 15.34 ± 7.19 months. Primary end point was the occurrence of any bleeding, while ischemic major adverse cardiovascular event (MACE) was a secondary endpoint. The incidence of total, BARC ≤ 2, and BARC ≥ 3 bleeding, according to BARC classification, was 19, 18, and 1%, respectively. Groups with any, and BARC ≤ 2 bleeding, had a lower average value of MAE ADP test after 24 hours, compared to the group without bleeding: 45.30 ± 18.63 U versus 50.99 ± 19.01 U; P = 0.005; and 45.75 ± 18.96 U versus 50.99 ± 18.99 U; P = 0.01; respectively. Female gender (HR 2.11; CI 1.37-3.25; P = 0.001), previous myocardial infarction (HR 0.56; CI 0.37-0.85; P = 0.006), lower body mass (HR 0.78; CI 0.62-0.98; P = 0.03), and MAE ADP test after 24 hours (HR 0.75; CI 0.61-0.93; P = 0.009) were the independent predictors for any bleeding by Cox univariate analysis. After adjustment, MAE ADP test after 24 hours, was the only independent predictor for any (HR 0.7; CI 0.56-0.87; P = 0.002), and BARC ≤ 2 (HR 0.71; CI 0.56-0.89; P = 0.003) bleeding, by Cox multivariate analysis.
Conclusion:
MAE ADP test before and after PCI, was associated with any, and BARC ≤ 2 bleeding after elective PCI.
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