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Platelet aggregation and the risk of stent thrombosis or bleeding in elective percutaneous coronary intervention
Krzysztof Kukula1, Mariusz Klopotowski, Pawel Kunicki
1aDepartment of Interventional Cardiology and Angiology bClinical Pharmacology Unit, Department of Clinical Biochemistry, Institute of Cardiology, Warsaw cDepartment of Public Health, Medical University of Bialystok, Bialystok, Poland.
Insights
Monitoring platelet aggregation with Multiplate testing helps predict risks after stent implantation. Impaired response to clopidogrel and aspirin increases stent thrombosis, cardiac death, and bleeding events.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Platelet aggregation monitoring is crucial for preventing stent thrombosis and bleeding post-implantation.
- Assessing patient response to antiplatelet medications like clopidogrel and aspirin is vital for personalized treatment.
Purpose of the Study:
- To evaluate if clopidogrel (ADPtest) and aspirin (ASPItest) response, measured by the Multiplate analyzer, predicts stent thrombosis, ischemic events, and bleeding in patients undergoing elective percutaneous coronary intervention.
- To identify prognostic factors for stent thrombosis, cardiac death, and bleeding complications.
Main Methods:
- Prospective observational study involving 697 patients undergoing elective percutaneous coronary intervention.
- Measurement of adenosine diphosphate (ADP)-dependent and aspirin-induced platelet aggregation using the Multiplate analyzer.
- Cox regression analysis to determine prognostic factors for adverse cardiovascular and bleeding events at 1-year follow-up.
Main Results:
- Higher ASPItest results (>203 AU·min) and ADPtest results (≥468 AU·min) were significantly associated with increased risk of stent thrombosis and cardiac death.
- Low ADPtest results (≤188 AU·min) predicted major and moderate bleeding events (GUSTO scale).
- A trend towards increased bleeding was observed with very low ASPItest results (<35 AU·min). Lower creatinine clearance and hemoglobin levels correlated with both ischemic and bleeding complications.
Conclusions:
- Impaired platelet response to clopidogrel and aspirin, as measured by the Multiplate analyzer, is linked to a higher risk of stent thrombosis and cardiac death.
- Elevated platelet response to clopidogrel is associated with an increased risk of major and moderate bleeding events.
- Multiplate testing can aid in risk stratification and personalized antiplatelet therapy management in patients post-stent implantation.
Abstract:
: Platelet aggregation monitoring in patients after stent implantation is a promising way of preventing stent thrombosis and bleeding. The aim of the study was to verify whether clopidogrel (ADPtest) and aspirin (ASPItest) response measured by Multiplate (Dynabyte, Munich, Germany) analyzer in elective percutaneous coronary implantation patients predict the risk of stent thrombosis or other ischemic adverse events and bleeding. In this prospective, observational study 697 elective percutaneous coronary implantation patients were analyzed. The median ASPItest was 86 AU min. In 69 patients (9.9%), an ASPI result of more than 203 AU min was observed. The median ADP-dependent platelet aggregation was 212 AU min. In 36 (5.2%) patients, the result was at least 468 AU min. Cox regression analysis showed the prognostic factors of definite or probable stent thrombosis and cardiac death at 1 year were higher ASPItest result [odds ratio (OR) 1.006, 95% confidence interval (CI) 1.004-1.008, P < 0.001], ASPItest more than 203 AU min (OR 7.61, 95% CI 2.83-20.43, P < 0.001), higher ADPtest result (OR 1.005, 95% CI 1.003-1.007, P < 0.001) and ADPtest at least 468 AU min (OR 12.54, 95% CI 4.56-35.53, P < 0.001). In turn, ADPtest 188 AU min or less predicted GUSTO scale major and moderate bleeding (OR 4.15, 95% CI 1.12-15.32, P = 0.033). There was also a strong trend toward higher rate of major and moderate bleeding for the ASPItest less than 35 AU min (lowest quintile) - (OR 3.04, 95% CI 0.96-9.58, P = 0.058). Lower creatinine clearance and lower hemoglobin level were associated with both ischemic and bleeding complications. The results of this study show that impaired platelet response to clopidogrel and aspirin measured by the Multiplate analyzer results in increased risk of stent thrombosis and cardiac death. Furthermore, the study showed that increased response to clopidogrel is related to major and moderate bleeding events.
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