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Updated: Oct 16, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
An optimal window of platelet reactivity by LTA assay for patients undergoing percutaneous coronary intervention
Jing Wang1,2, Jing Wang1, Zhou Dong1
1Departments of Cardiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
Insights
Optimizing dual antiplatelet therapy with aspirin and clopidogrel after PCI is key. An adenosine diphosphate (ADP) induced platelet aggregation window of 25.5-37.4% predicts fewer ischemic and bleeding events.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is standard after percutaneous coronary intervention (PCI).
- Platelet reactivity (PR) varies significantly among patients on DAPT.
- Predicting ischemic and bleeding events based on PR is crucial for optimizing patient outcomes.
Purpose of the Study:
- To determine the predictive value of platelet reactivity (PR) on DAPT for ischemic and bleeding events in patients undergoing PCI.
- To identify an optimal therapeutic window for PR to minimize net adverse clinical events (NACE).
Main Methods:
- A cohort of 1885 patients receiving aspirin and clopidogrel post-PCI were enrolled and followed for 12 months.
- Platelet aggregation was measured using the LTA assay, specifically adenosine diphosphate (ADP) induced platelet aggregation (PLADP).
- Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for PR.
Main Results:
- Optimal cut-off values for predicting ischemic and bleeding events were identified as 37.5% and 25.5% for PLADP, respectively.
- Patients were categorized into an 'inside the window' (IW) group (PLADP 25.5-37.4%) and an 'outside the window' (OW) group.
- The incidence of NACE was significantly lower in the IW group (16.8%) compared to the OW group (23.1%), with a hazard ratio of 0.69 (P=0.004).
Conclusions:
- An optimal therapeutic window for adenosine diphosphate (ADP) induced platelet aggregation (PLADP) of 25.5-37.4% is associated with the lowest risk of net adverse clinical events (NACE).
- This therapeutic window can guide tailored antiplatelet treatment strategies using LTA assays in patients post-PCI.
- Monitoring PR can help personalize DAPT to balance efficacy and safety, reducing ischemic and bleeding complications.
Objective:
This study was aimed to determine how platelet reactivity (PR) on dual antiplatelet therapy predicts ischemic and bleeding events in patients underwent percutaneous coronary intervention (PCI).
Design:
A total of 2768 patients who had received coronary stent implantation and had taken aspirin 100 mg in combination with clopidogrel 75 mg daily for > 5 days were consecutively screened and 1885 were enrolled. The recruited patients were followed-up for 12 months. The primary end-point was the net adverse clinical events (NACE) of cardiovascular death, nonfatal myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST) and any bleeding.
Result:
1709 patients completed the clinical follow-up. By using the receiver operating characteristic (ROC) curve analysis, the optimal cut-off values were found to be 37.5 and 25.5% respectively in predicting ischemic and bleeding events. Patients were classified into 2 groups according to PR: inside the window group (IW) [adenosine diphosphate (ADP) induced platelet aggregation (PLADP) 25.5-37.4%)] and outside the window group (OW) (PLADP < 25.5% or ≥ 37.5%). The incidence of NACE was 16.8 and 23.1% respectively in the IW and OW group. The hazard ratio of NACE in IW group was significantly lower [0.69 (95% CI, 0.54-0.89, P = 0.004)] than that in the OW group during 12-month follow-up.
Conclusion:
An optimal therapeutic window of 25.5-37.4% for PLADP predicts the lowest risk of NACE, which could be referred for tailored antiplatelet treatment while using LTA assay.
Trial Registration:
Trial registration number: ClinicalTrials.gov NCT01968499 . Registered 18 October 2013 - Retrospectively registered.
