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Updated: Aug 14, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
High-on-treatment platelet reactivity predicts adverse outcome after carotid artery stenting: A prospective study
G Simonte1, G Guglielmini2, E Falcinelli2
1Unit of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy.
Insights
High-on-treatment platelet reactivity (HTPR) after carotid artery stenting (CAS) predicts major adverse cardiovascular events (MACE). Testing HTPR using multiple assays can identify patients at higher risk for vascular events following CAS.
Area of Science:
- Cardiology
- Vascular Surgery
- Clinical Pharmacology
Background:
- High-on-treatment platelet reactivity (HTPR) is a known predictor of adverse cardiovascular events in patients undergoing percutaneous coronary interventions.
- The predictive value of HTPR in patients on dual antiplatelet therapy (DAPT) after carotid artery stenting (CAS) remains largely uninvestigated.
Purpose of the Study:
- To evaluate the association between HTPR in patients on aspirin plus clopidogrel therapy after CAS and subsequent major adverse cardiovascular events (MACE).
Main Methods:
- A prospective study enrolled consecutive patients undergoing CAS.
- High-on-treatment platelet reactivity (HTPR) was assessed using five laboratory assays prior to CAS.
- Major adverse cardiovascular events (MACE) incidence was monitored at 30 days and annually thereafter.
Main Results:
- Of 300 patients, 47 MACE occurred during a median follow-up of 5.8 years.
- HTPR detected by multiplate electronic aggregometry (MEA) and VASP phosphorylation assay (VASP) were associated with increased MACE risk.
- HTPR assessed by three assays (HTPR3) demonstrated a stronger predictive value for vascular events (p=0.002).
Conclusions:
- High-on-treatment platelet reactivity (HTPR) assessed by multiple assays predicts subsequent MACE in patients on DAPT after CAS.
- Further prospective studies are warranted to determine if platelet function testing-guided therapy improves outcomes compared to standard DAPT in CAS patients.
Background And Purpose:
High-on-treatment platelet reactivity (HTPR) has been established as a predictor of major adverse cardiovascular events (MACE) in patients undergoing percutaneous coronary interventions on dual antiplatelet therapy (DAPT), but no data are available on its predictive value in patients on DAPT after carotid artery stenting (CAS). We aimed to evaluate the possible association between HTPR in patients on aspirin plus clopidogrel therapy after CAS and subsequent MACE.
Methods:
All consecutive patients treated with CAS in a single institution were enrolled in a prospective clinical study. HTPR was evaluated with 5 different laboratory assays carried out just before CAS. MACE incidence (cerebral ischemia, myocardial infarction, stent thrombosis, acute limb ischemia and vascular death) was evaluated at 30 days and thereafter at yearly visits.
Results:
A total of 300 patients were enrolled in the study, and eight were then excluded because blood samples resulted unsuitable for the laboratory testing or CAS aborted for technical problems. Median follow-up was 5.8 years and during this period 47 MACE occurred. HTPR detected by multiplate electronic aggregometry (MEA) and the VASP phosphorylation assay (VASP) were associated with a significantly enhanced risk of MACE (p = 0.048 and p = 0.038, respectively). However, HTPR to three tests (HTPR3) was more strongly predictive of increased risk of a vascular event at follow up (p = 0.005) at bivariate analysis and also at Cox regression multivariate analysis (p = 0.002).
Conclusions:
HTPR to three different assays (mainly to VASP + PFA P2Y+ VerifyNow) in patients on DAPT after CAS has predictive value for subsequent MACE. Prospective studies to assess whether platelet function testing-guided antiplatelet therapy is superior to standard DAPT in patient undergoing CAS should be considered.
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