Related Experiment Video
Updated: Aug 6, 2026
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Prognostic Implications of High Platelet Reactivity According to DAPT Score After Drug-eluting Stent Implantation:
Seong Huan Choi1, Ki-Jeung Lee1, Ji-Hun Jang1
1Inha University Hospital, Inha University College of Medicine, Incheon, South Korea.
Insights
High platelet reactivity (HPR) increases cardiovascular risk after stenting, regardless of DAPT score. However, HPR only elevates bleeding risk in patients with a high DAPT score (≥2).
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Balancing ischemic and bleeding risks is critical for patients on dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI).
- High platelet reactivity (HPR) is a known risk factor, but its interaction with risk stratification scores like the DAPT score requires further investigation.
Purpose of the Study:
- To investigate the prognostic impact of high platelet reactivity (HPR) on clinical outcomes.
- To evaluate HPR in relation to the DAPT score strata (≥2 vs <2) after drug-eluting stent implantation.
Main Methods:
- Analysis of 11,714 patients from the PTRG-DES registry who underwent PCI and platelet function testing (VerifyNow assay).
- Patients stratified by DAPT score (≥2 vs <2); HPR defined as Platelet Reactivity Units (PRU) ≥ 252.
- Primary endpoint: major adverse cardiovascular and cerebrovascular events (MACCE); Secondary endpoints: ischemic events and major bleeding.
Main Results:
- HPR was independently associated with higher MACCE risk in both DAPT score groups (≥2 and <2).
- HPR increased all-cause mortality irrespective of DAPT score.
- Major bleeding risk associated with HPR was observed only in the DAPT score ≥2 group (p-interaction=0.03).
Conclusions:
- HPR identifies residual ischemic risk beyond DAPT score stratification.
- In patients with a DAPT score <2, HPR is associated with increased ischemic risk but not bleeding risk.
- This suggests a potential for tailored antiplatelet strategies based on HPR and DAPT score.
Abstract:
Balancing ischemic and bleeding risk remains challenging in patients receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. We investigated the prognostic impact of high platelet reactivity (HPR) according to DAPT score strata after drug-eluting stent implantation. We analyzed 11,714 patients from the nationwide multicenter PTRG-DES registry who underwent PCI and platelet function testing using the VerifyNow assay. Patients were stratified according to DAPT score (≥2 vs <2). HPR was defined as PRU ≥ 252. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), defined as all-cause mortality, myocardial infarction, stent thrombosis, or stroke. Secondary endpoints included individual ischemic outcomes and major bleeding. During a mean follow-up of 1,147 days, HPR was independently associated with higher risk of MACCE in both DAPT ≥ 2 (adjusted HR 1.34, 95% CI 1.04 to 1.75) and DAPT < 2 groups (adjusted HR 1.31, 95% CI 1.09 to 1.59). HPR was also associated with increased all-cause mortality irrespective of DAPT score. However, HPR was associated with major bleeding only in patients with DAPT ≥ 2, but not in those with DAPT < 2. A significant interaction between HPR and DAPT score strata was observed for major bleeding (p for interaction = 0.03), but not for ischemic outcomes. HPR identified residual ischemic risk beyond conventional DAPT score stratification, without increased bleeding risk among patients with DAPT score <2.
