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Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy

Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients on oral anticoagulants (OAC) remains a clinical conundrum. In fact, combining an OAC with dual antiplatelet therapy (triple antithrombotic therapy, TAT) increases the risk of bleeding. Clopidogrel is the only t...

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Autores principales: Gruttemeier, Julia, Cottin, Yves, Yao, Hermann, De Maistre, Emmanuel, Maza, Maud, Bonello, Laurent, Laine, Marc, Resseguier, Noemie, Zeller, Marianne, Camoin-Jau, Laurence, Paganelli, Franck
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068113/
https://www.ncbi.nlm.nih.gov/pubmed/33917717
http://dx.doi.org/10.3390/jcm10081565
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author Gruttemeier, Julia
Cottin, Yves
Yao, Hermann
De Maistre, Emmanuel
Maza, Maud
Bonello, Laurent
Laine, Marc
Resseguier, Noemie
Zeller, Marianne
Camoin-Jau, Laurence
Paganelli, Franck
author_facet Gruttemeier, Julia
Cottin, Yves
Yao, Hermann
De Maistre, Emmanuel
Maza, Maud
Bonello, Laurent
Laine, Marc
Resseguier, Noemie
Zeller, Marianne
Camoin-Jau, Laurence
Paganelli, Franck
author_sort Gruttemeier, Julia
collection PubMed
description Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients on oral anticoagulants (OAC) remains a clinical conundrum. In fact, combining an OAC with dual antiplatelet therapy (triple antithrombotic therapy, TAT) increases the risk of bleeding. Clopidogrel is the only thienopyridine recommended in TAT patients. Whether its response plays a relevant role in this setting remains uncertain. We aimed to evaluate the level of platelet reactivity inhibition (PRI) achieved by oral TAT in Acute Coronary Syndrome (ACS) patients undergoing PCI and its relationship with outcomes. We performed a multicenter prospective observational study and assessed PRI by vasodilator-stimulated phosphoprotein (VASP) index following a loading dose of clopidogrel. The primary endpoint was the incidence of major adverse cerebral or cardiovascular events (MACCE) at six months based on High on Treatment Platelet Reactivity (HTPR, VASP > 50%). The secondary endpoint was the incidence of bleeding at six months based on Low on Treatment Platelet Reactivity (LTPR, VASP < 16%). 491 patients were followed up for six months: 7.7% experienced MACCE and 17.3% experienced bleeding. There was no significant relationship between HTPR and MACCE, neither between LTPR and bleeding. Vitamin-K antagonist (VKA) treatment was associated with more MACCE and bleeding events, and the majority of events occurred within the first months. VASP index failed to predict outcomes in post-ACS patients with TAT. We confirm that direct acting OAC should be prioritized over VKA in TAT regimen.
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spelling pubmed-80681132021-04-25 Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy Gruttemeier, Julia Cottin, Yves Yao, Hermann De Maistre, Emmanuel Maza, Maud Bonello, Laurent Laine, Marc Resseguier, Noemie Zeller, Marianne Camoin-Jau, Laurence Paganelli, Franck J Clin Med Article Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients on oral anticoagulants (OAC) remains a clinical conundrum. In fact, combining an OAC with dual antiplatelet therapy (triple antithrombotic therapy, TAT) increases the risk of bleeding. Clopidogrel is the only thienopyridine recommended in TAT patients. Whether its response plays a relevant role in this setting remains uncertain. We aimed to evaluate the level of platelet reactivity inhibition (PRI) achieved by oral TAT in Acute Coronary Syndrome (ACS) patients undergoing PCI and its relationship with outcomes. We performed a multicenter prospective observational study and assessed PRI by vasodilator-stimulated phosphoprotein (VASP) index following a loading dose of clopidogrel. The primary endpoint was the incidence of major adverse cerebral or cardiovascular events (MACCE) at six months based on High on Treatment Platelet Reactivity (HTPR, VASP > 50%). The secondary endpoint was the incidence of bleeding at six months based on Low on Treatment Platelet Reactivity (LTPR, VASP < 16%). 491 patients were followed up for six months: 7.7% experienced MACCE and 17.3% experienced bleeding. There was no significant relationship between HTPR and MACCE, neither between LTPR and bleeding. Vitamin-K antagonist (VKA) treatment was associated with more MACCE and bleeding events, and the majority of events occurred within the first months. VASP index failed to predict outcomes in post-ACS patients with TAT. We confirm that direct acting OAC should be prioritized over VKA in TAT regimen. MDPI 2021-04-08 /pmc/articles/PMC8068113/ /pubmed/33917717 http://dx.doi.org/10.3390/jcm10081565 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gruttemeier, Julia
Cottin, Yves
Yao, Hermann
De Maistre, Emmanuel
Maza, Maud
Bonello, Laurent
Laine, Marc
Resseguier, Noemie
Zeller, Marianne
Camoin-Jau, Laurence
Paganelli, Franck
Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy
title Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy
title_full Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy
title_fullStr Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy
title_full_unstemmed Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy
title_short Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy
title_sort impact of platelet reactivity in acs patients on clinical outcomes with triple antithrombotic therapy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068113/
https://www.ncbi.nlm.nih.gov/pubmed/33917717
http://dx.doi.org/10.3390/jcm10081565
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