Cargando…
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...
Autores principales: | , , , , , , , , , , |
---|---|
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 |
_version_ | 1783682959627255808 |
---|---|
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. |
format | Online Article Text |
id | pubmed-8068113 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT gruttemeierjulia impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy AT cottinyves impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy AT yaohermann impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy AT demaistreemmanuel impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy AT mazamaud impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy AT bonellolaurent impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy AT lainemarc impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy AT resseguiernoemie impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy AT zellermarianne impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy AT camoinjaulaurence impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy AT paganellifranck impactofplateletreactivityinacspatientsonclinicaloutcomeswithtripleantithrombotictherapy |