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

被引:3
作者
Gruttemeier, Julia [1 ]
Cottin, Yves [1 ]
Yao, Hermann [1 ]
De Maistre, Emmanuel [2 ]
Maza, Maud [1 ]
Bonello, Laurent [3 ]
Laine, Marc [3 ]
Resseguier, Noemie [4 ]
Zeller, Marianne [5 ]
Camoin-Jau, Laurence [6 ]
Paganelli, Franck [3 ]
机构
[1] CHU Dijon Bourgogne, Dept Cardiol, F-21000 Dijon, France
[2] CHU Dijon Bourgogne, Dept Biol Haematol, F-21000 Dijon, France
[3] Aix Marseille Univ, Sch Med, ARCHANTEC, Dept Cardiol, F-13007 Marseille, France
[4] Aix Marseille Univ, Publ Hlth Chron Dis & Qual Life Res Unit, F-13007 Marseille, France
[5] Univ Burgundy Franche Comte, Dept Hlth Sci, Team PEC2, EA 7460, F-21000 Dijon, France
[6] Timone Hosp, AP HM, Dept Biol Haematol, F-13007 Marseille, France
关键词
acute coronary syndrome; triple antithrombotic therapy; VASP index; platelet reactivity; clopidogrel; PERCUTANEOUS CORONARY INTERVENTION; ATRIAL-FIBRILLATION PATIENTS; TISSUE-PLASMINOGEN ACTIVATOR; MYOCARDIAL-INFARCTION; ORAL ANTICOAGULATION; STENT THROMBOSIS; CLOPIDOGREL; RISK; DETERMINANTS; METAANALYSIS;
D O I
10.3390/jcm10081565
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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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页数:15
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