The Prognostic Value of ADP-Induced Platelet Aggregation for Bleeding Complications in Low - Intermediate Risk Patients with Acute Coronary Syndrome Taking Clopidogrel After Percutaneous Coronary Intervention

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• 作者：Lijun Jin ; MD^a ; ^{lijun_jin2000@126.com} ; Huimin Yu ; MD ; PhD^a ; Taiming Dong ; MD^a ; Bin Zhang ; MD^a ; Hong Yan ; MD^a ; Hongtao Liao ; MD^a ; Xia Zou ; MSPH^b
• 关键词：Platelet aggregation ; Haemorrhage ; Clopidogrel ; Percutaneous Coronary Intervention
• 刊名：Heart, Lung and Circulation
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：26
• 期：1
• 页码：49-57
• 全文大小：752 K
• 卷排序：26

文摘

Platelet aggregation may predict the bleeding outcomes after percutaneous coronary intervention (PCI).MethodsConsecutive patients with non-high risk acute coronary syndrome and indication for PCI were enrolled. Maximum adenosine diphosphate-induced platelet aggregation (ADP-PGmax) was assessed by light transmission aggregometry. Study endpoints were the incidence of haemorrhage, categorised by Thrombolysis in Myocardial Infarction criteria, and significant entry-site complications during hospitalisation and six-month follow-up period. Platelet aggregation test was organised at 24 h after PCI and 1 month after discharge respectively. The optimal platelet aggregation was detected defining enhanced clopidogrel response, and associations of measurements with endpoints were assessed.ResultsA total of 278 patients were included in analyses. Study endpoints were observed in 24 (8.6%) patients [major bleeding, n = 4 (1.4%); minor bleeding, n = 11 (4.0%); significant entry-site complication, n = 9 (3.2%)]. In multivariate analysis, follow-up ADP-PGmax[odds ratio (OR) = 0.96;95% confidence interval (CI),0.93–0.99;p = 0.008) and renal insufficiency (OR = 3.29; 95%CI, 1.23–8.85; p = 0.018) were predictors of bleeding events. The optimal cutoff value for follow-up ADP-PGmax was 24.5% (area under the curve = 0.72; 95% CI, 0.59–0.85; p<0.001). Bleeding occurred in 26.2% (16/61) of patients with enhanced clopidogrel response and 3.7% (8/217) of other patients (OR=9.26; p<0.001).ConclusionEnhanced clopidogrel responsiveness was associated with an increased risk of bleeding and entry-site complication. Platelet function testing at an appropriate time after clopidogrel administration helps to identify patients at high risk of bleeding.