1. High platelet reactivity on aspirin in patients with acute ST elevation myocardial infarction.
- Author
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Dillinger JG, Saeed A, Spagnoli V, Sollier CB, Sideris G, Silberman SM, Voicu S, Drouet L, and Henry P
- Subjects
- Acute Disease, Adenosine therapeutic use, Blood Platelets pathology, Brain Ischemia etiology, Cardiovascular Diseases etiology, Clopidogrel, Female, Humans, Male, Middle Aged, Platelet Aggregation drug effects, Platelet Function Tests, Prospective Studies, ST Elevation Myocardial Infarction blood, ST Elevation Myocardial Infarction complications, ST Elevation Myocardial Infarction pathology, Survival Analysis, Ticagrelor, Ticlopidine therapeutic use, Adenosine analogs & derivatives, Aspirin therapeutic use, Blood Platelets drug effects, Platelet Aggregation Inhibitors therapeutic use, Prasugrel Hydrochloride therapeutic use, Purinergic P2Y Receptor Antagonists therapeutic use, ST Elevation Myocardial Infarction drug therapy, Ticlopidine analogs & derivatives
- Abstract
Background: Despite dual antiplatelet treatment, major ischemic events are common following ST elevation myocardial infarction (STEMI). We aimed to assess high platelet reactivity on aspirin (HPR-aspirin) and its association with P2Y12i (HPR-P2Y12i) during the acute phase of STEMI., Methods: We included all consecutive patients admitted for STEMI treated by primary angioplasty in our center for 1year. All patients received a loading dose followed by a maintenance dose of aspirin (75mg/day) and prasugrel (ticagrelor or clopidogrel if contraindicated). Platelet reactivity was assessed 4±1days and 75±15days after admission using light transmission aggregometry with arachidonic acid (LTA-AA-HPR-aspirin) and VASP (HPR-P2Y12i) to define HPR as well as serum Thromboxane-B2 and LTA-ADP. Major cardiac and cerebrovascular events were recorded for 1year., Results: We included 106 patients - mean age was 61y.o., 76% were male and 20% had diabetes. STEMI was anterior in 52% and LV ejection fraction at discharge was 51±9%. 50% of patients were treated with prasugrel and 34% with ticagrelor. At day 4 after STEMI, HPR-aspirin was found in 26% patients and HPR-P2Y12i in 7%. HPR- both aspirin and P2Y12i was found in 4%. Diabetes and age were predictors of HPR-aspirin. HPR-aspirin was persistent 75days later in 36% patients. At 1year, 7.9% patients had experienced major adverse cardiovascular and cerebrovascular events (MACCE). HPR-aspirin and HPR on both aspirin and P2Y12i were significantly associated with MACCE., Conclusion: HPR-aspirin is frequent just after STEMI and associated with MACCE especially when associated with HPR-P2Y12i., (Copyright © 2016. Published by Elsevier Ltd.)
- Published
- 2016
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