1. High on-treatment platelet reactivity to both aspirin and clopidogrel is associated with the highest risk of adverse events following percutaneous coronary intervention
- Author
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Jochem W. van Werkum, Jurriën M. ten Berg, Ankie M. Harmsze, Johannes C. Kelder, Christian M. Hackeng, Nicoline J. Breet, and Heleen J. Bouman
- Subjects
Male ,medicine.medical_specialty ,Ticlopidine ,Platelet Aggregation ,medicine.medical_treatment ,Myocardial Infarction ,Kaplan-Meier Estimate ,P2Y12 ,Risk Factors ,Internal medicine ,Angioplasty ,medicine ,Clinical endpoint ,Humans ,Platelet ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Aged ,Aspirin ,business.industry ,Graft Occlusion, Vascular ,Percutaneous coronary intervention ,Thrombosis ,Middle Aged ,Atherosclerosis ,medicine.disease ,Clopidogrel ,Stroke ,Treatment Outcome ,Cardiology ,Drug Therapy, Combination ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Aim High on-clopidogrel platelet reactivity (HCPR) and high on-aspirin platelet reactivity (HAPR) are associated with atherothrombotic events following coronary stenting. There are, however, few data concerning high on-treatment platelet reactivity to both aspirin and clopidogrel simultaneously. The aim of the present study was to determine the incidence of dual high on-treatment platelet reactivity (DAPR) and its impact on clinical outcome. Methods On-treatment platelet reactivity was measured in parallel by ADP- and arachidonic acid-induced light transmittance aggregometry (LTA) (n¼921) and the point-of-care VerifyNow system (P2Y12 and aspirin) (n¼422) in patients on dual antiplatelet therapy undergoing elective stent implantation. HCPR and HAPR were established by receiver-operator characteristic curve analysis. The primary endpoint was a composite of all-cause death, non-fatal acute myocardial infarction, stent thrombosis and ischaemic stroke at 1-year follow-up. Results The incidence of DAPR varied between 14.7% and 26.9% depending on the platelet function test used. DAPR, assessed by LTA and the VerifyNow system, was highly associated with an adverse clinical outcome. At 1-year follow-up the primary endpoint occurred more frequently in patients with isolated HCPR (11.7%), isolated HAPR (9.6%) or DAPR (10.7%) compared with patients without high on-treatment platelet reactivity (4.2%, all p
- Published
- 2011
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