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Efficacy of Ex Vivo Autologous and In Vivo Platelet Transfusion in the Reversal of P2Y 12 Inhibition by Clopidogrel, Prasugrel, and Ticagrelor
- Source :
- Circulation: Cardiovascular Interventions. 8
- Publication Year :
- 2015
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2015.
-
Abstract
- Background— Allogenic platelet transfusions (PT) are administered to treat excessive bleeding in patients on P2Y 12 receptor inhibitors (RI). We assessed the effect of ex vivo and in vivo PT on platelet activation and aggregation in patients on dual antiplatelet therapy. Methods and Results— In the Antagonize P2Y 12 Treatment Inhibitors by Transfusion of Platelets in an Urgent or Delayed Timing After Acute Coronary Syndrome or Percutaneous Coronary Intervention Presentation-Acute Coronary Syndrome (APTITUDE-ACS) study, patients presenting with acute coronary syndrome or for elective percutaneous coronary intervention, receiving loading doses of clopidogrel (600 mg, n=13 or 900 mg, n=12), prasugrel 60 mg (n=10), or ticagrelor 180 mg (n=10) were included. PT was performed ex vivo by mixing platelet-rich plasma from blood sampling performed at baseline in increasing proportions with platelet-rich plasma sampled 4 hours after loading dose. The percentage restoration of residual platelet aggregation achieved with 80% proportion PT (residual platelet aggregation 80% PT mix/residual platelet aggregation baseline×100) significantly decreased with increasing potency of P2Y 12 RI (83.9±11%, 73±14%, 66.3±15%, 40.9±19% for clopidogrel 600 mg, clopidogrel 900 mg, prasugrel, and ticagrelor, respectively; P for trend 12 RI drug–effect, was assessed before and after in vivo PT administered for excessive bleeding in patients undergoing cardiac surgery while on a maintenance dose of aspirin and clopidogrel (n=45), prasugrel (n=6), or ticagrelor (n=3). When compared with baseline, there was a significant relative increase of 23.1% in platelet activation after PT transfusion (42.2±23.6% versus 56.6±18.2%; P =0.0008). Conclusions— PT restores platelet reactivity in patients with acute coronary syndrome/percutaneous coronary intervention and in patients undergoing cardiac surgery on P2Y 12 RI while bleeding with a less effect with increasing potency of P2Y 12 inhibition. Clinical Trial Registration— URL: http://www.recherche-biomedicale.sante.gouv.fr/pro/comites/coordonnees.htm and http://www.cnil.fr/ . Unique identifiers: No. 301111 and No. 1547216v0.
- Subjects :
- Male
Ticagrelor
medicine.medical_specialty
Adenosine
Ticlopidine
Prasugrel
Platelet Aggregation
Platelet Function Tests
Urology
Platelet Transfusion
Postoperative Hemorrhage
Percutaneous Coronary Intervention
medicine
Humans
Transplantation, Homologous
Platelet activation
Acute Coronary Syndrome
Aged
Prasugrel Hydrochloride
business.industry
Middle Aged
Clopidogrel
Treatment Outcome
Platelet transfusion
Anesthesia
Purinergic P2Y Receptor Antagonists
Platelet aggregation inhibitor
Female
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 19417632 and 19417640
- Volume :
- 8
- Database :
- OpenAIRE
- Journal :
- Circulation: Cardiovascular Interventions
- Accession number :
- edsair.doi.dedup.....3fb0e19a1ad25cd19161519a9f572f35