Advanced age and high‐residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor

Verdoia, Monica; Pergolini, Patrizia; Rolla, Roberta; Nardin, Matteo; Schaffer, Alon; Barbieri, Lucia; Marino, Paolo; Bellomo, Giorgio; Suryapranata, Harry; Luca, Giuseppe De

doi:10.1111/jth.13177

Cited by 66 publications

(46 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This might explain why females, especially older ones, under treatment with aspirin might be at increased bleeding risk, as reported in several studies. 33,34 In opposite, younger males had less potent aspirin effect on average, which, however, was sufficient in the majority of them with only 12% HTPR. For ADP antagonists, we identified platelet count (>320 g/L) as a risk factor for higher platelet reactivity, which might be only of minor clinical importance.…”

Section: Discussionmentioning

confidence: 93%

Platelet reactivity patterns in patients treated with dual antiplatelet therapy

Winter

Schneeweiss

Cremer

et al. 2019

Eur J Clin Investigation

View full text Add to dashboard Cite

Aim The aim of the present study was to investigate the patterns of platelet reactivity and discriminators of therapeutic response to dual antiplatelet therapy (DAPT) with aspirin and ticagrelor or prasugrel in patients with acute coronary syndrome (ACS). Design In this multicentre prospective observational study, 492 patients with ACS were enrolled. Platelet aggregation was determined by multiple electrode aggregometry after stimulation with adenosine diphosphate (ADP) or arachidonic acid (AA) as agonists in the maintenance phase of treatment with prasugrel or ticagrelor. Results Age emerged as the strongest variable influencing aspirin response status: The mean AA‐induced platelet aggregation in patients <49 years of age was 49% higher than in those >49 years (13.1 U vs 8.8 U; P = 0.011). The second strongest discriminator of aspirin response was sex: Male patients had a 40% higher AA‐induced platelet aggregation values than female patients (9.5 U vs 6.8 U; P = 0.026). Platelet count emerged as the only variable influencing ADP antagonists response status showing that patients with platelet count >320 g/L displayed higher ADP‐induced platelet aggregation. About 12% of patients had high on‐treatment platelet reactivity (HTPR) to aspirin, 3% and 4% a HTPR to prasugrel and ticagrelor, respectively, and only 2% displayed HTPR to dual antiplatelet therapy. Conclusion When potent platelet inhibitors as prasugrel and ticagrelor are administered with aspirin, HTPR to DAPT plays only a marginal role.

show abstract

Section: Discussionmentioning

confidence: 93%

Platelet reactivity patterns in patients treated with dual antiplatelet therapy

Winter

Schneeweiss

Cremer

et al. 2019

Eur J Clin Investigation

View full text Add to dashboard Cite

show abstract

“…Aging has been linked to both decreasing platelet counts but also increased platelet reactivity and reduced effectiveness of adenosine diphosphate receptor (ADP) antagonists. 42,43 Taken together, these findings suggest that in the elderly, lower absolute platelet counts and platelet resistance to antiplatelet therapies may account for the higher rate of both hemorrhagic and thrombotic events. Even though patients that developed new-onset TP tended to be older than in the no-TP group in all of the studies included in the meta-analysis, the association between TP and mortality persisted after adjustment for age and several age-related comorbidities (Supplementary Table S2).…”

Section: Discussionmentioning

confidence: 95%

The effect of in-hospital acquired thrombocytopenia on the outcome of patients with acute coronary syndromes: A systematic review and meta-analysis

Oikonomou

Repanas²,

Papanastasiou

et al. 2016

Thrombosis Research

View full text Add to dashboard Cite

Background In-hospital acquired thrombocytopenia (TP) is relatively common among patients hospitalized with acute coronary syndromes (ACS). However, its effect on short-term and long-term outcomes has yet to be reviewed systematically. Methods We conducted a systematic review and meta-analysis of clinical studies assessing the relationship between new-onset in-hospital TP and adverse outcomes among ACS patients. MEDLINE, Scopus and the Cochrane Library were searched for eligible studies published before March 20 2016. Results Ten studies reporting on a total of 142,161 ACS patients were identified. 8,133 patients showed evidence of new-onset TP during the course of their hospitalization. Compared with patients with normal platelet counts, patients with new-onset TP had a prolonged in-hospital stay, significantly higher risk of both short-term mortality (<30 days) (Odds ratio (OR) [95% confidence interval (CI)]: 5.58 [3.63–8.57]) and late death (6 months to 1 year) (OR [95%CI]: 3.45 [2.35–5.07]), as well as a significantly higher risk of major bleeding events in the first 30 days (OR [95%CI]: 6.93 [5.13–9.38]). In addition, risk for other secondary cardiovascular endpoints, including recurrent myocardial infarction, stroke, in-hospital heart failure, stent thrombosis and unplanned revascularization was also significantly higher in the TP versus the no TP group. Conclusions Development of TP during the in-hospital management of ACS patients is a significant predictor of both short- and long-term adverse events, including mortality. In the light of this evidence, clinicians should be cautious and closely monitor abnormal platelet counts that present early following an ACS.

show abstract

“…Older age was independently associated with a higher rate of high residual on-treatment platelet reactivity with both clopidogrel and ticagrelor in 494 patients on dual antiplatelet therapy [77]. Additionally, obesity (BMI ≥ 30 kg/m 2 ) was independently associated with higher residual platelet reactivity in clopidogrel-treated patients [78].…”

Section: Non-genetic Factors Influencing Clopidogrel Responsementioning

confidence: 99%

Pharmacokinetic and Pharmacodynamic Responses to Clopidogrel: Evidences and Perspectives

Zhang

Tang

et al. 2017

IJERPH

View full text Add to dashboard Cite

Clopidogrel has significantly reduced the incidence of recurrent atherothrombotic events in patients with acute coronary syndrome (ACS) and in those undergoing percutaneous coronary intervention (PCI). However, recurrence events still remain, which may be partly due to inadequate platelet inhibition by standard clopidogrel therapy. Genetic polymorphisms involved in clopidogrel’s absorption, metabolism, and the P2Y12 receptor may interfere with its antiplatelet activity. Recent evidence indicated that epigenetic modification may also affect clopidogrel response. In addition, non-genetic factors such as demographics, disease complications, and drug-drug interactions can impair the antiplatelet effect of clopidogrel. The identification of factors contributing to the variation in clopidogrel response is needed to improve platelet inhibition and to reduce risk for cardiovascular events. This review encompasses the most recent updates on factors influencing pharmacokinetic and pharmacodynamic responses to clopidogrel.

show abstract

Advanced age and high‐residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor

Cited by 66 publications

References 53 publications

Platelet reactivity patterns in patients treated with dual antiplatelet therapy

Platelet reactivity patterns in patients treated with dual antiplatelet therapy

The effect of in-hospital acquired thrombocytopenia on the outcome of patients with acute coronary syndromes: A systematic review and meta-analysis

Pharmacokinetic and Pharmacodynamic Responses to Clopidogrel: Evidences and Perspectives

Contact Info

Product

Resources

About