Comparison of Platelet Function Tests in Predicting Clinical Outcome in Patients Undergoing Coronary Stent Implantation

Abstract

Context High on-treatment platelet reactivity is associated with atherothrombotic events following coronary stent implantation. Objective To evaluate the capability of multiple platelet function tests to predict clinical outcome. Design, Setting, and Patients Prospective, observational, single-center cohort study of 1069 consecutive patients taking clopidogrel undergoing elective coronary stent implantation between December 2005 and December 2007. On-treatment platelet reactivity was measured in parallel by light transmittance aggregometry, VerifyNow P2Y12 and Plateletworks assays, and the IMPACT-R and the platelet function analysis system (PFA-100) (with the Dade PFA collagen/adenosine diphosphate [ADP] cartridge and Innovance PFA P2Y). Cut-off values for high on-treatment platelet reactivity were established by receiver operating characteristic curve analysis.Main Outcome Measurement The primary end point was defined as a composite of all-cause death, nonfatal acute myocardial infarction, stent thrombosis, and ischemic stroke. The primary safety end point included TIMI (Thrombolysis In Myocardial Infarction) criteria major and minor bleeding.Results At 1-year follow-up, the primary end point occurred more frequently in patients with high on-treatment platelet reactivity when assessed by light transmittance aggregometry (11.

Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy

“…In patients with ACS or undergoing PCI, HRPR is associated with ≈2‐ to 3‐fold greater risk of recurrent ischemic events and about 1.5‐fold greater risk of all‐cause mortality 27, 28, 29. In particular, this study shows a broad variability platelet function profiles in patients receiving clopidogrel, and OSA is associated with reduced clopidogrel‐induced antiplatelet effects and a greater likelihood of having HRPR.…”

Comparison of Antiplatelet Effect and Tolerability of Clopidogrel Resinate With Clopidogrel Bisulfate in Patients With Coronary Heart Disease (CHD) or CHD-Equivalent Risks: A Phase IV, Prospective, Double-Dummy, Parallel-Group, 4-Week Noninferiority Trial

“…[27][28][29][30] The degree of platelet inhibition assessed by the VerifyNow assay has been associated with hard clinical end points, including cardiac death, myocardial infarction, and ischemic stroke, and it has been suggested as a surrogate marker reflecting the efficacy of antiplatelet agents. [31][32][33] We enrolled patients with proven CHD or CHDequivalent risks according to National Cholesterol Education Program/Adult Treatment Panel III guidelines. 15 These patients have a high risk of cardiovascular events (Ͼ20% in 10 years) and in clinical practice are considered an important target group of antiplatelet therapy for the prevention of atherothrombotic events.…”

Impact of CYP2C19 Polymorphism on Platelet Function Tests and Coagulation and Inflammatory Biomarkers in Patients Undergoing Percutaneous Coronary Intervention

“…Based on the clinical outcomes of patients with ACS undergoing PCI, recent studies have advocated the use of careful monitoring of the on-clopidogrel PA level using various platelet function assays 15,16) . In a previous study, we also demonstrated the efficacy of on-clopidogrel PA monitoring by showing the cutoff level of on-clopidogrel PA that can be used to discriminate carriers of the functional CYP2C19 reducedfunction allele among patients with stable coronary artery disease (CAD) treated with clopidogrel 17) .…”