Correlation of inhibition of platelet aggregation after clopidogrel with post discharge bleeding events: assessment by different bleeding classifications

Abstract

Chronic oral combination antiplatelet regimens are associated with a very high (56.5-60.7%) prevalence of superficial bleeding episodes, which are grossly underestimated in trials and registries. The role of such frequent mild complications for the overall benefit of antiplatelet therapy is entirely unknown, as is their effect on compliance. Although IPA is well suited for defining the risk of minor complications, prediction of more severe bleeding events may be challenging.

Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: A retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial

“…Although greater platelet inhibition was associated with higher bleeding risk, the relationship between level of platelet inhibition and bleeding risk is not straightforward, 15,20 and it has not been established how to estimate risk of major bleeding by level of platelet inhibition. 15,20,21 As shown with race, increased drug exposure of ticagrelor has been reported for elderly patients and female patients in clinical pharmacology studies. 11 However, risk of PLATO major bleeding has not been significantly different according to gender and age in comparisons of ticagrelor and clopidogrel.…”

Prospective Evaluation of On-Clopidogrel Platelet Reactivity Over Time in Patients Treated With Percutaneous Coronary Intervention

“…On-clopidogrel PR at 1 month is the strongest predictor of adverse outcomes, and this can be predicted by combining genotype to baseline phenotype and clinical variables. (J Am Coll Cardiol 2011;57:2474-83) © 2011 by the American College of Cardiology Foundation Oral P2Y 12 inhibitors are a crucial pharmacologic tool in modern cardiovascular practice. Response to clopidogrel varies widely among patients, and those with a high residual on-clopidogrel platelet reactivity (PR) undergoing percutaneous coronary intervention (PCI) are at a greater risk for death, myocardial infarction, and stent thrombosis (1)(2)(3)(4)(5).…”

“…Our primary analysis compared the incidence of clopidogrel poor responders at baseline versus 1 month. Secondary assessments include: 1) incidence of clopidogrel poor responders at 1 month versus 6 months; 2) rate of death, myocardial infarction, and stroke; 3) occurrence of definite and probable stent thrombosis according to the Academic Research Consortium classification; 4) rate of bleedings according to TIMI (Thrombolysis In Myocardial Infarction) classification and BleedScore (12). Myocardial infarction is defined as the recurrence of ischemic symptoms and an elevation of creatine kinasemyocardial band Ն3ϫ upper limit of normal.…”

Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis – Translation From Basic Science to Clinical Medicine –

“…16,24,91,105-107 There still is ongoing discussion on how can we modify the P2Y12 receptor by drug intervention to achieve the best balance between antithrombotic effects and increased risk of serious bleeding. [107][108][109] New P2Y12 inhibitors (prasugrel and ticagrelor 38-40 ) were developed recently. Appropriate selection of the most suitable drug for a suitable patient population is an ongoing discussion.…”