Elevated Plasma Fibrinogen Rather Than Residual Platelet Reactivity After Clopidogrel Pre-Treatment Is Associated With an Increased Ischemic Risk During Elective Percutaneous Coronary Intervention

We showed herein by measurements of citrated whole blood samples from surgical patients that CFF MA values were different from FIBTEM MCF values measured in the same sample. Awareness that these whole blood assays provide different clot amplitude results is mandatory, particularly if they are being considered as tools for guiding fibrinogen supplementation. Thromboembolic side effects caused by a potentially too high fibrinogen substitution must also kept in mind in this context.

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“…Our concern is supported by the association observed between high fibrinogen levels and myocardial infarction [25] or stroke [11].…”

Section: Introductionmentioning

confidence: 63%

Comparison of functional fibrinogen (FF/CFF) and FIBTEM in surgical patients – a retrospective study

Prüller¹,

Münch

Preininger

et al. 2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…This analysis revealed that at least 69 outcome events were needed 1. Collection of study data from eligible subjects was continued until 69 MACE events were recorded at 6 months, then enrollees had both 6‐month and 2‐year MACE events identified.…”

Section: Methodsmentioning

confidence: 99%

“…Previously, it has been identified as a risk factor for both short‐ and long‐term adverse cardiovascular events 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. More recently, elevated baseline fibrinogen level has been reported to be associated with higher on‐thienopyridine platelet reactivity, periprocedural myocardial infarction (MI), and combined MACE within 12 months of the index PCI 1, 2, 3, 15. The present study was performed to determine whether a longer term adverse relationship between baseline serum fibrinogen level, on‐thienopyridine platelet reactivity, and ischemic cardiovascular events exists in patients undergoing PCI for both elective or acute coronary syndrome (ACS) indications.…”

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confidence: 99%

Elevated Baseline Serum Fibrinogen: Effect on 2‐Year Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention

Ang

Behnamfar

Palakodeti

et al. 2017

JAHA

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BackgroundElevated fibrinogen is associated with short‐term major adverse cardiovascular events (MACE) after percutaneous coronary intervention, but the relation with late MACE is unknown.Methods and ResultsBaseline demographics and 2‐year MACE were recorded among subjects undergoing nonemergent percutaneous coronary intervention. A total of 332 subjects (66.6±19.5 years, 69.9% male, 25.3% acute coronary syndrome) were enrolled. Two‐year MACE (periprocedural myocardial infarction 9.0%, rehospitalization 6.3%, revascularization 12.7%, non–periprocedural myocardial infarction 4.5%, stent thrombosis 0.9%, stroke 1.8%, and death 0.6%) were associated with higher fibrinogen (352.8±123.4 mg/dL versus 301.6±110.8 mg/dL; P<0.001), longer total stent length (40.1±25.3 mm versus 32.1±19.3 mm; P=0.004), acute coronary syndrome indication (38.7% versus 17.8%; P<0.001), number of bare‐metal stents (0.5±1.1 versus 0.2±0.5; P=0.002), and stent diameter ≤2.5 mm (55.8% versus 38.4%, P=0.003). No relation between platelet reactivity and 2‐year MACE was observed. Fibrinogen ≥280 mg/dL (odds ratio [OR] 3.0, confidence interval [CI], 1.6–5.4, P<0.001), total stent length ≥32 mm (OR 2.2, CI, 1.3–3.8, P<0.001), acute coronary syndrome indication (OR 4.1, CI, 2.3–7.5, P<0.001), any bare‐metal stents (OR 3.2, CI, 1.6–6.1, P<0.001), and stent diameter ≤2.5 mm (OR 2.0, CI, 1.2–3.5, P=0.010) were independently associated with 2‐year MACE. Following a landmark analysis excluding periprocedural myocardial infarction, fibrinogen ≥280 mg/dL remained strongly associated with 2‐year MACE (37.0% versus 17.4%, log‐rank P<0.001).ConclusionsElevated baseline fibrinogen level is associated with 2‐year MACE after percutaneous coronary intervention. Acute coronary syndrome indication for percutaneous coronary intervention, total stent length implanted, and use of bare‐metal stents or smaller‐diameter stents are also independently associated with 2‐year MACE, while measures of on‐thienopyridine platelet reactivity are not.

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“…Elevated fibrinogen levels have been prognostically associated with cardiovascular events after acute coronary syndrome and percutaneous coronary intervention. 11 The study by Kim et al extends those previous observation to offpump CABG, indicating that the prognostic benefit of being he package insert for clopidogrel recommends withholding the drug at least 5 days prior to any elective surgery, including coronary artery bypass grafting (CABG). Indeed, bleeding varied markedly compared with placebo in patients undergoing CABG in the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial according to whether clopidogrel was stopped for ≤5 days or >5 days before surgery.…”

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confidence: 82%

Preoperative Fibrinogen and Morbidity in Patients With Residual Platelet Inhibition Undergoing Off-Pump Coronary Artery Bypass Grafting

Capodanno

2014

Circ J

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Elevated Plasma Fibrinogen Rather Than Residual Platelet Reactivity After Clopidogrel Pre-Treatment Is Associated With an Increased Ischemic Risk During Elective Percutaneous Coronary Intervention

Abstract: Elevated fibrinogen is independently associated with the risk of ischemic myocardial injury following elective PCI with clopidogrel pre-treatment regardless of platelet reactivity as measured by the VerifyNow assay.

Cited by 31 publications

References 33 publications

Comparison of functional fibrinogen (FF/CFF) and FIBTEM in surgical patients – a retrospective study

Comparison of functional fibrinogen (FF/CFF) and FIBTEM in surgical patients – a retrospective study

Elevated Baseline Serum Fibrinogen: Effect on 2‐Year Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention

Preoperative Fibrinogen and Morbidity in Patients With Residual Platelet Inhibition Undergoing Off-Pump Coronary Artery Bypass Grafting

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