Monitoring of antiplatelet therapy with the PFA-100® in peripheral angioplasty patients

Ziegler, Sophie; Maca, Thomas; Alt, Elisabeth; Speiser, Wolfgang; Minar, Erich

doi:10.1080/0953710021000057866

Cited by 64 publications

(46 citation statements)

References 19 publications

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“…Additionally, the multivariate analyses support HSPA as an independent predictor of mortality rather than being merely a proxy for other risk factors. Recent findings in acute cardiac patients [10][11][12][13] and those with peripheral arterial occlusive disease [14] report that short CADP and/or short CEPI CT are associated with increased risk for recurrent and early in-hospital vascular events. However, our work shows that this concept of HSPA encompasses a much broader population of patients by the inclusion of those with stable cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

Hypersensitivity of platelets to adenosine diphosphate in patients with stable cardiovascular disease predicts major adverse events despite antiplatelet therapy

Christie¹,

Kottke‐Marchant

Gorman³

2008

Platelets

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Enhanced platelet activity correlates with early markers of myocardial damage in patients with cardiovascular disease. However, the extent to which enhanced platelet function signals subsequent adverse clinical outcomes in patients with cardiovascular disease is unknown. Blood from patients with stable cardiovascular disease receiving aspirin (325 mg/day) as the only antiplatelet therapy was tested for closure time (CT) with the Dade PFA-100 Platelet Function Analyzer system collagen/adenosine diphosphate (ADP) [CADP] cartridge and platelet aggregometry using 10 microM ADP. This study intentionally focused on those patients defined as aspirin sensitive by previously established criteria of arachidonic acid- and ADP-induced platelet aggregometry, and separately by collagen/epinephrine (CEPI) CT using the PFA-100. Follow up averaged 22 months for the adverse clinical events of death, myocardial infarction or cerebrovascular accident. For aspirin sensitivity determined by aggregometry, patients with CADP CT < 90 seconds (125/296 = 42.2%) had a composite endpoint rate of 19.2% (24/125), while those with CADP CT 90 seconds (171/296 = 57.8%) had an endpoint rate of 5.3% (9/171). Patients with CADP CT <90 seconds had a relative risk (RR) of 3.65 (95% CI.: 1.76-7.57) for recurrent events and 6.56 (95% CI.: 1.93-22.35) for death compared to patients with CADP CT 90s. Nearly identical results were obtained when patients were categorized as aspirin sensitive by CEPI CT. Platelet aggregometry with 10 microM ADP yielded no significant RR for the selected outcomes. Platelet function testing using the PFA-100 system appears to identify a subgroup of stable cardiovascular disease patients with increased risk of major adverse events that is associated with hypersensitivity to ADP, regardless of apparently effective aspirin therapy.

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Section: Discussionmentioning

confidence: 99%

Hypersensitivity of platelets to adenosine diphosphate in patients with stable cardiovascular disease predicts major adverse events despite antiplatelet therapy

Christie¹,

Kottke‐Marchant

Gorman³

2008

Platelets

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“…2 Significant variability in platelet function has also been demonstrated in aspirintreated patients in multiple clinical settings including healthy individuals, 41 with risk factors, 39,40 and patients with coronary, 10-33 peripheral vascular 37,38 or cerebrovascular disease. [3][4][5][6] Unfortunately, due to lack of a consensus definition and universally accepted diagnostic criteria, the term aspirin resistance has been used in miscellaneous clinical studies with diverse patient populations, different aspirin regimens, and different assays for assessment of the effect.…”

Section: Mechanisms For Aspirin Resistancementioning

confidence: 99%

Current evidence and clinical implications of aspirin resistance

Kasotakis

Pipinos

Lynch

2009

Journal of Vascular Surgery

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Atherothrombosis, characterized by atherosclerotic plaque rupture and subsequent occlusive or subocclusive thrombus formation is the primary cause of acute ischemic syndromes involving all vascular beds and accounts for more than one-third of all deaths in the developed world. Platelet activation and aggregation constitute the most critical component in the pathophysiology of atherothrombotic disease. Aspirin is currently the most commonly used antiplatelet agent and one of the most frequently prescribed drugs, with as many as 30 million Americans on chronic aspirin regimens. Multiple well-designed prospective randomized clinical trials have demonstrated aspirin's efficacy in both primary and secondary prevention of a wide variety of entities that the atherothrombotic disease spectrum encompasses, such as cerebrovascular, coronary artery, and peripheral vascular disease. Despite its proven benefit, however, a growing body of evidence suggests that up to 70% of aspirin-takers may still be at risk for atherothrombotic complications due to resistance. Patients with laboratory-confirmed aspirin resistance seem to have an almost fourfold increase in their risk for acute thrombotic episodes, which underlines the magnitude of the problem for the vascular specialist. In this article, we review the physiology of platelet activation and the role of aspirin as an antiplatelet agent; the various laboratory assays used in assessing aspirin effectiveness; and current data on aspirin resistance and its clinical implications in patients with cardiovascular disease. We also review the studies that explore this phenomenon in patients with peripheral arterial disease and discuss the optimal management options in aspirin-resistant individuals. Suggestions are advanced for the direction of future trials evaluating aspirin resistance in patients with vascular disease.

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“…The PFA-100 measures the time needed for a platelet plug to form after activation of platelets by pathophysiologically relevant stimuli (eg, collagen and adenosine diphosphate [CADP] or collagen and epinephrine [CEPI]), which is prognostic in peripheral arterial occlusive disease. 22 The CADP cartridge was used as the primary outcome variable. because unlike the CEPI closure time (CT), its value is typically not confounded by aspirin intake.…”

Section: Platelet Function Analyzer-100mentioning

confidence: 99%

Platelet Function Predicts Myocardial Damage in Patients With Acute Myocardial Infarction

et al. 2004

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Background-Platelet activation is a hallmark of acute coronary syndromes. Numerous lines of evidence suggest a mechanistic link between von Willebrand factor or platelet hyperfunction and myocardial damage in patients with acute coronary syndromes. Thus, we assessed whether platelet function under high shear rates (collagen adenosine diphosphate closure times [CADP-CTs]) measured with the platelet function analyzer (PFA-100) may be enhanced in patients with myocardial infarction (MI) and whether it may predict the extent of myocardial damage as measured by creatine kinase (CK-MB) or troponin T (TnT) levels. Methods and Results-Patients with acute chest pain or symptoms suggestive of acute coronary syndromes (nϭ216) were prospectively examined at an emergency department. CADP-CT was significantly shorter in patients with MI, particularly in those with an ST-segment-elevation MI (STEMI) compared with the other patient groups (unstable angina, stable coronary artery disease, or controls). Furthermore, CADP-CT and collagen epinephrine-CT at presentation were independent predictors of myocardial damage as measured by CK-MB or TnT. Patients with MI whose CADP-CT values fell in the first quartile had 3-fold higher CK-MB and TnT levels than those in the fourth quartile. Conclusions-Patients with STEMI have significantly enhanced platelet function when measured under high shear rates.CADP-CT is an independent predictor of the severity of MI, as measured by markers of cardiac necrosis. Measurement of platelet function with the PFA-100 may help in the risk stratification of patients presenting with MI. (Circulation.

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Monitoring of antiplatelet therapy with the PFA-100® in peripheral angioplasty patients

Abstract: PFA-100, upon stimulation with ADP, might predict patients under clopidogrel therapy with elevated risk for the development of complications following PTA of the lower limbs. This could offer the chance to switch to an alternative therapy or adapt the dose.

Cited by 64 publications

References 19 publications

Hypersensitivity of platelets to adenosine diphosphate in patients with stable cardiovascular disease predicts major adverse events despite antiplatelet therapy

Hypersensitivity of platelets to adenosine diphosphate in patients with stable cardiovascular disease predicts major adverse events despite antiplatelet therapy

Current evidence and clinical implications of aspirin resistance

Platelet Function Predicts Myocardial Damage in Patients With Acute Myocardial Infarction

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