Predictive Values of Post-Treatment Adenosine Diphosphate–Induced Aggregation and Vasodilator-Stimulated Phosphoprotein Index for Stent Thrombosis After Acute Coronary Syndrome in Clopidogrel-Treated Patients

Cuisset, Thomas; Frère, Corinne; Quilici, Jacques; Gaborit, Bénédicte; Castelli, Christel; Poyet, Raphaël; Bali, Laurent; Morange, Pierre‐Emmanuel; Alessi, Marie‐Christine; Bonnet, Jean‐Louis

doi:10.1016/j.amjcard.2009.06.007

Cited by 64 publications

(41 citation statements)

References 22 publications

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“…The relative risk for MACE in patients without HTPR was 89% lower compared to patients with HTPR. It has previously been proven that the PRI is not influenced by GP-IIb/ IIIa-inhibitors (17) and, moreover, the VASP-P assay has previously been shown to predict MACE including stent thrombosis (11,21,(40)(41)(42). However, knowledge of the predictive value of the VASP-P assay in high-risk STEMI patients is missing except for one recent publication which outlined that the VASP-P assay might be helpful in predicting cardiovascular death above a cut-off of PRI=61% in unselected patients (43).…”

Section: Discussionmentioning

confidence: 99%

Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events

Freynhofer¹,

Brozovic²,

Bruno³

et al. 2011

Thromb Haemost

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SummaryReduced antiplatelet effect of clopidogrel assessed with multiple electrode aggregometry (MEA) and vasodilator stimulated phosphoprotein-phosphorylation (VASP-P) assay has been proven to predict major adverse cardiovascular events (MACE) after coronary stenting. So far no consecutive registry has evaluated the usefulness of different adenosine diphosphate-based platelet function tests to predict outcome in unselected patients. Hence, our objective was to determine the feasibility of MEA and VASP-P for clinical routine and whether low-response to clopidogrel as determined by MEA and/or the VASP-P assays predicts MACE in a "real-life" population undergoing coronary stenting. Threehundred consecutive patients were included in this prospective registry. Blood was sampled 6-24 hours after stenting to measure MEA and VASP-P. The use of glycoprotein-IIb/IIIa-blockers limited MEA to 196 measurements. Concerning the VASP-P assay, 300 measurements were achieved. Receiver Operating Characteristics (ROC)-curves of sensitiv- ity and specificity estimates for MACE were plotted for VASP-P assay. The area under the ROC-curve was 0.683 (p=0.014) for the platelet reactivity index (PRI) calculated from median fluorescence intensities (FI) with an optimal cut-off at 60.2% PRI. Patients above 60.2% had a significantly increased risk for MACE at six months follow-up (p=0.007). Estimating the cut-offs for the PRI from mean FI (52%) or from geometric mean FI (56.6%) led to clinically relevant differences. VASP-P assay is feasible for clinical routine to measure clopidogrel effects and to predict post-procedural MACE in unselected patients. With regard to differing cut-offs, exact standardisation of the VASP-P assay is mandatory. The use of GP-IIb/IIIa-blockers prevents MEA testing and limits its usability in unselected patients.

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Section: Discussionmentioning

confidence: 99%

Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events

Freynhofer¹,

Brozovic²,

Bruno³

et al. 2011

Thromb Haemost

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“…The efficacy and safety results of TRITON-TIMI 38 and the PRASFIT studies should be discussed in the context of the therapeutic window of antiplatelet activity. This concept implies that the risk of thrombotic events is increased in patients with high on-treatment platelet reactivity (i.e., low platelet inhibition), and that the risk of bleeding is increased in patients with low on-treatment platelet reactivity (i.e., high platelet inhibition) [26][27][28][29].…”

Section: Risk Of Bleeding In the Prasfit Studiesmentioning

confidence: 99%

Risk of bleeding and repeated bleeding events in prasugrel-treated patients: a review of data from the Japanese PRASFIT studies

Nishikawa

Isshiki

Kimura

et al. 2017

Cardiovasc Interv and Ther

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Prasugrel is a third-generation thienopyridine that achieves potent platelet inhibition with less pharmacological variability than other thienopyridines. However, clinical experience suggests that prasugrel may be associated with a higher risk of de novo and recurrent bleeding events compared with clopidogrel in Japanese patients undergoing percutaneous coronary intervention (PCI). In this review, we evaluate the risk of bleeding in Japanese patients treated with prasugrel at the doses (loading/maintenance doses: 20/3.75 mg) adjusted for Japanese patients, evaluate the risk factors for bleeding in Japanese patients, and examine whether patients with a bleeding event are at increased risk of recurrent bleeding. This review covers published data and new analyses of the PRASFIT (PRASugrel compared with clopidogrel For Japanese patIenTs) trials of patients undergoing PCI for acute coronary syndrome or elective reasons. The bleeding risk with prasugrel was similar to that observed with the standard dose of clopidogrel (300/75 mg), including when bleeding events were re-classified using the Bleeding Academic Research Consortium criteria. The pharmacodynamics of prasugrel was not associated with the risk of bleeding events. The main risk factors for bleeding events were female sex, low body weight, advanced age, and presence of diabetes mellitus. Use of a radial puncture site was associated with a lower risk of bleeding during PCI than a femoral puncture site. Finally, the frequency and severity of recurrent bleeding events during continued treatment were similar between prasugrel and clopidogrel. In summary, this review provides important insights into the risk and types of bleeding events in prasugrel-treated patients.

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“…There are no other studies that would assess the myocardial injury in relation to type of antiplatelet drug used. However there is evidence that higher platelet reactivity during PCI is related to periprocedural myonecrosis [17] and worse prognosis [18][19][20][21][22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A pilot study: ONSIDE TEST pilot

et al. 2017

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Predictive Values of Post-Treatment Adenosine Diphosphate–Induced Aggregation and Vasodilator-Stimulated Phosphoprotein Index for Stent Thrombosis After Acute Coronary Syndrome in Clopidogrel-Treated Patients

Cited by 64 publications

References 22 publications

Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events

Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events

Risk of bleeding and repeated bleeding events in prasugrel-treated patients: a review of data from the Japanese PRASFIT studies

Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A pilot study: ONSIDE TEST pilot

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