The first six-month clinical outcomes and risk factors associated with high on-treatment platelet reactivity of clopidogrel in patients undergoing coronary interventions

Abstract

Objective:This study attempted to fill the gaps in evidence related to response to clopidogrel treatment in the Turkish population. The study aimed to determine the prevalence, associated risk factors, and clinical outcomes of high on-treatment platelet reactivity (HTPR) of clopidogrel in patients undergoing percutaneous coronary intervention (PCI) in a tertiary cardiovascular hospital in Turkey.Methods:In this prospective studied a total of 1.238 patients undergoing PCI were included in the present study. Blood samples were analyzed using a Multiplate analyzer. All patients were examined in the outpatient clinics at the end of the first and sixth months for recording drug therapy compliance and study endpoints.Results:Among the study population, 324 (30.2%) patients were found to have HTPR (mean age 58.03±11.88 years, 71.7% men). The incidence of HTPR was higher amongst females than amongst males (38.3% vs. 27%, p=0.010). Hypertension and diabetes mellitus were more frequently observed in the HTPR group (57.7% vs. 48.7%, p=0.004; 35% vs. 29.1%, p=0.040, respectively). When the recorded data were analyzed using multinomial regression analysis, hypertension, hemoglobin level, platelet, lymphocyte, and eosinophil count were independently associated with HTPR.Conclusion:On the basis of the results obtained from our study, we conclude that 30.2% of the Turkish population has HTPR. Our results also led us to believe that hypertension is an associated risk factor and decreased hemoglobin level as well as increased platelet counts are laboratory parameters that are strongly associated with the presence of HTPR. However, no differences were observed with regard to cardiovascular mortality and stent thrombosis. (Anatol J Cardiol 2016; 16: 967-73)

Factors related to on-treatment platelet aggregation assessed by multiple electrode aggregometry in percutaneous coronary intervention patients on clopidogrel and aspirin

“…Some authors have found no association between gender and antiplatelet drug response [ 39 ], while others reported greater prevalence of HPR in women [ 40 ]. Similarly, our finding that hypertension increased the odds of HPR may be confirmed in the literature [ 30 , 41 ], but one may also find evidence to testify otherwise [ 42 ]. In our study we did not find a relation of renal function to HPR or HAR, similarly to some authors [ 43 ], yet unlike other data, including our earlier study in a different cohort [ 44 – 47 ], possibly due to a low percentage of patients with significantly impaired renal function (eGFR below 30 ml/min/1.73 m 2 ).…”

Increased risk of adverse events in patients with low-on clopidogrel platelet reactivity after percutaneous coronary intervention: A systematic review and meta-analysis

“…Residual PR, as an independent risk factor also has several associations with patient characteristics and these may also influence the expressed risk. HPR is more frequently encountered in obese and diabetics, while LPR may more likely arise in patients with advanced age and lower body weight [ 40 , 41 ]. A significant association of LPR was revealed with lower body mass index in the current analysis.…”

Comparison of 7-Year, Real-World Clinical Outcomes between Drug-Coated Balloon Angioplasty versus Drug-Eluting Stent Implantation in Patients with Drug-Eluting Stent In-Stent Restenosis

“…In addition, aside from the stent-related and lesion-related factors, various elements related to medical therapy are also likely to have an impact. These factors include early dual anti-platelet therapy (DAPT) disruption, acute coronary syndrome (ACS) presentation, and high on-treatment platelet reactivity [ 16 , 17 ].…”