Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy
Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients on oral anticoagulants (OAC) remains a clinical conundrum. In fact, combining an OAC with dual antiplatelet therapy (triple antithrombotic therapy, TAT) increases the risk of bleeding. Clopidogrel is the only t...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/8/1565 |
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| author | Julia Gruttemeier Yves Cottin Hermann Yao Emmanuel De Maistre Maud Maza Laurent Bonello Marc Laine Noemie Resseguier Marianne Zeller Laurence Camoin-Jau Franck Paganelli |
| author_facet | Julia Gruttemeier Yves Cottin Hermann Yao Emmanuel De Maistre Maud Maza Laurent Bonello Marc Laine Noemie Resseguier Marianne Zeller Laurence Camoin-Jau Franck Paganelli |
| author_sort | Julia Gruttemeier |
| collection | DOAJ |
| description | Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients on oral anticoagulants (OAC) remains a clinical conundrum. In fact, combining an OAC with dual antiplatelet therapy (triple antithrombotic therapy, TAT) increases the risk of bleeding. Clopidogrel is the only thienopyridine recommended in TAT patients. Whether its response plays a relevant role in this setting remains uncertain. We aimed to evaluate the level of platelet reactivity inhibition (PRI) achieved by oral TAT in Acute Coronary Syndrome (ACS) patients undergoing PCI and its relationship with outcomes. We performed a multicenter prospective observational study and assessed PRI by vasodilator-stimulated phosphoprotein (VASP) index following a loading dose of clopidogrel. The primary endpoint was the incidence of major adverse cerebral or cardiovascular events (MACCE) at six months based on High on Treatment Platelet Reactivity (HTPR, VASP > 50%). The secondary endpoint was the incidence of bleeding at six months based on Low on Treatment Platelet Reactivity (LTPR, VASP < 16%). 491 patients were followed up for six months: 7.7% experienced MACCE and 17.3% experienced bleeding. There was no significant relationship between HTPR and MACCE, neither between LTPR and bleeding. Vitamin-K antagonist (VKA) treatment was associated with more MACCE and bleeding events, and the majority of events occurred within the first months. VASP index failed to predict outcomes in post-ACS patients with TAT. We confirm that direct acting OAC should be prioritized over VKA in TAT regimen. |
| first_indexed | 2024-03-10T12:30:34Z |
| format | Article |
| id | doaj.art-17c2d898d5544f5aae629861ec9c76c4 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T12:30:34Z |
| publishDate | 2021-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-17c2d898d5544f5aae629861ec9c76c42023-11-21T14:37:47ZengMDPI AGJournal of Clinical Medicine2077-03832021-04-01108156510.3390/jcm10081565Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic TherapyJulia Gruttemeier0Yves Cottin1Hermann Yao2Emmanuel De Maistre3Maud Maza4Laurent Bonello5Marc Laine6Noemie Resseguier7Marianne Zeller8Laurence Camoin-Jau9Franck Paganelli10Department of Cardiology, CHU Dijon Bourgogne, 21000 Dijon, FranceDepartment of Cardiology, CHU Dijon Bourgogne, 21000 Dijon, FranceDepartment of Cardiology, CHU Dijon Bourgogne, 21000 Dijon, FranceDepartment of Biological Haematology, CHU Dijon Bourgogne, 21000 Dijon, FranceDepartment of Cardiology, CHU Dijon Bourgogne, 21000 Dijon, FranceDepartment of Cardiology, ARCHANTEC, School of Medicine, Aix Marseille University, 13007 Marseille, FranceDepartment of Cardiology, ARCHANTEC, School of Medicine, Aix Marseille University, 13007 Marseille, FrancePublic Health, Chronic Diseases and Quality of Life—Research Unit, Aix-Marseille University, 13007 Marseille, FranceTeam PEC2, EA 7460, Department of Health Sciences, University of Burgundy Franche Comté, 21000 Dijon, FranceDepartment of Biological Haematology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, 13007 Marseille, FranceDepartment of Cardiology, ARCHANTEC, School of Medicine, Aix Marseille University, 13007 Marseille, FranceOptimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients on oral anticoagulants (OAC) remains a clinical conundrum. In fact, combining an OAC with dual antiplatelet therapy (triple antithrombotic therapy, TAT) increases the risk of bleeding. Clopidogrel is the only thienopyridine recommended in TAT patients. Whether its response plays a relevant role in this setting remains uncertain. We aimed to evaluate the level of platelet reactivity inhibition (PRI) achieved by oral TAT in Acute Coronary Syndrome (ACS) patients undergoing PCI and its relationship with outcomes. We performed a multicenter prospective observational study and assessed PRI by vasodilator-stimulated phosphoprotein (VASP) index following a loading dose of clopidogrel. The primary endpoint was the incidence of major adverse cerebral or cardiovascular events (MACCE) at six months based on High on Treatment Platelet Reactivity (HTPR, VASP > 50%). The secondary endpoint was the incidence of bleeding at six months based on Low on Treatment Platelet Reactivity (LTPR, VASP < 16%). 491 patients were followed up for six months: 7.7% experienced MACCE and 17.3% experienced bleeding. There was no significant relationship between HTPR and MACCE, neither between LTPR and bleeding. Vitamin-K antagonist (VKA) treatment was associated with more MACCE and bleeding events, and the majority of events occurred within the first months. VASP index failed to predict outcomes in post-ACS patients with TAT. We confirm that direct acting OAC should be prioritized over VKA in TAT regimen.https://www.mdpi.com/2077-0383/10/8/1565acute coronary syndrometriple antithrombotic therapyVASP indexplatelet reactivityclopidogrel |
| spellingShingle | Julia Gruttemeier Yves Cottin Hermann Yao Emmanuel De Maistre Maud Maza Laurent Bonello Marc Laine Noemie Resseguier Marianne Zeller Laurence Camoin-Jau Franck Paganelli Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy Journal of Clinical Medicine acute coronary syndrome triple antithrombotic therapy VASP index platelet reactivity clopidogrel |
| title | Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy |
| title_full | Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy |
| title_fullStr | Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy |
| title_full_unstemmed | Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy |
| title_short | Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy |
| title_sort | impact of platelet reactivity in acs patients on clinical outcomes with triple antithrombotic therapy |
| topic | acute coronary syndrome triple antithrombotic therapy VASP index platelet reactivity clopidogrel |
| url | https://www.mdpi.com/2077-0383/10/8/1565 |
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