Background: Poststenting ischemic events occur despite dual-antiplatelet therapy, suggesting that a "one size fits all" antithrombotic strategy has significant limitations. Ex vivo platelet function measurements may facilitate risk stratification and personalized antiplatelet therapy. Methods: We investigated the prognostic utility of the strength of adenosine diphosphate (ADP)-induced (MAADP) and thrombin-induced (MATHROMBIN) platelet-fibrin clots measured by thrombelastography and ADP-induced light transmittance aggregation (LTAADP) in 225 serial patients after elective stenting treated with aspirin and clopidogrel. Ischemic and bleeding events were assessed over 3 years. Results: Overall, 59 (26%) first ischemic events occurred. Patients with ischemic events had higher MAADP, MATHROMBIN, and LTAADP (P < .0001 for all comparisons). By receiver operating characteristic curve analysis, MAADP >47 mm had the best predictive value of long-term ischemic events compared with other measurements (P < .0001), with an area under the curve = 0.84 (95% CI 0.78-0.89, P < .0001). The univariate Cox proportional hazards model identified MAADP >47 mm, MATHROMBIN >69 mm, and LTAADP >34% as significant independent predictors of first ischemic events at the 3-year time point, with hazard ratios of 10.3 (P < .0001), 3.8 (P < .0001), and 4.8 (P < .0001), respectively. Fifteen bleeding events occurred. Receiver operating characteristic curve and quartile analysis suggests MAADP ≤31 as a predictive value for bleeding. Conclusion: This study is the first demonstration of the prognostic utility of MAADP in predicting long-term event occurrence after stenting. The quantitative assessment of ADP-stimulated platelet-fibrin clot strength measured by thrombelastography can serve as a future tool in investigations of personalized antiplatelet treatment designed to reduce ischemic events and bleeding.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine