TY - JOUR
T1 - Adenosine diphosphate-induced platelet-fibrin clot strength
T2 - A new thrombelastographic indicator of long-term poststenting ischemic events
AU - Gurbel, Paul A.
AU - Bliden, Kevin P.
AU - Navickas, Irene A.
AU - Mahla, Elizabeth
AU - Dichiara, Joseph
AU - Suarez, Thomas A.
AU - Antonino, Mark J.
AU - Tantry, Udaya S.
AU - Cohen, Eli
N1 - Funding Information:
The study was supported by Sinai Hospital of Baltimore and National Institutes of Health grant R44-HL059753 .
PY - 2010/8
Y1 - 2010/8
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ahj.2010.05.034
DO - 10.1016/j.ahj.2010.05.034
M3 - Article
C2 - 20691842
AN - SCOPUS:77955447165
SN - 0002-8703
VL - 160
SP - 346
EP - 354
JO - American heart journal
JF - American heart journal
IS - 2
ER -