Influence of platelet reactivity on BARC classification in East Asian patients undergoing percutaneous coronary intervention: Results of the ACCEL-BLEED study

Tae Jung Kwon, Udaya S. Tantry, Yongwhi Park, Young Min Choi, Jong Hwa Ahn, Kye Hwan Kim, Jin Sin Koh, Jeong Rang Park, Seok Jae Hwang, Choong Hwan Kwak, Jin Yong Hwang, Paul A. Gurbel, Sidney C. Smith, Young Hoon Jeong

Research output: Contribution to journalArticlepeer-review

Abstract

An increasing body of data suggests that East Asian patients have differing risk profiles for both thrombophilia and bleeding compared with Western population. This study was designed to evaluate the relationship of bleeding to platelet function in East Asians undergoing percutaneous coronary intervention (PCI). Patients who had undergone uneventful PCI (n= 301) were prospectively enrolled and bleeding events were evaluated during dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. Platelet function was measured during hospitalisation and at 30-day follow-up by light transmittance aggregometry (LTA) and vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) assay. During 30-day follow-up, 29.2 % of patients (n= 88) experienced post-discharge Bleeding Academic Research Consortium (BARC) complications (24.6 % and 7.0 % of BARC type 1 and 2, respectively). Patients presenting with acute myocardial infarction had fewer episodes of type 1 BARC bleeding (odds ratio: 0.41; 95 % confidence interval: 0.22 to 0.76; p= 0.005). The cut-off of low platelet reactivity (LPR) (20 μM ADP-induced platelet aggregation ≤ 46.1 %; platelet reactivity index ≤ 45.1 %) was the independent determinant of type 2 BARC bleeding (odds ratio: 3.55 and 4.44; p= 0.009 and 0.002, respectively). The first 30-day BARC bleeding episodes were associated with an increased rate of subsequent premature DAPT discontinuation during one-year follow-up (4.7 % vs 11.4 %; odds ratio: 2.60; 95 % confidence interval: 1.04 to 6.50; p= 0.035). In conclusion, among East Asians, mild bleeding episodes are common early after PCI and are associated with premature DAPT discontinuation. Type 2 BARC bleeding episodes are associated with LPR cut-offs measured at 30 days post-discharge.

Original languageEnglish (US)
Pages (from-to)979-992
Number of pages14
JournalThrombosis and Haemostasis
Volume115
Issue number5
DOIs
StatePublished - May 2016

Keywords

  • Asia
  • Bleeding
  • Clopidogrel
  • Genotype
  • Phenotype

ASJC Scopus subject areas

  • Hematology

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