Validation of Three Platelet Function Tests for Bleeding Risk Stratification During Dual Antiplatelet Therapy Following Coronary Interventions

Moo Hyun Kim, Sun Young Choi, Soo Yeon An, Victor Serebruany

Research output: Contribution to journalArticle

Abstract

Background: Although low platelet reactivity (LPR) is commonly detected during bleeding, a validated threshold for reliable DAPT bleeding risk stratification is lacking. We tested the diagnostic utility of 3 conventional platelet-activity assays to define the predictive value (if any) of LPR for bleeding. Hypothesis: We hypothesized whether one of these tests be better than any others for predicting bleeding events. Methods: Patients (n = 800) following drug-eluting stent implantation received DAPT. Bleeding was assessed by Bleeding Academic Research Consortium (BARC) classification and events were collected for 1 year after stenting. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow, and multiple electrode aggregometry (MEA). The LPR values for bleeding event stratification were defined as ≤15% for LTA, ≤139 PRU for VerifyNow, and ≤25 U for MEA. Results: Bleeding events occurred in 18 patients (2.3%). All tests distinguished LPR as an independent predictor for bleeding by univariate analysis ([HR]: 5.00, 95% [CI]: 1.8-14.0, P = 0.002 for LTA; HR: 21.3, 95% CI: 6.2-73.0, P <0.0001 for VerifyNow; and HR: 7.4, 95% CI: 2.2-25.5, P = 0.002 for MEA). Multivariate analysis revealed that only VerifyNow (HR: 11.5, 95% CI: 2.9-45.7, P <0.0004) remained an independent predictor for bleeding. However, the specificity (81.5%, 60.2%, and 81.7%, respectively) and sensitivity (61.1%, 83.3%, and 83.2%, respectively) of all 3 tests were quite low. Conclusions: Among 3 conventional platelet-activity assays, VerifyNow was better than LTA or MEA for triaging future bleeding risks. However, all 3 tests failed to reliably predict future bleeding.

Original languageEnglish (US)
Pages (from-to)385-390
Number of pages6
JournalClinical Cardiology
Volume39
Issue number7
DOIs
StatePublished - Jul 1 2016

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Platelet Function Tests
Hemorrhage
Blood Platelets
Electrodes
Therapeutics
Light
Drug-Eluting Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Validation of Three Platelet Function Tests for Bleeding Risk Stratification During Dual Antiplatelet Therapy Following Coronary Interventions. / Kim, Moo Hyun; Choi, Sun Young; An, Soo Yeon; Serebruany, Victor.

In: Clinical Cardiology, Vol. 39, No. 7, 01.07.2016, p. 385-390.

Research output: Contribution to journalArticle

Kim, Moo Hyun ; Choi, Sun Young ; An, Soo Yeon ; Serebruany, Victor. / Validation of Three Platelet Function Tests for Bleeding Risk Stratification During Dual Antiplatelet Therapy Following Coronary Interventions. In: Clinical Cardiology. 2016 ; Vol. 39, No. 7. pp. 385-390.
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title = "Validation of Three Platelet Function Tests for Bleeding Risk Stratification During Dual Antiplatelet Therapy Following Coronary Interventions",
abstract = "Background: Although low platelet reactivity (LPR) is commonly detected during bleeding, a validated threshold for reliable DAPT bleeding risk stratification is lacking. We tested the diagnostic utility of 3 conventional platelet-activity assays to define the predictive value (if any) of LPR for bleeding. Hypothesis: We hypothesized whether one of these tests be better than any others for predicting bleeding events. Methods: Patients (n = 800) following drug-eluting stent implantation received DAPT. Bleeding was assessed by Bleeding Academic Research Consortium (BARC) classification and events were collected for 1 year after stenting. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow, and multiple electrode aggregometry (MEA). The LPR values for bleeding event stratification were defined as ≤15{\%} for LTA, ≤139 PRU for VerifyNow, and ≤25 U for MEA. Results: Bleeding events occurred in 18 patients (2.3{\%}). All tests distinguished LPR as an independent predictor for bleeding by univariate analysis ([HR]: 5.00, 95{\%} [CI]: 1.8-14.0, P = 0.002 for LTA; HR: 21.3, 95{\%} CI: 6.2-73.0, P <0.0001 for VerifyNow; and HR: 7.4, 95{\%} CI: 2.2-25.5, P = 0.002 for MEA). Multivariate analysis revealed that only VerifyNow (HR: 11.5, 95{\%} CI: 2.9-45.7, P <0.0004) remained an independent predictor for bleeding. However, the specificity (81.5{\%}, 60.2{\%}, and 81.7{\%}, respectively) and sensitivity (61.1{\%}, 83.3{\%}, and 83.2{\%}, respectively) of all 3 tests were quite low. Conclusions: Among 3 conventional platelet-activity assays, VerifyNow was better than LTA or MEA for triaging future bleeding risks. However, all 3 tests failed to reliably predict future bleeding.",
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AB - Background: Although low platelet reactivity (LPR) is commonly detected during bleeding, a validated threshold for reliable DAPT bleeding risk stratification is lacking. We tested the diagnostic utility of 3 conventional platelet-activity assays to define the predictive value (if any) of LPR for bleeding. Hypothesis: We hypothesized whether one of these tests be better than any others for predicting bleeding events. Methods: Patients (n = 800) following drug-eluting stent implantation received DAPT. Bleeding was assessed by Bleeding Academic Research Consortium (BARC) classification and events were collected for 1 year after stenting. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow, and multiple electrode aggregometry (MEA). The LPR values for bleeding event stratification were defined as ≤15% for LTA, ≤139 PRU for VerifyNow, and ≤25 U for MEA. Results: Bleeding events occurred in 18 patients (2.3%). All tests distinguished LPR as an independent predictor for bleeding by univariate analysis ([HR]: 5.00, 95% [CI]: 1.8-14.0, P = 0.002 for LTA; HR: 21.3, 95% CI: 6.2-73.0, P <0.0001 for VerifyNow; and HR: 7.4, 95% CI: 2.2-25.5, P = 0.002 for MEA). Multivariate analysis revealed that only VerifyNow (HR: 11.5, 95% CI: 2.9-45.7, P <0.0004) remained an independent predictor for bleeding. However, the specificity (81.5%, 60.2%, and 81.7%, respectively) and sensitivity (61.1%, 83.3%, and 83.2%, respectively) of all 3 tests were quite low. Conclusions: Among 3 conventional platelet-activity assays, VerifyNow was better than LTA or MEA for triaging future bleeding risks. However, all 3 tests failed to reliably predict future bleeding.

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