Low On-Treatment Platelet Reactivity Predicts Long-Term Risk of Bleeding After Elective PCI

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Abstract

Background:

Bleeding after percutaneous coronary interventions (PCI) is an important complication with impact on prognosis.

Aim:

To evaluate the predictive value of enhanced platelet responsiveness to dual antiplatelet therapy with aspirin and clopidogrel, for bleeding, after elective PCI.

Methods and Results:

We performed multiple electrode aggregometry (MAE) platelet functional tests induced by arachidonic acid (ASPI) and adenosine-diphosphate (ADP) before PCI, and 24 hours after PCI, in 481 elective PCI patients who were followed-up for an average of 15.34 ± 7.19 months. Primary end point was the occurrence of any bleeding, while ischemic major adverse cardiovascular event (MACE) was a secondary endpoint. The incidence of total, BARC ≤ 2, and BARC ≥ 3 bleeding, according to BARC classification, was 19, 18, and 1%, respectively. Groups with any, and BARC ≤ 2 bleeding, had a lower average value of MAE ADP test after 24 hours, compared to the group without bleeding: 45.30 ± 18.63 U versus 50.99 ± 19.01 U; P = 0.005; and 45.75 ± 18.96 U versus 50.99 ± 18.99 U; P = 0.01; respectively. Female gender (HR 2.11; CI 1.37–3.25; P = 0.001), previous myocardial infarction (HR 0.56; CI 0.37–0.85; P = 0.006), lower body mass (HR 0.78; CI 0.62–0.98; P = 0.03), and MAE ADP test after 24 hours (HR 0.75; CI 0.61–0.93; P = 0.009) were the independent predictors for any bleeding by Cox univariate analysis. After adjustment, MAE ADP test after 24 hours, was the only independent predictor for any (HR 0.7; CI 0.56–0.87; P = 0.002), and BARC ≤ 2 (HR 0.71; CI 0.56–0.89; P = 0.003) bleeding, by Cox multivariate analysis.

Conclusion:

MAE ADP test before and after PCI, was associated with any, and BARC ≤ 2 bleeding after elective PCI.

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