Bleeding and stent thrombosis on P2Y12-inhibitors: collaborative analysis on the role of platelet reactivity for risk stratification after percutaneous coronary intervention.

Aradi, Daniel; Kirtane, Ajay; Bonello, Laurent; Gurbel, Paul A; Tantry, Udaya S; Huber, Kurt; Freynhofer, Matthias K; ten Berg, Jurrien; Janssen, Paul; Angiolillo, Dominick J; Siller-Matula, Jolanta M; Marcucci, Rossella; Patti, Giuseppe; Mangiacapra, Fabio; Valgimigli, Marco; Morel, Olivier; Palmerini, Tullio; Price, Matthew J; Cuisset, Thomas; Kastrati, Adnan; Stone, Gregg W; Sibbing, Dirk

doi:10.1093/eurheartj/ehv104

journal article

Title:: Bleeding and stent thrombosis on P2Y12-inhibitors: collaborative analysis on the role of platelet reactivity for risk stratification after percutaneous coronary intervention.
Document type:: Journal Article; Research Support, Non-U.S. Gov't; Article
Author(s):: Aradi, Daniel; Kirtane, Ajay; Bonello, Laurent; Gurbel, Paul A; Tantry, Udaya S; Huber, Kurt; Freynhofer, Matthias K; ten Berg, Jurrien; Janssen, Paul; Angiolillo, Dominick J; Siller-Matula, Jolanta M; Marcucci, Rossella; Patti, Giuseppe; Mangiacapra, Fabio; Valgimigli, Marco; Morel, Olivier; Palmerini, Tullio; Price, Matthew J; Cuisset, Thomas; Kastrati, Adnan; Stone, Gregg W; Sibbing, Dirk
Abstract:: Although platelet reactivity during P2Y12-inhibitors is associated with stent thrombosis (ST) and bleeding, standardized and clinically validated thresholds for accurate risk stratification after percutaneous coronary intervention (PCI) are lacking. We sought to determine the prognostic value of low platelet reactivity (LPR), optimal platelet reactivity (OPR), or high platelet reactivity (HPR) by applying uniform cut-off values for standardized devices.Authors of studies published before January 2015, reporting associations between platelet reactivity, ST, and major bleeding were contacted for a collaborative analysis using consensus-defined, uniform cut-offs for standardized platelet function assays. Based on best available evidence for each device (exploratory studies), LPR-OPR-HPR categories were defined as <95, 95-208, and >208 PRU for VerifyNow, <19, 19-46, and >46 U for the Multiplate analyser and <16, 16-50, and >50% for VASP assay. Seventeen studies including 20 839 patients were used for the analysis; 97% were treated with clopidogrel and 3% with prasugrel. Patients with HPR had significantly higher risk for ST [risk ratio (RR) and 95% CI: 2.73 (2.03-3.69), P < 0.00001], yet a slight reduction in bleeding [RR: 0.84 (0.71-0.99), P = 0.04] compared with those with OPR. In contrast, patients with LPR had a higher risk for bleeding [RR: 1.74 (1.47-2.06), P < 0.00001], without any further benefit in ST [RR: 1.06 (0.68-1.65), P = 0.78] in contrast to OPR. Mortality was significantly higher in patients with HPR compared with other categories (P < 0.05). Validation cohorts (n = 14) confirmed all results of exploratory studies (n = 3).Platelet reactivity assessment during thienopyridine-type P2Y12-inhibitors identifies PCI-treated patients at higher risk for mortality and ST (HPR) or at an elevated risk for bleeding (LPR).
Journal title abbreviation:: Eur Heart J
Year:: 2015
Journal volume:: 36
Journal issue:: 27
Pages contribution:: 1762-71
Language:: eng
Fulltext / DOI:: doi:10.1093/eurheartj/ehv104
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/25896078
Print-ISSN:: 0195-668X
TUM Institution:: I. Medizinische Klinik und Poliklinik (Kardiologie); Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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Occurrences:

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)2015

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2015