Thrombotic events in high risk patients are predicted by evaluating different pathways of platelet function

Anna Maria Gori; Rossella Marcucci; Rita Paniccia; Betti Giusti; Sandra Fedi; Emilia Antonucci; Piergiovanni Buonamici; David Antoniucci; Gian Franco Gensini; Rosanna Abbate

doi:10.1160/TH08-06-0374

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2008; 100(06): 1136-1145
DOI: 10.1160/TH08-06-0374

Platelets and Blood Cells

Schattauer GmbH

Thrombotic events in high risk patients are predicted by evaluating different pathways of platelet function

Authors

Anna Maria Gori

¹Department of Medical and Surgical Critical Care, University of Florence; Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy
Rossella Marcucci

¹Department of Medical and Surgical Critical Care, University of Florence; Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy
Rita Paniccia

¹Department of Medical and Surgical Critical Care, University of Florence; Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy
Betti Giusti

¹Department of Medical and Surgical Critical Care, University of Florence; Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy
Sandra Fedi

¹Department of Medical and Surgical Critical Care, University of Florence; Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy
Emilia Antonucci

¹Department of Medical and Surgical Critical Care, University of Florence; Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy
Piergiovanni Buonamici

²Department of Heart and Vessels, Azienda Ospedaliero-Universitaria, Florence, Italy
David Antoniucci

²Department of Heart and Vessels, Azienda Ospedaliero-Universitaria, Florence, Italy
Gian Franco Gensini

¹Department of Medical and Surgical Critical Care, University of Florence; Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy
Rosanna Abbate

¹Department of Medical and Surgical Critical Care, University of Florence; Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy

Abstract

Summary

A higher rate of clinical events in poor clopidogrel and/or aspirin responders was documented by using different methods to measure platelet function, but no conclusive data about the appropriate methodology to explore platelet reactivity are available.A total of 746 patients included in the cohort of the RECLOSE trial who had successful drug-eluting stent implantation were assessed for post-treatment residual platelet reactivity (RPR) in platelet-rich plasma by 10 µM adenosine 5’-diphosphate (ADP),1 mM arachidonic acid (AA) and 2 µg/ml collageninduced platelet aggregation and in whole blood by the PFA-100 system. At six-month follow-up, RPR by two stimuli (ADP and AA or ADP and collagen) and by three stimuli (ADP,AA and collagen) is significantly associated with higher percentage of primary (definite or probable stent thrombosis) and secondary cardiac mortality and stent thrombosis) end-points than RPR by ADP,AA, collagen and PFA-100 system.According to the primary and secondary end points, the specificity values for RPR identified by two (ADP and AA: 94%;ADP and collagen: 97%) and three stimuli were higher with respect to RPR by ADP (88%), or RPR by AA (83%) or RPR by collagen (90%).The positive likelihood ratio values of RPR by three stimuli (9.55) or of RPR by ADP and collagen (8.08) were higher than those of RPR by ADP (2.59), byAA (2.05), by collagen (4.73), or by PFA-100 (2.63).This prospective study documents that the evaluation of platelet reactivity addressed to identify patients at risk of thrombotic events on dual antiplatelet treatment has to be carried out by methods able to explore different pathways.

Keywords

Residual platelet reactivity - stent thrombosis - cardiac mortality - platelet function tests - aspirin - clopidogrel

Volltext

Referenzen

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