Platelet reactivity in patients and recurrent events post-stenting: Results of the PREPARE POST-STENTING study

Paul A. Gurbel, Kevin P. Bliden, Kirk Guyer, Peter W. Cho, Kazi A. Zaman, Rolf Kreutz, Ashwani K. Bassi, Udaya S. Tantry

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: We investigated the relation of high ex vivo platelet reactivity, rapid fibrin generation, and high thrombin-induced clot strength to postdischarge ischemic events in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: High platelet reactivity and rapid fibrin generation may affect the incidence of ischemic events after PCI. However, limited data is available to link these ex vivo markers to the occurrence of events. METHODS: We measured platelet reactivity to adenosine diphosphate (ADP) by light transmittance aggregometry (LTA) in patients undergoing PCI (n = 192). Clot strength, a measure of thrombin-induced fibrin and platelet interactions, and the time to initial fibrin generation, a marker of thrombin activity, were measured by thrombelastography. The relation of these measurements to ischemic event occurrence was prospectively examined over six months. RESULTS: A total of 100% and 84% of patients were on aspirin and clopidogrel therapy, respectively, at the time of the initial event. Posttreatment ADP-induced aggregation by LTA (63 ± 12% vs. 56 ± 15%, p = 0.02) and clot strength (MA) were higher (74 ± 5 mm vs. 65 ± 4 mm, p <0.001) and time to initial fibrin generation was shorter (4.3 ± 1.3 min vs. 5.9 ± 1.5 min, p <0.001) in patients with events (n = 38). The event rates in the highest quartiles of LTA and MA were 32% and 58%, respectively. CONCLUSIONS: High platelet reactivity and clot strength, and rapid fibrin formation are novel risk factors for ischemic events after PCI. Clot strength is more predictive than ADP-induced platelet aggregation and may explain the occurrence of events despite treatment with cyclooxygenase-1 and P2Y12 inhibitors.

Original languageEnglish (US)
Pages (from-to)1820-1826
Number of pages7
JournalJournal of the American College of Cardiology
Volume46
Issue number10
DOIs
StatePublished - Nov 15 2005
Externally publishedYes

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Fibrin
Blood Platelets
Percutaneous Coronary Intervention
Thrombin
Adenosine Diphosphate
clopidogrel
Light
Thrombelastography
Cyclooxygenase 1
Platelet Aggregation
Aspirin
Incidence
Therapeutics

ASJC Scopus subject areas

  • Nursing(all)

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Platelet reactivity in patients and recurrent events post-stenting : Results of the PREPARE POST-STENTING study. / Gurbel, Paul A.; Bliden, Kevin P.; Guyer, Kirk; Cho, Peter W.; Zaman, Kazi A.; Kreutz, Rolf; Bassi, Ashwani K.; Tantry, Udaya S.

In: Journal of the American College of Cardiology, Vol. 46, No. 10, 15.11.2005, p. 1820-1826.

Research output: Contribution to journalArticle

Gurbel, Paul A. ; Bliden, Kevin P. ; Guyer, Kirk ; Cho, Peter W. ; Zaman, Kazi A. ; Kreutz, Rolf ; Bassi, Ashwani K. ; Tantry, Udaya S. / Platelet reactivity in patients and recurrent events post-stenting : Results of the PREPARE POST-STENTING study. In: Journal of the American College of Cardiology. 2005 ; Vol. 46, No. 10. pp. 1820-1826.
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abstract = "OBJECTIVES: We investigated the relation of high ex vivo platelet reactivity, rapid fibrin generation, and high thrombin-induced clot strength to postdischarge ischemic events in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: High platelet reactivity and rapid fibrin generation may affect the incidence of ischemic events after PCI. However, limited data is available to link these ex vivo markers to the occurrence of events. METHODS: We measured platelet reactivity to adenosine diphosphate (ADP) by light transmittance aggregometry (LTA) in patients undergoing PCI (n = 192). Clot strength, a measure of thrombin-induced fibrin and platelet interactions, and the time to initial fibrin generation, a marker of thrombin activity, were measured by thrombelastography. The relation of these measurements to ischemic event occurrence was prospectively examined over six months. RESULTS: A total of 100{\%} and 84{\%} of patients were on aspirin and clopidogrel therapy, respectively, at the time of the initial event. Posttreatment ADP-induced aggregation by LTA (63 ± 12{\%} vs. 56 ± 15{\%}, p = 0.02) and clot strength (MA) were higher (74 ± 5 mm vs. 65 ± 4 mm, p <0.001) and time to initial fibrin generation was shorter (4.3 ± 1.3 min vs. 5.9 ± 1.5 min, p <0.001) in patients with events (n = 38). The event rates in the highest quartiles of LTA and MA were 32{\%} and 58{\%}, respectively. CONCLUSIONS: High platelet reactivity and clot strength, and rapid fibrin formation are novel risk factors for ischemic events after PCI. Clot strength is more predictive than ADP-induced platelet aggregation and may explain the occurrence of events despite treatment with cyclooxygenase-1 and P2Y12 inhibitors.",
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T1 - Platelet reactivity in patients and recurrent events post-stenting

T2 - Results of the PREPARE POST-STENTING study

AU - Gurbel, Paul A.

AU - Bliden, Kevin P.

AU - Guyer, Kirk

AU - Cho, Peter W.

AU - Zaman, Kazi A.

AU - Kreutz, Rolf

AU - Bassi, Ashwani K.

AU - Tantry, Udaya S.

PY - 2005/11/15

Y1 - 2005/11/15

N2 - OBJECTIVES: We investigated the relation of high ex vivo platelet reactivity, rapid fibrin generation, and high thrombin-induced clot strength to postdischarge ischemic events in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: High platelet reactivity and rapid fibrin generation may affect the incidence of ischemic events after PCI. However, limited data is available to link these ex vivo markers to the occurrence of events. METHODS: We measured platelet reactivity to adenosine diphosphate (ADP) by light transmittance aggregometry (LTA) in patients undergoing PCI (n = 192). Clot strength, a measure of thrombin-induced fibrin and platelet interactions, and the time to initial fibrin generation, a marker of thrombin activity, were measured by thrombelastography. The relation of these measurements to ischemic event occurrence was prospectively examined over six months. RESULTS: A total of 100% and 84% of patients were on aspirin and clopidogrel therapy, respectively, at the time of the initial event. Posttreatment ADP-induced aggregation by LTA (63 ± 12% vs. 56 ± 15%, p = 0.02) and clot strength (MA) were higher (74 ± 5 mm vs. 65 ± 4 mm, p <0.001) and time to initial fibrin generation was shorter (4.3 ± 1.3 min vs. 5.9 ± 1.5 min, p <0.001) in patients with events (n = 38). The event rates in the highest quartiles of LTA and MA were 32% and 58%, respectively. CONCLUSIONS: High platelet reactivity and clot strength, and rapid fibrin formation are novel risk factors for ischemic events after PCI. Clot strength is more predictive than ADP-induced platelet aggregation and may explain the occurrence of events despite treatment with cyclooxygenase-1 and P2Y12 inhibitors.

AB - OBJECTIVES: We investigated the relation of high ex vivo platelet reactivity, rapid fibrin generation, and high thrombin-induced clot strength to postdischarge ischemic events in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: High platelet reactivity and rapid fibrin generation may affect the incidence of ischemic events after PCI. However, limited data is available to link these ex vivo markers to the occurrence of events. METHODS: We measured platelet reactivity to adenosine diphosphate (ADP) by light transmittance aggregometry (LTA) in patients undergoing PCI (n = 192). Clot strength, a measure of thrombin-induced fibrin and platelet interactions, and the time to initial fibrin generation, a marker of thrombin activity, were measured by thrombelastography. The relation of these measurements to ischemic event occurrence was prospectively examined over six months. RESULTS: A total of 100% and 84% of patients were on aspirin and clopidogrel therapy, respectively, at the time of the initial event. Posttreatment ADP-induced aggregation by LTA (63 ± 12% vs. 56 ± 15%, p = 0.02) and clot strength (MA) were higher (74 ± 5 mm vs. 65 ± 4 mm, p <0.001) and time to initial fibrin generation was shorter (4.3 ± 1.3 min vs. 5.9 ± 1.5 min, p <0.001) in patients with events (n = 38). The event rates in the highest quartiles of LTA and MA were 32% and 58%, respectively. CONCLUSIONS: High platelet reactivity and clot strength, and rapid fibrin formation are novel risk factors for ischemic events after PCI. Clot strength is more predictive than ADP-induced platelet aggregation and may explain the occurrence of events despite treatment with cyclooxygenase-1 and P2Y12 inhibitors.

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