Thrombotic events in high risk patients are predicted by evaluating different pathways of platelet function
Anna Maria Gori1; Rossella Marcucci1; Rita Paniccia1; Betti Giusti1; Sandra Fedi1; Emilia Antonucci1; Piergiovanni Buonamici2; David Antoniucci2; Gian Franco Gensini1; Rosanna Abbate1
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; 2Department of Heart and Vessels, Azienda Ospedaliero-Universitaria, Florence, Italy
clopidogrel, Aspirin, platelet function tests, Stent thrombosis, Residual platelet reactivity, cardiac mortality
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 andAA: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.