Relation between Platelet Count and Platelet Reactivity to Thrombotic and Bleeding Risk

From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents Study

Gennaro Giustino, Ajay J. Kirtane, Philippe Genereux, Usman Baber, Bernhard Witzenbichler, Franz Josef Neumann, Giora Weisz, Akiko Maehara, Michael J. Rinaldi, Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Ernest L. Mazzaferri, Bruce R. Brodie, Thomas D. Stuckey, George D. Dangas, Dominic P. Francese, Claire Litherland, Roxana Mehran & 1 others Gregg W. Stone

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Whether the association between platelet count (PC) and thrombotic and bleeding risk is independent of or varies by residual platelet reactivity to antiplatelet therapies is unclear. We sought to investigate the independent and combined effects of PC and platelet reactivity on thrombotic and bleeding risk after coronary artery implantation of drug-eluting stents (DES). Patients enrolled in the prospective, multicenter Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents study were stratified by PC tertiles. The study cohort comprised 8,402 patients. By linear regression analysis, lower PC was strongly and independently associated with higher platelet reactive units (PRUs) on clopidogrel. After multivariable adjustment (including PRU and aspirin reactive units), high, but not low, PC tertile was independently associated with higher risk of thrombotic complications, including spontaneous myocardial infarction and stent thrombosis. Although no independent association was observed between PC tertiles and hemorrhagic risk, both high and low PC tertiles were associated with increased risk for all-cause mortality. After stratification of PC tertiles by tertiles of PRUs, the crude risk of thrombotic complications was highest in patients in the high PC and high PRU tertiles. By multivariable adjustment, PRU increases were uniformly associated with higher risk of thrombotic events across PC tertiles, without evidence of interaction. In conclusion, higher PCs and higher PRUs act independently and synergistically in determining thrombotic risk. Alongside PRU, PCs could be a simple hematological parameter to consider for risk stratification and in tailoring duration and potency of pharmacologic platelet inhibition after DES implantation.

Original languageEnglish (US)
Pages (from-to)1703-1713
Number of pages11
JournalAmerican Journal of Cardiology
Volume117
Issue number11
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

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Drug-Eluting Stents
Platelet Count
Blood Platelets
Hemorrhage
Therapeutics
clopidogrel
Aspirin
Stents
Linear Models
Coronary Vessels
Thrombosis
Cohort Studies
Myocardial Infarction
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Giustino, Gennaro ; Kirtane, Ajay J. ; Genereux, Philippe ; Baber, Usman ; Witzenbichler, Bernhard ; Neumann, Franz Josef ; Weisz, Giora ; Maehara, Akiko ; Rinaldi, Michael J. ; Metzger, Christopher ; Henry, Timothy D. ; Cox, David A. ; Duffy, Peter L. ; Mazzaferri, Ernest L. ; Brodie, Bruce R. ; Stuckey, Thomas D. ; Dangas, George D. ; Francese, Dominic P. ; Litherland, Claire ; Mehran, Roxana ; Stone, Gregg W. / Relation between Platelet Count and Platelet Reactivity to Thrombotic and Bleeding Risk : From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents Study. In: American Journal of Cardiology. 2016 ; Vol. 117, No. 11. pp. 1703-1713.
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abstract = "Whether the association between platelet count (PC) and thrombotic and bleeding risk is independent of or varies by residual platelet reactivity to antiplatelet therapies is unclear. We sought to investigate the independent and combined effects of PC and platelet reactivity on thrombotic and bleeding risk after coronary artery implantation of drug-eluting stents (DES). Patients enrolled in the prospective, multicenter Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents study were stratified by PC tertiles. The study cohort comprised 8,402 patients. By linear regression analysis, lower PC was strongly and independently associated with higher platelet reactive units (PRUs) on clopidogrel. After multivariable adjustment (including PRU and aspirin reactive units), high, but not low, PC tertile was independently associated with higher risk of thrombotic complications, including spontaneous myocardial infarction and stent thrombosis. Although no independent association was observed between PC tertiles and hemorrhagic risk, both high and low PC tertiles were associated with increased risk for all-cause mortality. After stratification of PC tertiles by tertiles of PRUs, the crude risk of thrombotic complications was highest in patients in the high PC and high PRU tertiles. By multivariable adjustment, PRU increases were uniformly associated with higher risk of thrombotic events across PC tertiles, without evidence of interaction. In conclusion, higher PCs and higher PRUs act independently and synergistically in determining thrombotic risk. Alongside PRU, PCs could be a simple hematological parameter to consider for risk stratification and in tailoring duration and potency of pharmacologic platelet inhibition after DES implantation.",
author = "Gennaro Giustino and Kirtane, {Ajay J.} and Philippe Genereux and Usman Baber and Bernhard Witzenbichler and Neumann, {Franz Josef} and Giora Weisz and Akiko Maehara and Rinaldi, {Michael J.} and Christopher Metzger and Henry, {Timothy D.} and Cox, {David A.} and Duffy, {Peter L.} and Mazzaferri, {Ernest L.} and Brodie, {Bruce R.} and Stuckey, {Thomas D.} and Dangas, {George D.} and Francese, {Dominic P.} and Claire Litherland and Roxana Mehran and Stone, {Gregg W.}",
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Giustino, G, Kirtane, AJ, Genereux, P, Baber, U, Witzenbichler, B, Neumann, FJ, Weisz, G, Maehara, A, Rinaldi, MJ, Metzger, C, Henry, TD, Cox, DA, Duffy, PL, Mazzaferri, EL, Brodie, BR, Stuckey, TD, Dangas, GD, Francese, DP, Litherland, C, Mehran, R & Stone, GW 2016, 'Relation between Platelet Count and Platelet Reactivity to Thrombotic and Bleeding Risk: From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents Study', American Journal of Cardiology, vol. 117, no. 11, pp. 1703-1713. https://doi.org/10.1016/j.amjcard.2016.03.001

Relation between Platelet Count and Platelet Reactivity to Thrombotic and Bleeding Risk : From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents Study. / Giustino, Gennaro; Kirtane, Ajay J.; Genereux, Philippe; Baber, Usman; Witzenbichler, Bernhard; Neumann, Franz Josef; Weisz, Giora; Maehara, Akiko; Rinaldi, Michael J.; Metzger, Christopher; Henry, Timothy D.; Cox, David A.; Duffy, Peter L.; Mazzaferri, Ernest L.; Brodie, Bruce R.; Stuckey, Thomas D.; Dangas, George D.; Francese, Dominic P.; Litherland, Claire; Mehran, Roxana; Stone, Gregg W.

In: American Journal of Cardiology, Vol. 117, No. 11, 01.06.2016, p. 1703-1713.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Relation between Platelet Count and Platelet Reactivity to Thrombotic and Bleeding Risk

T2 - From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents Study

AU - Giustino, Gennaro

AU - Kirtane, Ajay J.

AU - Genereux, Philippe

AU - Baber, Usman

AU - Witzenbichler, Bernhard

AU - Neumann, Franz Josef

AU - Weisz, Giora

AU - Maehara, Akiko

AU - Rinaldi, Michael J.

AU - Metzger, Christopher

AU - Henry, Timothy D.

AU - Cox, David A.

AU - Duffy, Peter L.

AU - Mazzaferri, Ernest L.

AU - Brodie, Bruce R.

AU - Stuckey, Thomas D.

AU - Dangas, George D.

AU - Francese, Dominic P.

AU - Litherland, Claire

AU - Mehran, Roxana

AU - Stone, Gregg W.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Whether the association between platelet count (PC) and thrombotic and bleeding risk is independent of or varies by residual platelet reactivity to antiplatelet therapies is unclear. We sought to investigate the independent and combined effects of PC and platelet reactivity on thrombotic and bleeding risk after coronary artery implantation of drug-eluting stents (DES). Patients enrolled in the prospective, multicenter Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents study were stratified by PC tertiles. The study cohort comprised 8,402 patients. By linear regression analysis, lower PC was strongly and independently associated with higher platelet reactive units (PRUs) on clopidogrel. After multivariable adjustment (including PRU and aspirin reactive units), high, but not low, PC tertile was independently associated with higher risk of thrombotic complications, including spontaneous myocardial infarction and stent thrombosis. Although no independent association was observed between PC tertiles and hemorrhagic risk, both high and low PC tertiles were associated with increased risk for all-cause mortality. After stratification of PC tertiles by tertiles of PRUs, the crude risk of thrombotic complications was highest in patients in the high PC and high PRU tertiles. By multivariable adjustment, PRU increases were uniformly associated with higher risk of thrombotic events across PC tertiles, without evidence of interaction. In conclusion, higher PCs and higher PRUs act independently and synergistically in determining thrombotic risk. Alongside PRU, PCs could be a simple hematological parameter to consider for risk stratification and in tailoring duration and potency of pharmacologic platelet inhibition after DES implantation.

AB - Whether the association between platelet count (PC) and thrombotic and bleeding risk is independent of or varies by residual platelet reactivity to antiplatelet therapies is unclear. We sought to investigate the independent and combined effects of PC and platelet reactivity on thrombotic and bleeding risk after coronary artery implantation of drug-eluting stents (DES). Patients enrolled in the prospective, multicenter Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents study were stratified by PC tertiles. The study cohort comprised 8,402 patients. By linear regression analysis, lower PC was strongly and independently associated with higher platelet reactive units (PRUs) on clopidogrel. After multivariable adjustment (including PRU and aspirin reactive units), high, but not low, PC tertile was independently associated with higher risk of thrombotic complications, including spontaneous myocardial infarction and stent thrombosis. Although no independent association was observed between PC tertiles and hemorrhagic risk, both high and low PC tertiles were associated with increased risk for all-cause mortality. After stratification of PC tertiles by tertiles of PRUs, the crude risk of thrombotic complications was highest in patients in the high PC and high PRU tertiles. By multivariable adjustment, PRU increases were uniformly associated with higher risk of thrombotic events across PC tertiles, without evidence of interaction. In conclusion, higher PCs and higher PRUs act independently and synergistically in determining thrombotic risk. Alongside PRU, PCs could be a simple hematological parameter to consider for risk stratification and in tailoring duration and potency of pharmacologic platelet inhibition after DES implantation.

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U2 - 10.1016/j.amjcard.2016.03.001

DO - 10.1016/j.amjcard.2016.03.001

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JO - American Journal of Cardiology

JF - American Journal of Cardiology

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