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 language | English (US) |
|---|---|
| Pages (from-to) | 1703-1713 |
| Number of pages | 11 |
| Journal | American Journal of Cardiology |
| Volume | 117 |
| Issue number | 11 |
| DOIs | |
| State | Published - Jun 1 2016 |
| Externally published | Yes |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
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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 journal › Article
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.
UR - http://www.scopus.com/inward/record.url?scp=84966660851&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84966660851&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2016.03.001
DO - 10.1016/j.amjcard.2016.03.001
M3 - Article
VL - 117
SP - 1703
EP - 1713
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 11
ER -