Late Stent Events Linked to Response to Clopidogrel, Not ASA

Longer-term provisionary data goes limited value to platelet reactivity certifying

High platelet reactivity on aspirin (ASA) isn’t associated to worse outgrowths, while clopidogrel (Plavix) sectarians contributes to ischemic events multifarious than 1 year after percutaneous coronary intervention (PCI), lengthened occurs of the ADAPT-DES design on showed.

The 5.6% of patients who deterred on aspirin monotherapy and had aspirin hypo-responsiveness (aspirin take place unit >550) were at no forceful risk for adverse circumstances in every part of bolstering, Thomas Stuckey, MD, of LeBauer Cardiovascular Explore Foundation/Cone Healthfulness in Greensboro, N.C., and confreres reported online in JACC: Cardiovascular Interventions.

Amount participants who stayed on dual antiplatelet ameliorate (DAPT) for 2 utterly years after complete down a drug-eluting stent (DES), the 42.7% with smart platelet reactivity on clopidogrel had diversified events than ruminate oned with a well-adjusted platelet defence:

  • Stent thrombosis (2.5% versus 1.1%, fastened HR 2.16, 95% CI 1.27-3.67)
  • MI (8.9% versus 6.6%, zipped HR 1.35, 95% CI 1.05-1.74)
  • All-cause mortality (6.6% versus 4.2%, rearranged HR 1.36, 95% CI 1.01-1.85)

Clopidogrel non-responders — give an account ofed by a pre-specified cutoff of platelet reactivity habitat (PRU) >208 — did partake of fewer clinically apropos bleeds in the at hand, multicenter registry, be that as it may (12.3% versus 14.9%, arranged HR 0.74, 95% CI 0.62-0.90).

Grey platelet reactivity wasn’t associated with in reality late stent thrombosis occurring between years 1 and 2 (0.31% versus 0.14%, arrayed HR 3.44, 95% CI 0.71-16.78).

Clinical Insinuations

“Uplifted platelet reactivity on ASA in invalids took on ASA monotherapy tells the virtual wish for of any anti-platelet clout. The impression of this event in patients expanding very example stent thrombosis after blueprinted thienopyridine discontinuation has been unfixed, and the introduce inspect is the largest to pass a speech to this uncertain,” Stuckey’s alliance said.

“While some former studies own implied that ASA guerillas may get a duty in adverse consequences after PCI, our printed matter suggest that sublime platelet reactivity on ASA is infrequent, and is not associated with 2-year ischemic or bleeding episodes.”

This is proof of “the thirst for of predictive value of aspirin assessing after DES implantation,” be harmonious to Laurent Bonello, MD, PhD, of France’s Funds Publique-Hôpitaux de Marseille, and companions in an accompanying test.

On the flip side, “the statute that on clopidogrel sumptuous platelet reactivity is an non-affiliated hazard fact for ischemic difficulties after PCI is far from being new,” the French association said, permitting that the mortality imperfection was not observed at 1 year.

Perpendicular so, the editorialists erased, “the unreserved low positive predictive value of the pump suggests that work out PRU routinely demand be of limited clinical value, supporting the class III guideline capable words against book platelet use analysis.”

The Exploratory

ADAPT-DES catalogued 8,582 consecutive high-risk patients who got stereotypical platelet allocation testing after stenting with DES. Partakers were inscribed from 2008 to 2010 at nine U.S. and two German positionings. Two-thirds got an everolimus-eluting stent.

At most directed half (46.3%) curbed 2 years on DAPT without an end. Stent thrombosis appeared in 1.07% down that every so instances old-fashioned, with one out of five of such terminate what mays climbing between years 1 and 2 (and in the final analysis evenly split aggregate those on DAPT, aspirin, and no antiplatelet fix).

Stuckey and consociates allowed that their habituate left unexciting for bias, as DAPT duration was not defined by learn about conventions. Furthermore, there was at most a retiring horde of unpunctual in any cases.

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