Navigation Links
Global platelet reactivity and high risk ACS patients
Date:8/28/2012

Global platelet reactivity is more effective than responsiveness to clopidogrel in identifying acute coronary syndrome (ACS) patients at high risk of ischemic events, according to research presented at ESC Congress 2012.

The results from the RECLOSE 2-ACS study were presented by Dr Rossella Marcucci from the University of Florence.

The Responsiveness to Clopidogrel and Stent thrombosis 2 ACS (RECLOSE 2-ACS) study is a prospective, observational, referral centre cohort study of 1,789 patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) at the Division of Cardiology, Careggi Hospital, Florence, Italy.

Dual antiplatelet therapy with aspirin and clopidogrel is the cornerstone of therapy in these patients to improve prognosis and reduce adverse cardiovascular events, stent thrombosis and cardiovascular death.

"In recent years, we and other groups have focused our attention on the role of platelet inhibition," said Dr Marcucci.

"We found that a significant percentage of patients on clopidogrel therapy the so-called nonresponders to clopidogrel had a high platelet reactivity (HPR) on clopidogrel and a significantly higher risk of developing an adverse ischemic event at a follow-up of 2 years."

A number of genetic and acquired conditions are associated with a high platelet reactivity on clopidogrel. Carriers of a genetic variant (the CYP2C19*2 polymorphism), diabetics, older patients, females and patients with a reduced renal and cardiac function have a higher risk of maintaining a high platelet reactivity on clopidogrel. In addition, the concomitant use of drugs such as proton pump inhibitors (PPIs) is associated with a reduced metabolization of clopidogrel (which is a prodrug and needs to be metabolized to the active drug by the liver) and a high risk of high platelet reactivity.

The aim of the current study was to evaluate whether a high platelet reactivity due to nonresponsiveness to aspirin could also identify ACS patients at high risk of ischemic events. The investigators also evaluated whether the combination of aspirin and clopidogrel nonresponsiveness could identify high risk patients more effectively than one measure alone.

The researchers measured platelet reactivity in response to aspirin and clopidogrel in patients enrolled in the RECLOSE 2-ACS study. They found that approximately 12% of patients had a high platelet reactivity to aspirin and were therefore nonresponders. These patients had a significantly higher prevalence of an ischemic event or cardiac death at the 2 year follow-up (major adverse cardiac events [MACE]: Hazard Ratio [HR]=1.4 [1.0-1.8], p<0.04; Cardiac death: HR=1.7 [1.2-2.6],p=0.004).

The researchers calculated the net reclassification index (NRI), which is a method to define whether the addition of a new parameter increases the predictive value. Dr Marcucci said: "We found that adding the response to aspirin to the response to clopidogrel enabled us to recognize a higher number of patients at risk of ischemic events and cardiac events."

Approximately 9% of patients had high platelet reactivity (i.e. were nonresponders) to both clopidogrel and aspirin. This phenotype is known as global high platelet reactivity (GHPR).

GHPR was significantly associated with cardiovascular ischemic events and cardiac death in a Cox regression analysis (MACE: HR=1.8[1.2-3.0], p<0.01); Cardiac death: HR=1.5 [1.0-2.2], p=0.02). The analysis was adjusted for age, sex, body mass index, smoking, diabetes, hypertension, hypercholesterolemia, history of myocardial infarction, serum creatinine higher than 1.5 mg/dl, left ventricular ejection fraction <40%, Killip class III or IV at admission, 3-vessel coronary disease, use of drug eluting stents, total stent length, multivessel PCI and use of abciximab.

Dr Marcucci said: "These results show that global high platelet reactivity is the most effective parameter for identifying ACS patients at high risk of ischemic events."

She added: "This shifts the focus of risk stratification from response to clopidogrel to assessing response to both clopidogrel and aspirin. Responsiveness to both antiplatelet drugs should be assessed in all patients with ACS in order to identify and reduce their risk of ischemic events."


'/>"/>

Contact: European Society of Cardiology
press@escardio.org
33-049-294-8627
European Society of Cardiology
Source:Eurekalert

Related medicine news :

1. NIH awards $20 million over 5 years to train next generation of global health researchers
2. Canada should play a role in addressing the global cancer epidemic
3. Global cardiology leaders meet in Dubai
4. Global, common approach to pharmaceutical supply chain integrity the focus of workshop
5. International breast health global summit will focus on supportive care and quality of life
6. Scientists rewrite rulebook on breast cancer in landmark global study
7. Global CVD leaders call the world to action - 25 by 2025 - from the World Congress of Cardiology
8. Centre for Global Non-Communicable Diseases launched to tackle killer diseases
9. UCLA researchers combat global disease with a cell phone, Google Maps and a lot of ingenuity
10. New study identifies how information technology is used to solve global health challenges
11. New global report says US lags behind 130 other nations in preterm birth rate
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... Comfort Keepers® ... American Cancer Society and the Road To Recovery® program to drive cancer patients to ... and other adults to ensure the highest quality of life and ongoing independence. ...
(Date:6/24/2016)... TX (PRWEB) , ... June 24, 2016 , ... People ... part in Genome magazine’s Code Talker Award, an essay contest in which patients and ... an award to be presented at the 2016 National Society of Genetic Counselors (NSGC) ...
(Date:6/24/2016)... ... June 24, 2016 , ... The Haute Beauty ... Barry M. Weintraub as a prominent plastic surgeon and the network’s newest partner. ... and the most handsome men, look naturally attractive. Plastic surgery should be invisible.” ...
(Date:6/24/2016)... , ... June 24, 2016 , ... ... actively feeding the Frederick area economy by obtaining investment capital for emerging technology ... past 2½ years that have already resulted in more than a million dollars ...
(Date:6/24/2016)... ... June 24, 2016 , ... Venture Construction Group (VCG) ... held on June 20th at the Woodmont Country Club at 1201 Rockville Pike, ... organization dedicated to helping service members that have been wounded in battle and their ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... , June 24, 2016  Consumers have ... and regulators/payers have placed more emphasis on patient ... patient support programs in the pharmaceutical industry have ... medications. Consequently, pharmaceutical companies are focusing on becoming ... are providing products and services that improve health. ...
(Date:6/24/2016)... June 24, 2016  Global Blood Therapeutics, Inc. (GBT) ... developing novel therapeutics for the treatment of grievous ... the closing of its previously announced underwritten public ... the public offering price of $18.75 per share. ... offered by GBT. GBT estimates net proceeds from ...
(Date:6/24/2016)... , June 24, 2016 ... has announced the addition of the " Global ... This report ... provides an updated review, including its applications in various ... total market, which includes three main industries: pharmaceutical and ...
Breaking Medicine Technology: