Thrombus aspiration is associated with improved platelet inhibition rate following dual antiplatelet therapy in acute myocardial infarction patients.
Humans
Male
Female
Platelet Aggregation Inhibitors
/ therapeutic use
Middle Aged
Myocardial Infarction
/ complications
Aged
Percutaneous Coronary Intervention
/ methods
Retrospective Studies
Dual Anti-Platelet Therapy
/ methods
Aspirin
/ therapeutic use
Thrombosis
/ etiology
Blood Platelets
/ drug effects
Thrombectomy
/ methods
Myocardial infarction
Percutaneous coronary intervention
Platelet antagonist
Platelet function tests
Thrombosis
Journal
European journal of medical research
ISSN: 2047-783X
Titre abrégé: Eur J Med Res
Pays: England
ID NLM: 9517857
Informations de publication
Date de publication:
14 Aug 2024
14 Aug 2024
Historique:
received:
23
01
2024
accepted:
08
08
2024
medline:
15
8
2024
pubmed:
15
8
2024
entrez:
14
8
2024
Statut:
epublish
Résumé
It is well-established that thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) indicates a higher thrombus burden and necessitates more intensive antithrombotic therapy. The bidirectional association between adverse events in AMI patients and platelet reactivity is typically observed during dual antiplatelet therapy (DAPT). To investigate platelet reactivity after DAPT in AMI patients with thrombus aspiration performed during PCI. In this retrospective study, we examined 269 consecutive AMI patients who underwent PCI and recorded their demographic, clinical and laboratory data. The platelet reactivity was measured with thromboelastogram (TEM). Ultimately, 208 patients were included in this study and divided into a Thrombus Aspiration group (N = 97) and a PCI Alone group (N = 111) based on whether thrombus aspiration was performed or not. The adenosine diphosphate (ADP)-induced platelet inhibition rate in the Thrombus Aspiration group was higher than that in the PCI Alone group (P < 0.001). Furthermore, multivariate linear regression analysis revealed that the ADP-induced platelet inhibition rate was independently associated with leukocyte count, thrombus aspiration and the combination of aspirin and ticagrelor as DAPT after adjusting for potential covariates in all AMI patients. In conclusion, clinicians should exercise heightened attention towards the bleeding risk among patients undergoing PCI concomitant with Thrombus Aspiration postoperatively.
Sections du résumé
BACKGROUND
BACKGROUND
It is well-established that thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) indicates a higher thrombus burden and necessitates more intensive antithrombotic therapy. The bidirectional association between adverse events in AMI patients and platelet reactivity is typically observed during dual antiplatelet therapy (DAPT).
OBJECTIVE
OBJECTIVE
To investigate platelet reactivity after DAPT in AMI patients with thrombus aspiration performed during PCI.
METHODS
METHODS
In this retrospective study, we examined 269 consecutive AMI patients who underwent PCI and recorded their demographic, clinical and laboratory data. The platelet reactivity was measured with thromboelastogram (TEM).
RESULTS
RESULTS
Ultimately, 208 patients were included in this study and divided into a Thrombus Aspiration group (N = 97) and a PCI Alone group (N = 111) based on whether thrombus aspiration was performed or not. The adenosine diphosphate (ADP)-induced platelet inhibition rate in the Thrombus Aspiration group was higher than that in the PCI Alone group (P < 0.001). Furthermore, multivariate linear regression analysis revealed that the ADP-induced platelet inhibition rate was independently associated with leukocyte count, thrombus aspiration and the combination of aspirin and ticagrelor as DAPT after adjusting for potential covariates in all AMI patients.
CONCLUSION
CONCLUSIONS
In conclusion, clinicians should exercise heightened attention towards the bleeding risk among patients undergoing PCI concomitant with Thrombus Aspiration postoperatively.
Identifiants
pubmed: 39143607
doi: 10.1186/s40001-024-02018-9
pii: 10.1186/s40001-024-02018-9
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Aspirin
R16CO5Y76E
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
420Informations de copyright
© 2024. The Author(s).
Références
Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet. 2017;389(10065):197–210.
doi: 10.1016/S0140-6736(16)30677-8
pubmed: 27502078
Gragnano F, Mehran R, Branca M, Franzone A, Baber U, Jang Y, Kimura T, Hahn JY, Zhao Q, Windecker S, Gibson CM, Kim BK, Watanabe H, Song YB, Zhu Y, Vranckx P, Mehta S, Hong SJ, Ando K, Gwon HC, Calabro P, Serruys PW, Dangas GD, McFadden EP, Angiolillo DJ, Heg D, Valgimigli M. Single versus dual antiplatelet therapy, P2Y(12) inhibitor monotherapy or dual antiplatelet therapy after complex percutaneous coronary interventions. J Am Coll Cardiol. 2023;81(6):537–52.
doi: 10.1016/j.jacc.2022.11.041
pubmed: 36754514
Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ, Group ESCSD. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407–77.
doi: 10.1093/eurheartj/ehz425
pubmed: 31504439
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimsky P, Group ESCSD. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–77.
doi: 10.1093/eurheartj/ehx393
pubmed: 28886621
Kumar V, Sharma AK, Kumar T, Nath RK. Large intracoronary thrombus and its management during primary PCI. Indian Heart J. 2020;72(6):508–16.
doi: 10.1016/j.ihj.2020.11.009
pubmed: 33357638
pmcid: 7772595
Laine M, Panagides V, Frère C, Cuisset T, Gouarne C, Jouve B, Thuny F, Paganelli F, Alessi MC, Mancini J, Bonello L. Platelet reactivity inhibition following ticagrelor loading dose in patients undergoing percutaneous coronary intervention for acute coronary syndrome. J Thromb Haemost. 2019;17(12):2188–95.
doi: 10.1111/jth.14592
pubmed: 31351022
Helten C, Naguib D, Dannenberg L, Pohl M, Ayhan A, Hohlfeld T, Levkau B, Kelm M, Zeus T, Polzin A. Platelet function testing: dead or alive. J Thromb Haemost. 2018;16(5):984–6.
doi: 10.1111/jth.13997
pubmed: 29512292
Shen W, Zhou JY, Gu Y, Shen WY, Li M. Establishing a reference range for thromboelastography maximum amplitude in patients administrating with antiplatelet drugs. J Clin Lab Anal. 2020;34(4): e23144.
doi: 10.1002/jcla.23144
pubmed: 31811687
Wang Y, Meng X, Wang A, Xie X, Pan Y, Johnston SC, Li H, Bath PM, Dong Q, Xu A, Jing J, Lin J, Niu S, Wang Y, Zhao X, Li Z, Jiang Y, Li W, Liu L, Xu J, Chang L, Wang L, Zhuang X, Zhao J, Feng Y, Man H, Li G, Wang B. Ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with stroke or TIA. N Engl J Med. 2021;385(27):2520–30.
doi: 10.1056/NEJMoa2111749
pubmed: 34708996
Jolly SS, Cairns JA, Lavi S, Cantor WJ, Bernat I, Cheema AN, Moreno R, Kedev S, Stankovic G, Rao SV, Meeks B, Chowdhary S, Gao P, Sibbald M, Velianou JL, Mehta SR, Tsang M, Sheth T, Dzavik V, Investigators T. Thrombus aspiration in patients with high thrombus burden in the TOTAL Trial. J Am Coll Cardiol. 2018;72(14):1589–96.
doi: 10.1016/j.jacc.2018.07.047
pubmed: 30261959
Pruthi S, Bangalore S. The state of coronary thrombus aspiration. J Am Heart Assoc. 2022;11(16): e026849.
doi: 10.1161/JAHA.122.026849
pubmed: 35946445
pmcid: 9496285
Elfekky EM, Penjameen MN, Nassar AI, Elias RR. Outcome of manual thrombus aspiration for patients undergoing primary PCI for acute STEMI showing large thrombus burden. Egypt Heart J. 2021;73(1):8.
doi: 10.1186/s43044-020-00122-9
pubmed: 33438135
pmcid: 7803842
Gurbel PA, Jeong YH, Navarese EP, Tantry US. Platelet-mediated thrombosis: from bench to bedside. Circ Res. 2016;118(9):1380–91.
doi: 10.1161/CIRCRESAHA.115.307016
pubmed: 27126648
Koltai K, Kesmarky G, Feher G, Tibold A, Toth K. Platelet aggregometry testing: molecular mechanisms, techniques and clinical implications. Int J Mol Sci. 2017. https://doi.org/10.3390/ijms18081803 .
doi: 10.3390/ijms18081803
pubmed: 28820484
pmcid: 5578190
Vinholt PJ, Hvas AM, Nielsen C, Söderström AC, Sprogøe U, Fialla AD, Nybo M. Reduced platelet activation and platelet aggregation in patients with alcoholic liver cirrhosis. Platelets. 2018;29(5):520–7.
doi: 10.1080/09537104.2017.1349308
pubmed: 28895774
Ortega-Paz L, Brugaletta S, Ariotti S, Akkerhuis KM, Karagiannis A, Windecker S, Valgimigli M. Adenosine and ticagrelor plasma levels in patients with and without ticagrelor-related dyspnea. Circulation. 2018;138(6):646–8.
doi: 10.1161/CIRCULATIONAHA.118.034489
pubmed: 29794083
Li Y, Chang H, Ni L, Xue P, Li C, Yuan L, Cui H, Yu C. Analysis of thrombelastogram-guided medication in patients with coronary heart disease after percutaneous coronary intervention. Exp Ther Med. 2019;17(4):3047–52.
pubmed: 30936976
pmcid: 6434236
Hou XM, Han WZ, Qiu XB, Fang WY. Clinical characteristics associated with high on-treatment platelet reactivity of patients undergoing PCI after a 300 mg loading dose of clopidogrel, measured by thrombelastography. Heart Asia. 2013;5(1):66–9.
doi: 10.1136/heartasia-2013-010296
pubmed: 27326080
pmcid: 4832659
Zhang JH, Tang XF, Zhang Y, Wang J, Yao Y, Ma YL, Xu B, Gao RL, Gao Z, Chen J, Song L, Wu Y, Meng XM, Yuan JQ. Relationship between ABCB1 polymorphisms, thromboelastography and risk of bleeding events in clopidogrel-treated patients with ST-elevation myocardial infarction. Thromb Res. 2014;134(5):970–5.
doi: 10.1016/j.thromres.2014.08.017
pubmed: 25217066
Tantry US, Bonello L, Aradi D, Price MJ, Jeong YH, Angiolillo DJ, Stone GW, Curzen N, Geisler T, TenBerg J, Kirtane A, Siller-Matula J, Mahla E, Becker RC, Bhatt DL, Waksman R, Rao SV, Alexopoulos D, Marcucci R, Reny JL, Trenk D, Sibbing D, Gurbel PA. Working group on on-treatment platelet, consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol. 2013;62(24):2261–73.
doi: 10.1016/j.jacc.2013.07.101
pubmed: 24076493
He D, Guo Y, Zhang Y, Zhao J, Wu L, Yu Z, Qu W, Luo X. Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke. J Neurointerv Surg. 2022;14(7):672–6.
doi: 10.1136/neurintsurg-2021-017615
pubmed: 34326196
Arachchillage DRJ, Laffan M. Can mean platelet volume be used as a predictor of vascular disease? Problems and pitfalls. Semin Thromb Hemost. 2017;43(6):599–608.
doi: 10.1055/s-0037-1603360
pubmed: 28609798
Lai HM, Xu R, Yang YN, Ma YT, Li XM, Zhao Q, Chen QJ, Zhai H, Liu F, Chen BD. Association of mean platelet volume with angiographic thrombus burden and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Catheter Cardiovasc Interv. 2015;85(Suppl 1):724–33.
doi: 10.1002/ccd.25860
pubmed: 25630273
Akkaif MA, Daud NAA, Sha’aban A, Ng ML, Abdul Kader MAS, Noor DAM, Ibrahim B. The role of genetic polymorphism and other factors on clopidogrel resistance (CR) in an Asian population with coronary heart disease (CHD). Molecules. 2021. https://doi.org/10.3390/molecules26071987 .
doi: 10.3390/molecules26071987
pubmed: 33915807
pmcid: 8036376
Park DW, Kwon O, Jang JS, Yun SC, Park H, Kang DY, Ahn JM, Lee PH, Lee SW, Park SW, Choi SW, Lee SG, Yoon HJ, Ahn T, Kim MH, Nah DY, Lee SY, Chae JK, Park SJ. Clinically significant bleeding with ticagrelor versus clopidogrel in Korean patients with acute coronary syndromes intended for invasive management: a randomized clinical trial. Circulation. 2019;140(23):1865–77.
doi: 10.1161/CIRCULATIONAHA.119.041766
pubmed: 31553203
Back M, Yurdagul A Jr, Tabas I, Oorni K, Kovanen PT. Inflammation and its resolution in atherosclerosis: mediators and therapeutic opportunities. Nat Rev Cardiol. 2019;16(7):389–406.
pubmed: 30846875
pmcid: 6727648
Ono M, Tomaniak M, Koenig W, Khamis R, de Silva R, Chichareon P, Kawashima H, Hara H, Gao C, Wang R, Huber K, Vrolix M, Jasionowicz P, Wykrzykowska JJ, Piek JJ, Jüni P, Hamm C, Steg PG, Windecker S, Onuma Y, Storey RF, Serruys PW. Impact of white blood cell count on clinical outcomes in patients treated with aspirin-free ticagrelor monotherapy after percutaneous coronary intervention: insights from the GLOBAL LEADERS trial. Eur Heart J Cardiovasc Pharmacotherapy. 2022;8(1):39–47.
doi: 10.1093/ehjcvp/pvaa110
Costa F, van Klaveren D, James S, Heg D, Räber L, Feres F, Pilgrim T, Hong M-K, Kim H-S, Colombo A, Steg PG, Zanchin T, Palmerini T, Wallentin L, Bhatt DL, Stone GW, Windecker S, Steyerberg EW, Valgimigli M. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017;389(10073):1025–34.
doi: 10.1016/S0140-6736(17)30397-5
pubmed: 28290994
Li J, Yuan D, Jiang L, Tang X, Xu J, Song Y, Chen J, Qiao S, Yang Y, Gao R, Xu B, Yuan J, Zhao X. Similar inflammatory biomarkers reflect different platelet reactivity in percutaneous coronary intervention patients treated with clopidogrel: a large-sample study from China. Front Cardiovasc Med. 2021;8: 736466.
doi: 10.3389/fcvm.2021.736466
pubmed: 34671655
pmcid: 8521006