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Risk for ischemic events linked to high residual platelet reactivity status

Parodi G. JAMA. 2011;306:1215-1223.

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High residual platelet reactivity status was associated with increased risk for ischemic events at short- and long-term follow-up among patients receiving platelet reactivity-guided antithrombotic medication after percutaneous coronary intervention, according to a study.

The prospective study included patients with acute coronary syndrome undergoing PCI from April 2005 to April 2009. Platelet reactivity after clopidogrel (Plavix, Sanofi-Aventis) loading was prospectively assessed in all patients. According to the study, ACS included unstable angina with ST segment changes, non-STEMI and STEMI. Follow-up examinations were at 1, 6 and 12 months, and then annually. Researchers defined the primary endpoint as a composite of cardiac death, MI, any urgent coronary revascularization and stroke at 2-year follow-up; and secondary endpoint as each component of the primary endpoint and stent thrombosis.

In patients with high residual platelet reactivity (HRPR), researchers found stent thrombosis was higher vs. low residual platelet reactivity (absolute risk increase=3.2%; 95% CI, 0.4-6.7). Researchers also found a higher estimated risk for primary endpoint rates in HRPR (27.5%; 95% CI, 18.3-36.7) vs. low residual platelet reactivity (8.7%; 95% CI, 1.6-11.1). There was a 14% incidence rate of HRPR by adenosine diphosphate test after clopidogrel loading, and there was a more frequent rate of congestive HF and left ventricular ejection fraction of less than 40% in HRPR patients. There was an overall follow-up rate of 99.6% of patients with HRPR and 98.9% of patients without HRPR (P=.31). Adherence to dual antiplatelet treatment was very high at 6 months, with 97% of patients taking aspirin and thienopyridine. Sixty-three percent of low residual platelet reactivity patients and 68% of HRPR patients were taking two antiplatelet agents by a median follow-up of 2.8 years, according to the study.

Researchers found that patients were older and had a higher incidence of diabetes mellitus, hypercholesterolemia and a history of previous MI with HRPR vs. patients with low residual platelet reactivity, who had more frequent STEMI.

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