What question did this study set out to answer?

To determine whether high-responsiveness to dual antiplatelet therapy increases the risk of major bleeding complications in patients undergoing drug-eluting stent implantation.

January 1, 2010Circulation JournalOpen Access

Impact of High-Responsiveness to Dual Antiplatelet Therapy on Bleeding Complications in Patients Receiving Drug-Eluting Stents

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Why the study?

Does high-responsiveness to antiplatelet therapy increase bleeding complications in patients receiving drug-eluting stents?

Population

184 patients undergoing elective drug-eluting stent implantation treated with aspirin and a thienopyridine

Comparison

High-responsiveness to antiplatelet therapy vs Middle-responders and low-responders to…

Design

Cohort

Follow-up

average of 16 months

Authors

KTKengo TsukaharaFujisawa City Hospital KKKazuo KimuraInterventional Cardiology SMSatoshi MoritaKyoto University

Discussion

Member takes

Implication

High platelet responsiveness may elevate major bleeding risk on DAPT after DES; leaves open whether function testing should guide therapy.

Key Points

To determine whether high-responsiveness to dual antiplatelet therapy increases the risk of major bleeding complications in patients undergoing drug-eluting stent implantation.
Assessed post-treatment platelet reactivity to adenosine diphosphate before elective drug-eluting stent implantation in 184 patients receiving aspirin and a thienopyridine (ticlopidine 200 mg/day or clopidogrel 75 mg/day).
Divided participants into high-responders (1st quartile), middle-responders (2nd and 3rd quartiles), and low-responders (4th quartile), with clinical follow-up averaging 16 months.
Major bleeding occurred significantly more often in high-responders (15%) than in middle-responders (4%) or low-responders (2%, P=0.02), with high-responsiveness independently predicting major bleeding (OR 4.26, P=0.03).
Adverse cardiac events were documented in 24% of high-responders, 16% of middle-responders, and 37% of low-responders (P=0.02).
Middle-responders demonstrated superior net clinical outcomes compared with both high- and low-responders (21% vs 39% vs 39%, P=0.02).

Structured PICO

Does high-responsiveness to antiplatelet therapy increase bleeding complications in patients receiving drug-eluting stents?

Population

184 patients undergoing elective drug-eluting stent implantation treated with aspirin and a thienopyridine (200 mg/day of ticlopidine or 75 mg/day of clopidogrel)

Intervention

High-responsiveness to antiplatelet therapy (defined as the 1st quartile of post-treatment platelet reactivity to adenosine diphosphate before stenting)

Comparator

Middle-responders (2nd and 3rd quartiles) and low-responders (4th quartile) to antiplatelet therapy

Outcome

Major bleedingsafety

High-responsiveness to dual antiplatelet therapy in patients receiving drug-eluting stents is associated with an increased risk of major bleeding without a corresponding reduction in adverse cardiac events.

Cite This Study

Tsukahara et al. (2010) studied this question.

synapsesocial.com/papers/6a7df77ac2b228f3e18caad3 https://doi.org/10.1253/circj.cj-09-0601

Topics

Coronary artery disease Dual antiplatelet therapy Women and heart disease

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Implication

High platelet responsiveness may elevate major bleeding risk on DAPT after DES; leaves open whether function testing should guide therapy.

Impact of High-Responsiveness to Dual Antiplatelet Therapy on Bleeding Complications in Patients Receiving Drug-Eluting Stents

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Impact of High-Responsiveness to Dual Antiplatelet Therapy on Bleeding Complications in Patients Receiving Drug-Eluting Stents

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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