title: Predictive value of post-treatment platelet reactivity for occurrence of post-discharge bleeding after non-ST elevation acute coronary syndrome. Shifting from antiplatelet resistance to bleeding risk assessment?
abstract: OBJECTIVE
  We assessed prospectively the association between occurrence of post-discharge non-CABG-related TIMI major and minor bleeding and post-treatment platelet reactivity in patients with non-ST elevation acute coronary syndrome (NSTE ACS).
  
  
  RESULTS
  Five hundred and ninety-seven consecutive patients admitted with NSTE ACS were prospectively included. Between hospital discharge and one month follow-up, we observed 16 (2.7%) non-CABG-related TIMI haemorrhagic complications including five (0.84%) major and 11 (1.8%) minor bleeds. Patients with bleeding had significantly lower post-treatment values of ADP-induced aggregation (43+/-14% versus. 56+/-19%, p=0.002) and platelet reactivity index VASP (43+/-14% versus 54+/-23%; p=0.04) and a trend for lower values of arachidonic acid-induced aggregation (2.4+/-5.4 versus 13+/-21; p=0.27). After stratification by quartiles based on post-treatment ADP-induced platelet aggregation, we identified patients in the first quartile as hyper-responders with very low post-treatment platelet reactivity, below <40%. The risk of TIMI major and minor bleeding was significantly higher in the first quartile of hyper-responders than in the others quartiles: 10 (6.6%) versus six (1.4%), p=0.001.
  
  
  CONCLUSIONS
  Our results suggest that assessment of post-treatment platelet reactivity might be used to detect hyper-responders to antiplatelet therapy with higher risk of non-CABG related bleeding and tailor antiplatelet therapy according to both ischaemic and bleeding risk.
authors.affiliation: Department of Cardiology, CHU Timone, Marseille, France. thomascuisset@voila.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuisset
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.forename: Corinne
authors.initials: C
authors.lastname: Frere
authors.forename: Jacques
authors.initials: J
authors.lastname: Quilici
authors.forename: Raphael
authors.initials: R
authors.lastname: Poyet
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Gaborit
authors.forename: Laurent
authors.initials: L
authors.lastname: Bali
authors.forename: Pierre Emmanuel
authors.initials: PE
authors.lastname: Morange
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Alessi
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bonnet
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D000244:Adenosine Diphosphate; D000368:Aged; D016718:Arachidonic Acid; D001241:Aspirin / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D015815:Cell Adhesion Molecules / Q000097:blood; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D004359:Drug Therapy, Combination; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000139:chemically induced; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000097:blood / Q000139:chemically induced; D008297:Male; D008840:Microfilament Proteins / Q000097:blood; D008875:Middle Aged; D010351:Patient Discharge; D010750:Phosphoproteins / Q000097:blood; D010766:Phosphorylation; D010865:Pilot Projects; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome; D000098662:Vasodilator-Stimulated Phosphoprotein
chemical_list: D015415:Biomarkers; D015815:Cell Adhesion Molecules; D008840:Microfilament Proteins; D010750:Phosphoproteins; D010975:Platelet Aggregation Inhibitors; D000098662:Vasodilator-Stimulated Phosphoprotein; D016718:Arachidonic Acid; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin