Adenosine diphosphate-induced platelet-fibrin clot strength: a new thrombelastographic indicator of long-term poststenting ischemic events.
BACKGROUND
Poststenting ischemic events occur despite dual-antiplatelet therapy, suggesting that a "one size fits all" antithrombotic strategy has significant limitations. Ex vivo platelet function measurements may facilitate risk stratification and personalized antiplatelet therapy.


METHODS
We investigated the prognostic utility of the strength of adenosine diphosphate (ADP)-induced (MA(ADP)) and thrombin-induced (MA(THROMBIN)) platelet-fibrin clots measured by thrombelastography and ADP-induced light transmittance aggregation (LTA(ADP)) in 225 serial patients after elective stenting treated with aspirin and clopidogrel. Ischemic and bleeding events were assessed over 3 years.


RESULTS
Overall, 59 (26%) first ischemic events occurred. Patients with ischemic events had higher MA(ADP), MA(THROMBIN), and LTA(ADP) (P < .0001 for all comparisons). By receiver operating characteristic curve analysis, MA(ADP) >47 mm had the best predictive value of long-term ischemic events compared with other measurements (P < .0001), with an area under the curve = 0.84 (95% CI 0.78-0.89, P < .0001). The univariate Cox proportional hazards model identified MA(ADP) >47 mm, MA(THROMBIN) >69 mm, and LTA(ADP) >34% as significant independent predictors of first ischemic events at the 3-year time point, with hazard ratios of 10.3 (P < .0001), 3.8 (P < .0001), and 4.8 (P < .0001), respectively. Fifteen bleeding events occurred. Receiver operating characteristic curve and quartile analysis suggests MA(ADP) <or=31 as a predictive value for bleeding.


CONCLUSIONS
This study is the first demonstration of the prognostic utility of MA(ADP) in predicting long-term event occurrence after stenting. The quantitative assessment of ADP-stimulated platelet-fibrin clot strength measured by thrombelastography can serve as a future tool in investigations of personalized antiplatelet treatment designed to reduce ischemic events and bleeding.
Gurbel
Paul A
PA
Sinai Center for Thrombosis Research, Baltimore, MD 21215, USA. pgurbel@lifebridgehealth.org
Bliden
Kevin P
KP
Navickas
Irene A
IA
Mahla
Elizabeth
E
Dichiara
Joseph
J
Suarez
Thomas A
TA
Antonino
Mark J
MJ
Tantry
Udaya S
US
Cohen
Eli
E
D000244:Adenosine Diphosphate / Q000494:pharmacology; D006801:Humans; D015994:Incidence; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015607:Stents; D013916:Thrombelastography
D000244:Adenosine Diphosphate