title: Relationship between post-treatment platelet reactivity and ischemic and bleeding events at 1-year follow-up in patients receiving prasugrel.
abstract: BACKGROUND
  Post-treatment platelet reactivity (PR) is associated with ischemic and bleeding events in patients receiving P2Y12 receptor antagonists.
  
  
  OBJECTIVE
  We aimed to study the relationship between post-treatment PR after a 60-mg loading dose (LD) of prasugrel and 1-year thrombotic and bleeding events.
  
  
  METHODS
  Patients were prospectively included in this multicenter study if they had a successful percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and received prasugrel. The platelet reactivity index (PRI) was measured using the Vasodilator-Stimulated Phosphoprotein index (VASP) after a prasugrel LD. Endpoints included the rate of thrombotic events and bleeding events at 1 year.
  
  
  RESULTS
  Among the 301 patients enrolled, 9 (3%) were lost to follow-up at 1 year. The rates of thrombotic and bleeding events at 1 year were of 7.5% and 6.8%, respectively. Receiver-operating curve (ROC) analysis demonstrated an optimal cut-off value of 53.5% of PRI to predict thrombotic events at 1 year. Using this cut-off value we observed that patients exhibiting high on-treatment platelet reactivity (HTPR) had a higher rate of thrombotic events (22.4% vs. 2.9%; P < 0.001). In parallel the optimal cut-off value of PRI to predict bleeding was 16%. Patients with a PRI ≤ 16% had a higher rate of bleeding events compared with those with a PRI > 16% (15.6% vs. 3.3%; P < 0.001). In multivariate analysis, the PRI predicted both thrombotic and bleeding events (OR: 1.44, 95% confidence interval [CI]: 1.2-1.72; P < 0.001 and OR: 0.75, 95% CI: 0.59-0.96; P = 0.024 [respectively, per 10% increase]).
  
  
  CONCLUSIONS
  Platelet reactivity measurement after a prasugrel LD predicts both ischemic and bleeding events at 1 year follow-up for ACS patients undergoing PCI.
authors.affiliation: Département de Cardiologie, Hôpital universitaire nord, Aix-Marseille Univ., France. laurentbonello@yahoo.fr
authors.forename: L
authors.initials: L
authors.lastname: Bonello
authors.forename: J
authors.initials: J
authors.lastname: Mancini
authors.forename: M
authors.initials: M
authors.lastname: Pansieri
authors.forename: L
authors.initials: L
authors.lastname: Maillard
authors.forename: P
authors.initials: P
authors.lastname: Rossi
authors.forename: F
authors.initials: F
authors.lastname: Collet
authors.forename: B
authors.initials: B
authors.lastname: Jouve
authors.forename: O
authors.initials: O
authors.lastname: Wittenberg
authors.forename: M
authors.initials: M
authors.lastname: Laine
authors.forename: P
authors.initials: P
authors.lastname: Michelet
authors.forename: J
authors.initials: J
authors.lastname: Bessereau
authors.forename: G
authors.initials: G
authors.lastname: Lemesle
authors.forename: F
authors.initials: F
authors.lastname: Dignat-George
authors.forename: F
authors.initials: F
authors.lastname: Paganelli
authors.forename: L
authors.initials: L
authors.lastname: Camoin-Jau
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000401:mortality / Q000628:therapy*; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D015815:Cell Adhesion Molecules / Q000097:blood; D003328:Coronary Thrombosis / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008840:Microfilament Proteins / Q000097:blood; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010750:Phosphoproteins / Q000097:blood; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects*; D018570:Risk Assessment; D012307:Risk Factors; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D000098662:Vasodilator-Stimulated Phosphoprotein
chemical_list: D015815:Cell Adhesion Molecules; D008840:Microfilament Proteins; C548576:P2RY12 protein, human; D010750:Phosphoproteins; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D013876:Thiophenes; D000098662:Vasodilator-Stimulated Phosphoprotein; D000068799:Prasugrel Hydrochloride