title: Mean platelet volume and high-residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor.
abstract: OBJECTIVE
  High on-treatment platelet reactivity (HRPR) is associated with a two- to ninefold increased risk of recurrent ischemic events among patients receiving dual antiplatelet therapy (DAPT) for coronary artery disease. However, its determinants are still poorly understood. The aim of the present study was to assess the impact of mean platelet volume (MPV) on platelet reactivity in patients receiving DAPT after an acute coronary syndrome or PCI.
  
  
  METHODS
  Patients treated with DAPT (acetylsalicylic acid [ASA] and clopidogrel or ticagrelor) were scheduled for platelet function assessment at 30 - 90 days post-discharge. By whole blood impedance aggregometry, HRPR was considered for ASPI test > 862 aggregation units (AU)*min (for ASA) and ADP test values ≥ 417 AU*min (for ADP-antagonists).
  
  
  RESULTS
  Our population is represented by a total of 487 patients on DAPT, divided according to MPV tertiles (< 10.4 fl; 10.4 - 11.29 fl; ≥ 11.3 fl). Larger-sized platelets were associated with use of statins (p < 0.001) and beta-blockers (p = 0.03), higher hemoglobin levels (p = 0.002) and lower platelets count (p < 0.001). Higher platelet reactivity was observed at ASPI test in patients with higher MPV (r = 0.12, p = 0.008), but not for ADP-mediated aggregation (r = -0.007, p = 0.88). However, a low prevalence of HRPR was observed with ASA, with no impact of MPV tertiles (1.2 vs 1.1 vs 1.6%, p = 0.70, adjusted OR [95% CI] = 1.05 [0.51 - 1.77], p = 0.87). MPV did not influence the prevalence of HRPR for ADP-antagonists (25.9 vs 1 vs 26.5%, p = 0.89; adjusted OR [95% CI] = 1.1 [0.84 - 1.45], p = 0.50) with similar results among the 259 patients receiving clopidogrel (adjusted OR [95% CI] = 1.15 [0.82 - 1.62], p = 0.43) and the 228 patients on ticagrelor (adjusted OR [95% CI] = 1.46 [0.84 - 2.55], p = 0.18).
  
  
  CONCLUSIONS
  In patients receiving DAPT, MPV does not affect the response to major antiplatelet therapies. In fact, MPV elevation does not influence the risk of HRPR with clopidogrel, ticagrelor or ASA.
authors.affiliation: Eastern Piedmont University, Ospedale 'Maggiore della Carità', Department of Cardiology , C.so Mazzini, 18 28100 Novara , Italy +39 0321 3733141 ; +39 0321 3733407 ; giuseppe.deluca@maggioreosp.novara.it.
authors.forename: Monica
authors.initials: M
authors.lastname: Verdoia
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pergolini
authors.forename: Roberta
authors.initials: R
authors.lastname: Rolla
authors.forename: Matteo
authors.initials: M
authors.lastname: Nardin
authors.forename: Lucia
authors.initials: L
authors.lastname: Barbieri
authors.forename: Alon
authors.initials: A
authors.lastname: Schaffer
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bellomo
authors.forename: Paolo
authors.initials: P
authors.lastname: Marino
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects* / Q000473:pathology / Q000502:physiology; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D063847:Mean Platelet Volume; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin
keywords: clopidogrel; coronary artery disease; dual antiplatelet therapy; high-residual platelet reactivity; mean platelet volume; platelet aggregation; platelet volume; ticagrelor