title: Antiplatelet effects of clopidogrel and aspirin after interventional patent foramen ovale/ atrium septum defect closure.
abstract: The optimal antiplatelet therapy after patent foramen ovale (PFO)/ atrium septum defect (ASD) closure is a matter of discussion. It is challenging as inter-individual responses to antiplatelet medication vary significantly and common complications are bleeding and ischemic events. In this study, we aimed to analyze the incidence of high on-treatment platelet reactivity (HTPR) to antiplatelet medication in patients undergoing PFO/ASD closure as well as clinical complications and thrombus formation on the occluder during six-month follow-up. This hypothesis generating pilot study was observed, which included 140 patients undergoing PFO/ASD closure. The primary endpoint was pharmacodynamic response to antiplatelet medication. A composite of death, myocardial infarction, bleeding, stroke and thrombus formation on the occluder during six-month follow-up was the secondary endpoint. HTPR to clopidogrel was analyzed using the vasodilator-stimulated protein phosphorylation (VASP), HTPR to aspirin by light-transmission aggregometry (LTA). In 71% of patients HTPR to clopidogrel was detected, HTPR to aspirin in only 4%. We observed 12 complications, 9 bleeding events (including 3 major bleeding events) and 3 transient ischemic attacks. No stroke and no thrombus formation on the occluder occurred. The primary endpoint was not associated with the secondary endpoint. The incidence of HTPR to clopidogrel in PFO/ASD closure patients is very high. Despite this high incidence, no stroke or thrombus formation on the occluder occurred at all. This leads to the hypothesis, that the benefit of additional clopidogrel medication is questionable and has to be investigated in large-scale clinical trials.
authors.affiliation: a Division of Cardiology, Pulmonology, and Vascular Medicine , Heinrich Heine University Medical Center Düsseldorf , Düsseldorf , Germany.
authors.forename: Amin
authors.initials: A
authors.lastname: Polzin
authors.affiliation: a Division of Cardiology, Pulmonology, and Vascular Medicine , Heinrich Heine University Medical Center Düsseldorf , Düsseldorf , Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dannenberg
authors.affiliation: a Division of Cardiology, Pulmonology, and Vascular Medicine , Heinrich Heine University Medical Center Düsseldorf , Düsseldorf , Germany.
authors.forename: Valérie-
authors.initials: V
authors.lastname: Sophia Popp
authors.affiliation: a Division of Cardiology, Pulmonology, and Vascular Medicine , Heinrich Heine University Medical Center Düsseldorf , Düsseldorf , Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: a Division of Cardiology, Pulmonology, and Vascular Medicine , Heinrich Heine University Medical Center Düsseldorf , Düsseldorf , Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Zeus
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D006348:Cardiac Surgical Procedures; D000077144:Clopidogrel; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000097:blood* / Q000188:drug therapy* / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000187:drug effects; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011182:Postoperative Care; D011300:Preoperative Care; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: ASD; PFO; aspirin; clopidogrel; high on-treatment platelet reactivity