title: Low On-Treatment Platelet Reactivity Predicts Long-Term Risk of Bleeding After Elective PCI.
abstract: BACKGROUND
  Bleeding after percutaneous coronary interventions (PCI) is an important complication with impact on prognosis.
  
  
  OBJECTIVE
  To evaluate the predictive value of enhanced platelet responsiveness to dual antiplatelet therapy with aspirin and clopidogrel, for bleeding, after elective PCI.
  
  
  RESULTS
  We performed multiple electrode aggregometry (MAE) platelet functional tests induced by arachidonic acid (ASPI) and adenosine-diphosphate (ADP) before PCI, and 24 hours after PCI, in 481 elective PCI patients who were followed-up for an average of 15.34 ± 7.19 months. Primary end point was the occurrence of any bleeding, while ischemic major adverse cardiovascular event (MACE) was a secondary endpoint. The incidence of total, BARC ≤ 2, and BARC ≥ 3 bleeding, according to BARC classification, was 19, 18, and 1%, respectively. Groups with any, and BARC ≤ 2 bleeding, had a lower average value of MAE ADP test after 24 hours, compared to the group without bleeding: 45.30 ± 18.63 U versus 50.99 ± 19.01 U; P = 0.005; and 45.75 ± 18.96 U versus 50.99 ± 18.99 U; P = 0.01; respectively. Female gender (HR 2.11; CI 1.37-3.25; P = 0.001), previous myocardial infarction (HR 0.56; CI 0.37-0.85; P = 0.006), lower body mass (HR 0.78; CI 0.62-0.98; P = 0.03), and MAE ADP test after 24 hours (HR 0.75; CI 0.61-0.93; P = 0.009) were the independent predictors for any bleeding by Cox univariate analysis. After adjustment, MAE ADP test after 24 hours, was the only independent predictor for any (HR 0.7; CI 0.56-0.87; P = 0.002), and BARC ≤ 2 (HR 0.71; CI 0.56-0.89; P = 0.003) bleeding, by Cox multivariate analysis.
  
  
  CONCLUSIONS
  MAE ADP test before and after PCI, was associated with any, and BARC ≤ 2 bleeding after elective PCI.
authors.affiliation: Dedinje Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Mirko D
authors.initials: MD
authors.lastname: Čolić
authors.affiliation: Dedinje Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Branko M
authors.initials: BM
authors.lastname: Čalija
authors.affiliation: Dedinje Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Bratislav M
authors.initials: BM
authors.lastname: Milosavljević
authors.affiliation: Cardiology Clinic, Military Academy, Belgrade, Serbia.
authors.forename: Aleksandra G
authors.initials: AG
authors.lastname: Grdinić
authors.affiliation: Dedinje Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Lazar G
authors.initials: LG
authors.lastname: Angelkov
authors.affiliation: Dedinje Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Dragan Ž
authors.initials: DŽ
authors.lastname: Sagić
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic.
authors.forename: Peter
authors.initials: P
authors.lastname: Kruzliak
authors.affiliation: School of Medicine, Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia.
authors.forename: Jelena M
authors.initials: JM
authors.lastname: Marinković
authors.affiliation: Dedinje Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Rade M
authors.initials: RM
authors.lastname: Babić
authors.affiliation: Urgent Cardiology, Emergency Hospital, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Igor B
authors.initials: IB
authors.lastname: Mrdović
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin