title: Influence of platelet reactivity on BARC classification in East Asian patients undergoing percutaneous coronary intervention. Results of the ACCEL-BLEED study.
abstract: An increasing body of data suggests that East Asian patients have differing risk profiles for both thrombophilia and bleeding compared with Western population. This study was designed to evaluate the relationship of bleeding to platelet function in East Asians undergoing percutaneous coronary intervention (PCI). Patients who had undergone uneventful PCI (n= 301) were prospectively enrolled and bleeding events were evaluated during dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. Platelet function was measured during hospitalisation and at 30-day follow-up by light transmittance aggregometry (LTA) and vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) assay. During 30-day follow-up, 29.2 % of patients (n= 88) experienced post-discharge Bleeding Academic Research Consortium (BARC) complications (24.6 % and 7.0 % of BARC type 1 and 2, respectively). Patients presenting with acute myocardial infarction had fewer episodes of type 1 BARC bleeding (odds ratio: 0.41; 95 % confidence interval: 0.22 to 0.76; p= 0.005). The cut-off of low platelet reactivity (LPR) (20 µM ADP-induced platelet aggregation ≤ 46.1 %; platelet reactivity index ≤ 45.1 %) was the independent determinant of type 2 BARC bleeding (odds ratio: 3.55 and 4.44; p= 0.009 and 0.002, respectively). The first 30-day BARC bleeding episodes were associated with an increased rate of subsequent premature DAPT discontinuation during one-year follow-up (4.7 % vs 11.4 %; odds ratio: 2.60; 95 % confidence interval: 1.04 to 6.50; p= 0.035). In conclusion, among East Asians, mild bleeding episodes are common early after PCI and are associated with premature DAPT discontinuation. Type 2 BARC bleeding episodes are associated with LPR cut-offs measured at 30 days post-discharge.
authors.forename: Tae Jung
authors.initials: TJ
authors.lastname: Kwon
authors.forename: Udaya S
authors.initials: US
authors.lastname: Tantry
authors.forename: Yongwhi
authors.initials: Y
authors.lastname: Park
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Choi
authors.forename: Jong-Hwa
authors.initials: JH
authors.lastname: Ahn
authors.forename: Kye Hwan
authors.initials: KH
authors.lastname: Kim
authors.forename: Jin-Sin
authors.initials: JS
authors.lastname: Koh
authors.forename: Jeong-Rang
authors.initials: JR
authors.lastname: Park
authors.forename: Seok-Jae
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Choong Hwan
authors.initials: CH
authors.lastname: Kwak
authors.forename: Jin-Yong
authors.initials: JY
authors.lastname: Hwang
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gurbel
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.affiliation: Dr. Young-Hoon Jeong, Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju, Gyeongsangnam-do, 660-702, Korea, Tel.: +82 55 750 8873, Fax: +82 55 750 8873, E-mail: goodoctor@naver.com.
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Jeong
mesh_terms: D000368:Aged; D044466:Asian People / Q000235:genetics; D001241:Aspirin / Q000008:administration & dosage; D015815:Cell Adhesion Molecules / Q000097:blood; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics; D005202:Asia, Eastern; D005260:Female; D006470:Hemorrhage / Q000145:classification* / Q000209:etiology*; D006801:Humans; D008297:Male; D008840:Microfilament Proteins / Q000097:blood; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010750:Phosphoproteins / Q000097:blood; D015539:Platelet Activation; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D010979:Platelet Function Tests; D020641:Polymorphism, Single Nucleotide; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D000098662:Vasodilator-Stimulated Phosphoprotein
chemical_list: D015815:Cell Adhesion Molecules; D008840:Microfilament Proteins; D010750:Phosphoproteins; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000098662:Vasodilator-Stimulated Phosphoprotein; D000077144:Clopidogrel; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine; D001241:Aspirin
keywords: Asia; bleeding; clopidogrel; genotype; phenotype