title: The Prognostic Value of ADP-Induced Platelet Aggregation for Bleeding Complications in Low - Intermediate Risk Patients with Acute Coronary Syndrome Taking Clopidogrel After Percutaneous Coronary Intervention.
abstract: BACKGROUND
  Platelet aggregation may predict the bleeding outcomes after percutaneous coronary intervention (PCI).
  
  
  METHODS
  Consecutive patients with non-high risk acute coronary syndrome and indication for PCI were enrolled. Maximum adenosine diphosphate-induced platelet aggregation (ADP-PGmax) was assessed by light transmission aggregometry. Study endpoints were the incidence of haemorrhage, categorised by Thrombolysis in Myocardial Infarction criteria, and significant entry-site complications during hospitalisation and six-month follow-up period. Platelet aggregation test was organised at 24h after PCI and 1 month after discharge respectively. The optimal platelet aggregation was detected defining enhanced clopidogrel response, and associations of measurements with endpoints were assessed.
  
  
  RESULTS
  A total of 278 patients were included in analyses. Study endpoints were observed in 24 (8.6%) patients [major bleeding, n=4 (1.4%); minor bleeding, n=11 (4.0%); significant entry-site complication, n=9 (3.2%)]. In multivariate analysis, follow-up ADP-PGmax[odds ratio (OR)=0.96;95% confidence interval (CI),0.93-0.99;p=0.008) and renal insufficiency (OR=3.29; 95%CI, 1.23-8.85; p=0.018) were predictors of bleeding events. The optimal cutoff value for follow-up ADP-PGmaxwas 24.5% (area under the curve=0.72; 95% CI, 0.59-0.85; p<0.001). Bleeding occurred in 26.2% (16/61) of patients with enhanced clopidogrel response and 3.7% (8/217) of other patients (OR=9.26; p<0.001).
  
  
  CONCLUSIONS
  Enhanced clopidogrel responsiveness was associated with an increased risk of bleeding and entry-site complication. Platelet function testing at an appropriate time after clopidogrel administration helps to identify patients at high risk of bleeding.
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong Cardiovascular Institute, 510080, Guangzhou, China. Electronic address: lijun_jin2000@126.com.
authors.forename: Lijun
authors.initials: L
authors.lastname: Jin
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong Cardiovascular Institute, 510080, Guangzhou, China.
authors.forename: Huimin
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong Cardiovascular Institute, 510080, Guangzhou, China.
authors.forename: Taiming
authors.initials: T
authors.lastname: Dong
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong Cardiovascular Institute, 510080, Guangzhou, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong Cardiovascular Institute, 510080, Guangzhou, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Yan
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong Cardiovascular Institute, 510080, Guangzhou, China.
authors.forename: Hongtao
authors.initials: H
authors.lastname: Liao
authors.affiliation: Department of Medical Statistical Record, Guangzhou Oncology Hospital, Guangzhou Medical College, Guangzhou, 510095, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Zou
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000628:therapy*; D000244:Adenosine Diphosphate / Q000494:pharmacology*; D000368:Aged; D000077144:Clopidogrel; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010974:Platelet Aggregation / Q000187:drug effects*; D011379:Prognosis; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Clopidogrel; Haemorrhage; Percutaneous Coronary Intervention; Platelet aggregation