title: Platelet-to-lymphocyte ratio but not neutrophil-to-lymphocyte ratio predicts high on-treatment platelet reactivity in clopidogrel-treated patients with acute coronary syndrome.
abstract: OBJECTIVE
  Dual antiplatelet therapy (DAPT), consisting of clopidogrel and aspirin, is the main-stay treatment of acute coronary syndromes (ACS). However, major adverse cardiovascular events may occur even in patients undergoing DAPT, and this has been related to the variable pharmacodynamic efficacy of these drugs, especially clopidogrel. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are novel inflammatory markers for cardiovascular risk stratification, which may reflect an inflammatory state and thus high on-treatment platelet reactivity (HPR).
  
  
  METHODS
  We investigated the usefulness of PLR and NLR in predicting HPR in clopidogrel-treated patients with ACS. A total of 244 patients were enrolled in this study, and 43 of them were nonresponsive to clopidogrel.
  
  
  RESULTS
  Logistic regression analysis indicated that PLR was significantly associated with HPR (P< 0.001). Using a cutoff level of 331, PLR predicted HPR with a sensitivity of 73% and a specificity of 69% (odds ratio: 376.15, 95% confidence interval = 37.813-3741.728P< 0.001, receiver operating characteristic curve: 0.885).
  
  
  CONCLUSIONS
  We suggest that more attention should be paid to the PLR values of these patients on admission to identify individuals who may not benefit from clopidogrel during the course of ACS.
authors.affiliation: Tınaztepe Hospital, Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Edem
authors.initials: E
authors.lastname: Efe
authors.affiliation: Department of Cardiology, Izmir Bergama State Hospital, Izmir, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Kocayiğit
authors.affiliation: Department of Cardiology, Izmir Bergama State Hospital, Izmir, Turkey.
authors.forename: Pabuccu Mustafa
authors.initials: PM
authors.lastname: Türker
authors.affiliation: Department of Cardiology, Dokuz Eylül University Faculty of Medicine, Turkey.
authors.forename: Küçükukur
authors.initials: K
authors.lastname: Murat
authors.affiliation: Department of Cardiology, Uşak State Hospital, Usak, Turkey.
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Erkan
authors.affiliation: Department of Cardiology, Uşak State Hospital, Usak, Turkey.
authors.forename: Taş
authors.initials: T
authors.lastname: Sedat
authors.affiliation: Department of Cardiology, Uşak State Hospital, Usak, Turkey.
authors.forename: Çil
authors.initials: Ç
authors.lastname: Alper
authors.affiliation: Department of Cardiology, Izmir Bergama State Hospital, Izmir, Turkey.
authors.forename: Aksoy Murat
authors.initials: AM
authors.lastname: Necati
authors.affiliation: Department of Cardiology, Izmir Bergama State Hospital, Izmir, Turkey.
authors.forename: Vural Mustafa
authors.initials: VM
authors.lastname: Gökhan
authors.affiliation: Department of Cardiology, Uşak State Hospital, Usak, Turkey.
authors.forename: Akdeniz
authors.initials: A
authors.lastname: Bahri
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D015415:Biomarkers; D001772:Blood Cell Count; D001792:Blood Platelets / Q000166:cytology*; D000077144:Clopidogrel; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016015:Logistic Models; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Acute coronary syndrome; clopidogrel; drug resistance; lymphocyte; neutrophil; platelet