Increased mean platelet volume is associated with non-responsiveness to clopidogrel

Elad Asher; Paul Fefer; Michael Shechter; Roy Beigel; David Varon; Boris Shenkman; Naphtali Savion; Hanoch Hod; Shlomi Matetzky

doi:10.1160/TH13-10-0845

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2014; 112(01): 137-141
DOI: 10.1160/TH13-10-0845

Platelets and Blood Cells

Schattauer GmbH

Increased mean platelet volume is associated with non-responsiveness to clopidogrel

Authors

Elad Asher

¹Heart Center, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Paul Fefer

¹Heart Center, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Michael Shechter

¹Heart Center, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Roy Beigel

¹Heart Center, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
David Varon

²Coagulation Unit, Dept. of Hematology, Hadassah Medical Center, Hebrew University Medical Center, Jerusalem, Israel
Boris Shenkman

³Hematology Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Naphtali Savion

⁴Goldschleger Eye Institute, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Hanoch Hod

¹Heart Center, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Shlomi Matetzky

¹Heart Center, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Abstract

Summary

Prior studies have demonstrated significant individual variability of platelet response to clopidogrel, which affects clinical outcome. In patients with stable coronary artery disease (CAD) smoking, diabetes mellitus, elevated body mass index and renal insufficiency, significantly impact response to clopidogrel. The determinants of platelet response to clopidogrel in patients with acute coronary syndrome are unknown. Adenosine diphosphate (ADP)-induced platelet aggregation (PA), hs C-reactive protein, platelet count and mean platelet volume (MPV) were determined 72 hours post clopidogrel loading in 276 consecutive acute myocardial infarction (AMI) patients. Patients with ADP-platelet aggregation ≥ 70% were considered to be clopidogrel non-responders. Eighty-four patients (30%) were clopidogrel non-responders and 192 (70%) were responders (ADP-induced PA: 81 ± 17% vs 49 ± 17%, respectively, p<0.001). Both study groups were comparable with respect to age, gender, prior cardiovascular history, prior aspirin use and risk factors for CAD, including smoking (42% for both groups) and diabetes mellitus (26% vs 22%, respectively, p=0.4). Responders and non-responders had similar angiographic characteristics, indices of infarct size, and similar hs-CRP (29 ± 34 vs 28 ± 34 mg/l, p=0.7) and creatinine (1.08 ± 0.4 mg% vs 1.07 ± 0.4, p=0.9) levels. On the contrary non-responders had significantly larger mean MPV (9 ± 1.2 fl vs 8 ± 1 fl, respectively, p=0.0018), and when patients were stratified into quartiles based on MPV, ADP-induced PA increased gradually and significantly across the quartiles of MPV (p<0.001). In conclusion, increased MPV associated with platelet activation, predicts non-responsiveness to clopidogrel among patients with acute coronary syndrome.

Keywords

Acute coronary syndrome - platelet activation - response to clopidogrel - mean platelet volume

Full Text

References

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