Influence of platelet reactivity on BARC classification in East Asian patients undergoing percutaneous coronary intervention

Tae Jung Kwon; Udaya S. Tantry; Yongwhi Park; Young-Min Choi; Jong-Hwa Ahn; Kye Hwan Kim; Jin-Sin Koh; Jeong-Rang Park; Seok-Jae Hwang; Choong Hwan Kwak; Jin-Yong Hwang; Paul A. Gurbel; Sidney C. Smith Jr; Young-Hoon Jeong

doi:10.1160/TH15-05-0366

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(05): 979-992
DOI: 10.1160/TH15-05-0366

Cellular Haemostasis and Platelets

Schattauer GmbH

Influence of platelet reactivity on BARC classification in East Asian patients undergoing percutaneous coronary intervention

Results of the ACCEL-BLEED study

Tae Jung Kwon

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

²Department of Internal Medicine, Changwon Fatima Hospital, Changwon, South Korea

,

Udaya S. Tantry

³Sinai Center for Thrombosis Research, Baltimore, Maryland, USA

,

Yongwhi Park

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

,

Young-Min Choi

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

,

Jong-Hwa Ahn

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

,

Kye Hwan Kim

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

,

Jin-Sin Koh

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

,

Jeong-Rang Park

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

,

Seok-Jae Hwang

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

,

Choong Hwan Kwak

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

,

Jin-Yong Hwang

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

,

Paul A. Gurbel

³Sinai Center for Thrombosis Research, Baltimore, Maryland, USA

,

Sidney C. Smith Jr

⁴Center for Cardiovascular Science and Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA

,

Young-Hoon Jeong

¹Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea

› Author Affiliations

Abstract

Summary

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.

Keywords

Asia - clopidogrel - phenotype - genotype - bleeding

Full Text

References

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