PMID- 22987197
OWN - NLM
STAT- MEDLINE
DCOM- 20140117
LR  - 20211021
IS  - 1573-742X (Electronic)
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 36
IP  - 1
DP  - 2013 Jul
TI  - Increased risk of minor bleeding and antiplatelet therapy cessation in patients 
      with acute coronary syndromes and low on-aspirin platelet reactivity. A 
      prospective cohort study.
PG  - 22-30
LID - 10.1007/s11239-012-0808-5 [doi]
AB  - Bleeding negatively affects prognosis and adherence to antiplatelet therapy after 
      acute coronary syndromes (ACSs). The potential association of on-aspirin platelet 
      reactivity and bleeding is not established. We sought to determine whether low 
      on-aspirin platelet reactivity (LAPR) is associated with bleeding events and 
      antiplatelet therapy compliance in patients with ACSs receiving coronary 
      stenting. On-aspirin platelet reactivity was measured by the VerifyNow Aspirin 
      assay (Accumetrics Inc., San Diego, CA, USA) in 531 patients with ACS. Cut-offs 
      for LAPR were calculated by receiver-operating characteristic curve (ROC) 
      analysis. Bleeding was reported according to Bleeding Academic Research 
      Consortium (BARC) definition. The endpoints were minor bleeding (BARC types 1 or 
      2), major bleeding (BARC types 3 or 5) and antiplatelet therapy cessation during 
      6-months follow-up. By ROC analysis the VerifyNow Aspirin assay was able to 
      distinguish between patients with and without minor bleeding (area under the 
      curve [AUC] 0.66, 95 % confidence interval [CI] 0.62-0.70, P < 0.0001) whereas 
      major bleeding could not be predicted by the assay (AUC 0.54, 95 % CI 0.49-0.58, 
      P = 0.473). By logistic regression, LAPR was associated with increased risk of 
      minor bleeding (odds ratio [OR] 4.32, 95 % CI 2.78-6.71, P < 0.0001) but not 
      major bleeding (OR 2.05, 95 % CI 0.83-5.06, P = 0.117). Antiplatelet therapy 
      discontinuation was more frequent in patients with LAPR as compared to those with 
      no LAPR (21.6 vs. 9.1 %, P = 0.0008). In conclusion, early point-of-care 
      on-aspirin platelet reactivity testing in ACS may identify patients with 
      increased risk of minor bleeding events and subsequent discontinuation of 
      antiplatelet therapy. The possible impact of LAPR on major bleeding needs to be 
      determined in larger trials.
FAU - Huczek, Zenon
AU  - Huczek Z
AD  - Ist Chair and Department of Cardiology, The Medical University of Warsaw, 1a 
      Banacha Street, 02-097 Warsaw, Poland. zenon.huczek@wum.edu.pl
FAU - Filipiak, Krzysztof J
AU  - Filipiak KJ
FAU - Kochman, Janusz
AU  - Kochman J
FAU - Michalak, Marcin
AU  - Michalak M
FAU - Grabowski, Marcin
AU  - Grabowski M
FAU - Opolski, Grzegorz
AU  - Opolski G
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Acute Coronary Syndrome/blood/diagnosis/*drug therapy
MH  - Aged
MH  - Aspirin/administration & dosage/*adverse effects/pharmacokinetics
MH  - Female
MH  - Follow-Up Studies
MH  - Hemorrhage/*chemically induced/diagnosis
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/administration & dosage/*adverse 
      effects/pharmacokinetics
MH  - *Point-of-Care Systems
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Factors
MH  - Withholding Treatment
PMC - PMC3682102
EDAT- 2012/09/19 06:00
MHDA- 2014/01/18 06:00
PMCR- 2012/09/18
CRDT- 2012/09/19 06:00
PHST- 2012/09/19 06:00 [entrez]
PHST- 2012/09/19 06:00 [pubmed]
PHST- 2014/01/18 06:00 [medline]
PHST- 2012/09/18 00:00 [pmc-release]
AID - 808 [pii]
AID - 10.1007/s11239-012-0808-5 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2013 Jul;36(1):22-30. doi: 10.1007/s11239-012-0808-5.