| Correlation of inhibition of platelet aggregation after clopidogrel with post discharge bleeding events: assessment by different bleeding classifications. | |
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MedLine Citation:
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PMID: 19854728 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: To correlate inhibition of platelet aggregation (IPA) with bleeding events assessed by TIMI, GUSTO, and BleedScore scales in a large cohort of patients with coronary artery disease (CAD) and ischaemic stroke (IS) treated with chronic low-dose aspirin plus clopidogrel. Data from recent trials and registries suggest a link between increased risk of bleeding and cardiovascular mortality. However, the potential association of bleeding risk and IPA is not established. It may play a critical role for the safety of more aggressive platelet inhibition or/and individual tailoring of antiplatelet strategies. METHODS AND RESULTS: Secondary post hoc analyses of 5 microM ADP-induced IPA and bleeding complications assessed by TIMI, GUSTO, and BleedScore scales in a combined data set consisting of patients with documented CAD (n = 246) and previous IS (n = 117). Demographic characteristics differ substantially depending on the underlying vascular disease; however, IPA and bleeding risks were similar between CAD and IS. All three bleeding scales adequately captured serious haemorrhagic events, where the TIMI scale was the most exclusive, whereas BleedScore was the most inclusive. Over half of all patients experienced superficial event(s), most commonly occurring during two to three distinct bleeding episodes. There was no correlation between IPA and duration of antiplatelet therapy. Inhibition of platelet aggregation >50% strongly correlates with minor (r(2) = 0.58, P < 0.001; c-statistic = 0.92), but not severe (r(2) = 0.11, P = 0.038; c-statistic = 0.57), bleeding events. CONCLUSION: Chronic oral combination antiplatelet regimens are associated with a very high (56.5-60.7%) prevalence of superficial bleeding episodes, which are grossly underestimated in trials and registries. The role of such frequent mild complications for the overall benefit of antiplatelet therapy is entirely unknown, as is their effect on compliance. Although IPA is well suited for defining the risk of minor complications, prediction of more severe bleeding events may be challenging. |
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Authors:
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Victor Serebruany; Sunil V Rao; Matthew A Silva; Jennifer L Donovan; Abir O Kannan; Leonid Makarov; Shinya Goto; Dan Atar |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2009-10-23 |
Journal Detail:
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Title: European heart journal Volume: 31 ISSN: 1522-9645 ISO Abbreviation: Eur. Heart J. Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2010-01-15 Completed Date: 2011-01-11 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 227-35 Citation Subset: IM |
Affiliation:
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HeartDrug Research Laboratories, Johns Hopkins University Towson, 7600 Osler Drive, Towson, MD 21204, USA. heartdrug@aol.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Blood Coagulation Tests / methods Coronary Artery Disease / drug therapy* Female Hemorrhage / chemically induced*, classification Humans Male Middle Aged Platelet Aggregation Platelet Aggregation Inhibitors / adverse effects, therapeutic use* Stroke / drug therapy* Ticlopidine / adverse effects, analogs & derivatives*, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Platelet Aggregation Inhibitors; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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