Pendyala, Lakshmana K Loh, Joshua P Lhermusier, Thibault Minha, Sa'ar Magalhaes, Marco A Torguson, Rebecca Chen, Fang Satler, Lowell F Pichard, Augusto D Waksman, Ron

Does baseline hematocrit influence the assays of on-treatment platelet reactivity to clopidogrel?.

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: High on-treatment platelet reactivity (HTPR) has been shown to be associated with adverse cardiac events in patients undergoing percutaneous coronary intervention, but the effect of baseline hematologic parameters upon platelet reactivity remains controversial. OBJECTIVE: The present study aims to evaluate the impact of hematocrit on 2 different assay methods used to assess on-treatment platelet reactivity to clopidogrel. METHODS: We tested clopidogrel on-treatment platelet reactivity in 466 consecutive patients using VerifyNow P2Y12 (VN) and light transmission aggregometry (LTA) with adenosine diphosphate (ADP) 5 and 20 muM assays 6 to 24 hours after percutaneous coronary intervention. Patients were categorized into 4 groups according to baseline hematocrit. One-year major adverse cardiac events, including death, nonfatal myocardial infarction, and definite stent thrombosis, were collected. RESULTS: Lower hematocrit was associated with higher P2Y12 reaction unit (PRU) and a higher rate of HTPR (P < .001) as measured by VN assay. No differences were seen among the 4 groups in platelet reactivity measured by LTA using ADP 5 muM (P = .23) and ADP 20 muM (P = .21). In a multivariable logistic regression model, baseline hematocrit was independently associated with PRU >208 (odds ratio [OR] 0.92, 95% CI 0.86-0.97, P = .005) but had no correlation with LTA ADP 5 muM >46% (OR 1.0, 95% CI 0.95-1.06, P = .88) or LTA ADP 20 muM >59% (OR 1.03, 95% CI 0.97-1.09, P = .39). In a logistic regression model, the addition of VN assay results, hematocrit, and interaction between the hematocrit and assay results had shown a significant influence on the area under curve for prediction of 1-year major adverse cardiac events compared with baseline clinical variables only for PRU (0.63 vs 0.76, P = .006) but not with LTA (0.64 vs 0.74, P = .13). CONCLUSION: Baseline hematocrit has a differential influence on results of the ex vivo platelet functional assays. Lower baseline hematocrit was independently associated with HTPR by VN but not LTA. This may affect the interpretation of platelet function testing in patients with significant anemia.Copyright � 2014 Mosby, Inc. All rights reserved.


English

0002-8703


Aged
*Blood Platelets/de [Drug Effects]
Elective Surgical Procedures/mt [Methods]
Female
Follow-Up Studies
*Hematocrit/mt [Methods]
Humans
Male
Middle Aged
*Myocardial Infarction/bl [Blood]
Myocardial Infarction/dt [Drug Therapy]
Myocardial Infarction/su [Surgery]
*Percutaneous Coronary Intervention
*Platelet Aggregation/de [Drug Effects]
Prospective Studies
Purinergic P2Y Receptor Antagonists/pd [Pharmacology]
Reproducibility of Results
*Stents
*Ticlopidine/aa [Analogs & Derivatives]
Ticlopidine/pd [Pharmacology]
Treatment Outcome


MedStar Heart & Vascular Institute

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