Author + information
- Xuyun Wang,
- Yundai Chen and
- Tong Yin
This study aimed to display the value of ADP-induced platelet-fibrin clot strength (MAADP) for the prediction of clinical outcomes and side effects in ticagrelor treated ACS patients.
Consecutive ACS patients on duel antiplatelet treatment (DAPT) with ticagrelor and aspirin were recruited. After 3 to 5 days maintenance dose of ticagrelor administration, MAADP, measured by thrombelastography (TEG), were recorded for the evaluation of ticagrelor anti-platelet reactivity. The pre-specified cutoffs of MAADP > 47mm for high on-treatment platelet reactivity (HTPR) and MAADP < 31mm for low on-treatment platelet reactivity (LTPR) were applied for the evaluation. The occurrences of the ischemic events [including major ischemic events(cardiac death, non-fatal myocardial infarction, stroke, unexpected coronary revascularization, and stent thrombosis) and composited ischemic events (major ischemic events and readmission of unstable angina)], the PLATO defined major and minor bleeding events, and ticagrelor related dyspnea were recorded after a duration of 6 months follow-up.
Overall, 341 ACS patients under DAPT with ticagrelor were recruited. The value of MAADP ranged from 1.2% to 72.9% [(20.6±12.2)% on average], with the distribution higher skewed towards the lower values. Using the pre-specific cutoffs for HTPR and LTPR, 15 patients (4.4%) were identified as HTPR and 279 patients (81.8%) as LTPR. After a follow-up of 6 months in 338 patients, the major ischemic events occurred in 9 patients (9/338, 2.7%), with 4 patients (44.4%) classified as HTPR, 5 patients (55.6%) classified as non-HTPR (P<0.001). The composited cardiovascular events occurred in 31 patients (31/338, 9.2%), with 6 patients (19.4%) classified as HTPR, 25 patients (80.6%) classified as non-HTPR (P=0.001). PLATO defined major bleeding events occurred in 7 patients, all classified as LTPR. PLATO defined minor bleeding events occurred in 36 patients, with 34 (94.4%) classified as LTPR and 2 (5.6%) classified as non-LTPR (P=0.04). Ticagrelor related dyspnea occurred in 73 patients (73/338, 21.6%), with 64 (87.7%) classified as LTPR and 9 (12.3%) classified as non-LTPR (P=0.13).
In ticagrelor treated ACS patients, TEG measured MAADP might be valuable for the prediction of ticagrelor related bleeding and dyspnea.