Clinical InvestigationInterventional CardiologyAdenosine diphosphate–induced platelet-fibrin clot strength: A new thrombelastographic indicator of long-term poststenting ischemic events
Section snippets
Patients
The study was approved by the Investigational Review Board of Sinai Hospital, Baltimore, MD. Two hundred twenty-five consecutive patients undergoing nonemergent PCI were prospectively enrolled between 2004 and 2005 after providing informed consent. All patients were older than 18 years. Inclusion and exclusion criteria were described previously.5 Aspirin (325 mg) was administered to all patients on the day of the procedure and daily thereafter (81-325 mg). Sixty-six percent of the patients
Demographic and procedural characteristics
Two hundred twenty-five patients undergoing PCI were enrolled. Fifty-nine patients (26%) sustained an ischemic event within 3 years after the index PCI. Patient demographics and procedural characteristics are shown in Table I, Table II, respectively. Briefly, patients with ischemic events had a higher prevalence of hyperlipidemia, diabetes, prior percutaneous transluminal coronary angioplasty (PTCA), and calcium-channel blocker use and had lower ejection fraction as compared with patients
Discussion
Thrombus formation is a dynamic and nonlinear process involving many interacting elements, most notably the vascular wall, blood components, and blood flow. Light transmittance aggregometry has long been the methodology of choice to determine platelet reactivity. However, our study suggests that the TEG MA parameters, MAADP and MATHROMBIN, provide additional information for post-PCI risk assessment. In vivo, the strength of the clot determines whether it will resist the shear forces of the
Conclusions
Management of patients using universal fixed-dosing dual-antiplatelet therapy is associated with an unacceptable rate of recurrent events. This study was able to characterize post-PCI patients according to risk for long-term recurrence of ischemic events based on selected TEG Platelet Mapping results, specifically MAADP and MATHROMBIN. This is the first study to compare the prognostic utility of conventional aggregometry with TEG for long-term events and also the first to examine the role of MA
Sources of funding
The study was supported by Sinai Hospital of Baltimore and National Institutes of Health grant R44-HL059753.
Disclosures
Paul A. Gurbel has received research funding from Astra Zeneca, Daiichi Sankyo, Lilly, Schering-Plough, Pozen, Portola Pharmaceuticals, Bayer Healthcare, Sanofi-Aventis, Haemonetics, and NIH. Eli Cohen and Irene Navickas are former employees of Haemoscope Corporation. All other authors report no conflicts of interest.
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