Ist Chair and Department of Cardiology, The Medical University of Warsaw, 1a Banacha Street, 02-097 Warsaw, Poland.
J Thromb Thrombolysis. 2013 Jul;36(1):22-30. doi: 10.1007/s11239-012-0808-5.
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.
出血对急性冠状动脉综合征（ACS）后抗血小板治疗的预后和依从性有负面影响。阿司匹林抵抗与出血之间的潜在关联尚未确定。我们旨在确定在接受冠状动脉支架置入术的 ACS 患者中，低阿司匹林反应性（LAPR）是否与出血事件和抗血小板治疗依从性相关。通过 Accumetrics Inc.（圣地亚哥，CA，美国）的 VerifyNow™阿司匹林测定法（Accumetrics Inc.，圣地亚哥，CA，美国）测量了 531 例 ACS 患者的阿司匹林血小板反应性。通过接收者操作特征曲线（ROC）分析计算 LAPR 的截断值。根据 Bleeding Academic Research Consortium（BARC）定义报告出血情况。终点是 6 个月随访期间的轻微出血（BARC 类型 1 或 2）、主要出血（BARC 类型 3 或 5）和抗血小板治疗停药。通过 ROC 分析，VerifyNow™阿司匹林测定法能够区分有轻微出血和无轻微出血的患者（曲线下面积 [AUC] 0.66，95%置信区间 [CI] 0.62-0.70，P<0.0001），而该测定法不能预测主要出血（AUC 0.54，95%CI 0.49-0.58，P=0.473）。通过逻辑回归，LAPR 与轻微出血风险增加相关（比值比 [OR] 4.32，95%CI 2.78-6.71，P<0.0001），但与主要出血无关（OR 2.05，95%CI 0.83-5.06，P=0.117）。与无 LAPR 的患者相比，LAPR 患者的抗血小板治疗停药更为频繁（21.6%比 9.1%，P=0.0008）。总之，ACS 患者的即时护理点抗阿司匹林血小板反应性检测可识别出血事件风险增加和随后抗血小板治疗停药的患者。LAPR 对主要出血的可能影响需要在更大的试验中确定。
