An assessment of platelet response to ticagrelor in post-percutaneous coronary intervention patients using light transmission platelet aggregometry (LTA)
DOI:
https://doi.org/10.46542/pe.2023.234.180184Keywords:
Acute coronary syndrome, Cardiovascular disease, Dual antiplatelet therapy, Light transmission aggregometry, Platelet function testingAbstract
Background: Low on-treatment platelet reactivity (LTPR) or High on-treatment platelet reactivity (HTPR) with P2Y12 inhibitors is associated with bleeding (LTPR) or ischemic events (HTPR) in patients on dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI).
Objective: Mapping of Indonesian patients’ platelet response secondary to ticagrelor and thus identifying either LTPR or HTPR.
Method: During May – June 2019, 20 post-PCI patients on aspirin–ticagrelor combination were included. Light transmission aggregometry (LTA) for monitoring platelet function was used. Ticagrelor’s LTA <40% is LTPR while >70% is HTPR.
Result: Patients were mostly male (18 patients) and aged between 40-73 years old with a history of diabetes and/or hypertension and smoking. About eight patients (40%) were LTPR and one (5%) patient was HTPR.
Conclusion: A personalised DAPT strategy for preventing bleeding events, a de-escalation, might be valuable for Indonesian patients.
References
Alaamri, S., & Dalbhi, A. (2021). Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis. Medicine (Baltimore), 100(44). https://doi.org/10.1097/MD.0000000000027398
Angiolillo, D.A., Galli, M., Collet, J.-P., Kastrati, A., & O’Donoghue, M.O. (2022). Antiplatelet therapy after percutaneous coronary intervention. EuroIntervention, 17(17), e1371–e1396. https://doi.org/10.4244/EIJ-D-21-00904
Charpentier, T., Ferdynus, C., Lair, T., Cordier, C., Brulliard, C., Valance, D., Emery, M., Caron, M., Allou, N., & rô me Allyn, J.I. (2020). Bleeding risk of ticagrelor compared to clopidogrel in intensive care unit patients with acute coronary syndrome: A propensity-score matching analysis. PLoS ONE, 15(5). https://doi.org/10.1371/journal.pone.0232768
Cho, J.Y., Lee, S.-Y., Kyeong, Yun, H., Kim, B.-K., Hong, S.-J., Jum, Ko, S., Sang, Rhee, J., Seok, Oh, K., Shin, D.-H., Ahn, C.-M., Kim, J.-S., Ko, Y.-G., Choi, D., Hong, M.-K., & Jang, Y. (2021). Factors Related to Major Bleeding After Ticagrelor Therapy: Results from the TICO Trial. Journal of the American Heart Association, 10, 19630. https://doi.org/10.1161/JAHA.120.019630
Claassens, D.M.F., & Sibbing, D. (2020). De-escalation of antiplatelet treatment in patients with myocardial infarction who underwent percutaneous coronary intervention: A review of the current literature. In Journal of Clinical Medicine, 9(9), 1–10. https://doi.org/10.3390/jcm9092983
Deharo, P., Quilici, J., Camoin-Jau, L., Johnson, W.T., Bassez, C., Bonnet, G., Fernandez, M., Ibrahim, M., Suchon, P., Verdier, V., Fourcade, L., Morange, P.E., Bonnet, J.L., Alessi, M.C., & Cuisset, T. (2017). Benefit of switching dual antiplatelet therapy after acute coronary syndrome according to on-treatment platelet reactivity elsevier enhanced reader. JACC: Cardiovascular Interventions, 10(24), 2560–2570. https://doi.org/http://dx.doi.org/10.1016/j.jcin.2017.08.044
Gupta, R., Kirtane, A.J., Liu, Y., Crowley, A., Witzenbichler, B., Rinaldi, M.J., Metzger, D.C., Weisz, G., Stuckey, T.D., Brodie, B.R., Mehran, R., Ben-Yehuda, O., & Stone, G.W. (2019). Impact of smoking on platelet reactivity and clinical outcomes after percutaneous coronary intervention: Findings from the ADAPT-DES study. Circulation: Cardiovascular Interventions, 12(11). https://doi.org/10.1161/CIRCINTERVENTIONS.119.007982
Jeong, Y.H., Oh, J.H., Yoon, H.J., Park, Y., Suh, J., Lee, S.W., Lee, K., Kim, J.S., Chun, W.J., Park, Y.H., Nam, C.W., Kim, J.H., Ahn, J.H., Hwang, S.J., Hwang, J.Y., Tantry, U.S., Gurbel, P.A., & Shin, E.S. (2021). Pharmacodynamic profile and prevalence of bleeding episode in East Asian patients with acute coronary syndromes treated with prasugrel standard-sose versus de-escalation strategy: A randomized A-MATCH trial. Thrombosis and Haemostasis, 121(10), 1376–1386. https://doi.org/10.1055/a-1346-3300
Kang, J., & Kim, H.-S. (2018). The evolving concept of dual antiplatelet therapy after percutaneous coronary intervention: Focus on unique feature of East Asian and “Asian Paradox.” Korean Circulation Journal, 48(7), 537–551. https://doi.org/10.4070/kcj.2018.0166
Karunawan, N.H., & Pinzon, R.T. (2021). Prevalence of aspirin and clopidogrel resistance in patients with recurrent ischaemic cerebrovascular disease. In European Cardiology Review, 16, 72. https://doi.org/10.15420/ecr.2021.16.PO16
Krittayaphong, R., Boonbaichaiyapruck, S., Kiatchoosakun, S., Piamsomboon, C., Chotinaiwattarakul, C., Kunjara-Na-Ayudhya, R., Srimahachota, S., Buddhari, W., Tanprasert, P., Tresukosol, D., Med, J., & Thai, A. (2017). Demographics and outcomes of percutaneous coronary intervention in Thailand: Data from Thai percutaneous coronary intervention registry. Journal of the Medical Association of Thailand, 100(3). https://pubmed.ncbi.nlm.nih.gov/29911783/
Li, L., Dean Linden, M., Mo, D., Liu, Y., Huang, H., Guo, Y., Zhang, Y., Zhao, J., Wu, L., Yu, Z., He, D., & Luo, X. (2021). Impact of diabetes on platelet function in acute ischemic stroke patients taking dual antiplatelet therapy. Frontiers in Neurology, 1, 712024. https://doi.org/10.3389/fneur.2021.712024
Lordkipanidzé, M., Thomas, M., Alessi, M.-C., Siller-Matula, J. M., Ostrowska, M., Kubica, J., Adamski, P., Kubica, A., Eyileten, C., Postula, M., Toma, A., & Hengstenberg, C. (2019). Stratified approaches to antiplatelet therapies based on platelet reactivity testing. Frontiers in Cardiovascular Medicine, 6, 176. https://doi.org/10.3389/fcvm.2019.0017
Mehran, R., Rao, S. v., Bhatt, D. L., Gibson, C. M., Caixeta, A., Eikelboom, J., Kaul, S., Wiviott, S. D., Menon, V., Nikolsky, E., Serebruany, V., Valgimigli, M., Vranckx, P., Taggart, D., Sabik, J. F., Cutlip, D. E., Krucoff, M. W., Ohman, E. M., Steg, P. G., & White, H. (2011). Standardized bleeding definitions for cardiovascular clinical trials: A consensus report from the bleeding academic research consortium. Circulation, 123(23), 2736–2747. https://doi.org/10.1161/CIRCULATIONAHA.110.009449
Misumida, N., Aoi, S., Kim, S.M., Ziada, K.M., & Abdel-Latif, A. (2018). Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome: Systematic review and meta-analysis. Cardiovascular Revascularization Medicine, 19(6), 689–694. https://doi.org/10.1016/J.CARREV.2018.01.009
Park, D., Kwon, O., Jang, J., Yun, S., Park, H., Kang, D., Ahn, J., Lee, P., Lee, S., Park, S., Choi, S., Lee, S., Yoon, H., Ahn, T., Kim, M., Nah, D., Lee, S., Chae, J., & Park, S. (2019). Clinically significant bleeding with ticagrelor versus clopidogrel in Korean patients with acute coronary syndromes intended for invasive management: A randomized clinical trial. Circulation, 140, 1865–1877. https://doi.org/10.1161/CIRCULATIONAHA.119.041766
Siller-Matula, J.M., Trenk, D., Schrör, K., Gawaz, M., Kristensen, S.D., Storey, R.F., & Huber, K. (2015). How to improve the concept of individualised antiplatelet therapy with P2Y12 receptor inhibitors - Is an algorithm the answer? Thrombosis and Haemostasis, 113(1), 37–52. https://doi.org/10.1160/TH14-03-0238
Tatarunas, V., Kupstyte-Kristapone, N., Zvikas, V., Jakstas, V., Zaliunas, R., & Lesauskaite, V. (2020). Factors associated with platelet reactivity during dual antiplatelet therapy in patients with diabetes after acute coronary syndrome. Nature, 10. https://doi.org/10.1038/s41598-020-59663-3
Wang, G., Wang, X., Zhao, G., Huang, X., Guo, R., & Nie, S. (2020). De-escalation of antiplatelet therapy after percutaneous coronary intervention among East Asians and non-East Asians: A meta-analysis of randomized controlled trials. BMC Cardiovascular Disorders, 22(29). https://doi.org/10.1186/s12872-022-02476-1
Wen, M., Li, Y., Qu, X., Zhu, Y., Tian, L., Shen, Z., Yang, X., & Shi, X. (2020). Comparison of platelet reactivity between prasugrel and ticagrelor in patients with acute coronary syndrome: A meta-analysis. BMC Cardiovascular Disorders, 20(430). https://doi.org/10.1186/s12872-020-01603-0
