Thromb Haemost 2016; 115(05): 979-992
DOI: 10.1160/TH15-05-0366
Cellular Haemostasis and Platelets
Schattauer GmbH

Influence of platelet reactivity on BARC classification in East Asian patients undergoing percutaneous coronary intervention

Results of the ACCEL-BLEED study
Tae Jung Kwon
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
2   Department of Internal Medicine, Changwon Fatima Hospital, Changwon, South Korea
,
Udaya S. Tantry
3   Sinai Center for Thrombosis Research, Baltimore, Maryland, USA
,
Yongwhi Park
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
,
Young-Min Choi
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
,
Jong-Hwa Ahn
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
,
Kye Hwan Kim
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
,
Jin-Sin Koh
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
,
Jeong-Rang Park
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
,
Seok-Jae Hwang
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
,
Choong Hwan Kwak
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
,
Jin-Yong Hwang
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
,
Paul A. Gurbel
3   Sinai Center for Thrombosis Research, Baltimore, Maryland, USA
,
Sidney C. Smith Jr
4   Center for Cardiovascular Science and Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
,
Young-Hoon Jeong
1   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, South Korea
› Author Affiliations
Further Information

Publication History

Received: 02 May 2015

Accepted after major revision: 28 January 2015

Publication Date:
06 December 2017 (online)

Summary

An increasing body of data suggests that East Asian patients have differing risk profiles for both thrombophilia and bleeding compared with Western population. This study was designed to evaluate the relationship of bleeding to platelet function in East Asians undergoing percutaneous coronary intervention (PCI). Patients who had undergone uneventful PCI (n= 301) were prospectively enrolled and bleeding events were evaluated during dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. Platelet function was measured during hospitalisation and at 30-day follow-up by light transmittance aggregometry (LTA) and vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) assay. During 30-day follow-up, 29.2 % of patients (n=88) experienced post-discharge Bleeding Academic Research Consortium (BARC) complications (24.6 % and 7.0 % of BARC type 1 and 2, respectively). Patients presenting with acute myocardial infarction had fewer episodes of type 1 BARC bleeding (odds ratio: 0.41; 95 % confidence interval: 0.22 to 0.76; p= 0.005). The cut-off of low platelet reactivity (LPR) (20 μM ADP-induced platelet aggregation ≤ 46.1 %; platelet reactivity index ≤ 45.1 %) was the independent determinant of type 2 BARC bleeding (odds ratio: 3.55 and 4.44; p= 0.009 and 0.002, respectively). The first 30-day BARC bleeding episodes were associated with an increased rate of subsequent premature DAPT discontinuation during one-year follow-up (4.7 % vs 11.4 %; odds ratio: 2.60; 95 % confidence interval: 1.04 to 6.50; p= 0.035). In conclusion, among East Asians, mild bleeding episodes are common early after PCI and are associated with premature DAPT discontinuation. Type 2 BARC bleeding episodes are associated with LPR cut-offs measured at 30 days post-discharge.

 
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