On-clopidogrel platelet reactivity as predictor for long-term clinical outcome in patients after planned discontinuation of clopidogrel

Timo Bömicke; Christian M. Valina; Christian Stratz; Michael Amann; Franz-Josef Neumann; Willibald Hochholzer

doi:10.1160/TH17-02-0122

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2017; 117(08): 1644-1650
DOI: 10.1160/TH17-02-0122

Atherosclerosis and Ischaemic Disease

Schattauer GmbH

On-clopidogrel platelet reactivity as predictor for long-term clinical outcome in patients after planned discontinuation of clopidogrel

Authors

Timo Bömicke

¹Department of Cardiology and Angiology II, University Heart Center Freiburg • Bad Krozingen, Bad Krozingen, Germany
Christian M. Valina

¹Department of Cardiology and Angiology II, University Heart Center Freiburg • Bad Krozingen, Bad Krozingen, Germany
Christian Stratz

¹Department of Cardiology and Angiology II, University Heart Center Freiburg • Bad Krozingen, Bad Krozingen, Germany
Michael Amann

¹Department of Cardiology and Angiology II, University Heart Center Freiburg • Bad Krozingen, Bad Krozingen, Germany
Franz-Josef Neumann

¹Department of Cardiology and Angiology II, University Heart Center Freiburg • Bad Krozingen, Bad Krozingen, Germany
Willibald Hochholzer

¹Department of Cardiology and Angiology II, University Heart Center Freiburg • Bad Krozingen, Bad Krozingen, Germany

Abstract

Summary

It is unknown whether the known association of high on-treatment platelet reactivity (HTPR) with worse clinical outcome in patients on clopidogrel following coronary stent implantation persists after planned discontinuation of clopidogrel. This study investigated the association of HTPR with major ischaemic events after planned discontinuation of clopidogrel. Consecutive patients undergoing elective coronary stent implantation after loading with clopidogrel 600 mg were followed for up to seven years (n=765). Platelet reactivity was tested on day 1 after coronary intervention. Clopidogrel was continued for six months after implantation of drug-eluting stents and for one month if only bare-metal stents were used. The combined primary endpoint was death of any cause or non-fatal myocardial infarction (MACE). HTPR was found in 217 of 765 patients (28%). During a median follow-up of 5.7 years, the primary endpoint occurred in 145 subjects after planned discontinuation of clopidogrel. Patients with HTPR showed a higher incidence of MACE after discontinuation of clopidogrel. There was a significant interaction of HTPR and time following discontinuation of clopidogrel beyond one year (p for interaction 0.08). Landmark analyses confirmed that the association of HTPR and MACE was only significant within the first year (HR: 2.93, 95%-CI 1.13–7.60, p=0.03), but not beyond the first year following discontinuation of clopidogrel (HR: 1.19, 95%-CI 0.82–1.72, p=0.37). In conclusion, patients with HTPR persist to be at high risk for death or myocardial infarction even following planned discontinuation of clopidogrel. However, this association was only significant for the first year following discontinuation of clopidogrel.

Keywords

Antiplatelet therapy - platelet function - discontinuation - outcome

Full Text

References

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