Abstract 4310: Impact of Platelet Response to Clopidogrel on Major In-hospital Bleeding Events in Patients Undergoing Coronary Stent Placement
Introduction: In patients undergoing percutaneous coronary intervention (PCI) a causal link between bleedings and excess mortality has been demonstrated in clinical trials. A potential association, however, of bleedings and platelet response to clopidogrel has not been well established yet. The aim of this study was to assess the impact of peri-procedural ADP-induced platelet aggregation (PA) measurements on the risk of bleeding events in clopidogrel treated patients undergoing PCI.
Methods: Consecutive patients (n=2,533) undergoing PCI after pretreatment with 600 mg clopidogrel were prospectively enrolled in this study. Blood was obtained directly before PCI. ADP-induced PA was assessed on a Multiplate analyzer. The primary endpoint was the incidence of in-hospital Thrombolysis in Myocardial Infarction (TIMI) major bleeding.
Results: Thirty-four (1.3%) in-hospital major bleedings were observed. Patients were classified into tertiles according to PA measurements. The risk for a major bleeding was significantly higher in the tertile with the lowest PA values (=tertile 1) of patients as compared to patients in tertiles 2–3 (see Fig.⇓). After adjusting for possible confounding variables including age, gender, renal insufficiency and BMI, a PA value in the lowest tertile was found to be an independent predictor for the occurrence of a major bleeding (OR 2.88, 95% CI 1.44 –5.78; P=0.003).
Conclusions: Major bleedings can be predicted by assessing the peri-procedural platelet response to clopidogrel. Whether guidance of antiplatelet treatment based on platelet function testing proves useful for avoiding bleeding events has to be tested in specifically designed trials.