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J Am Coll Cardiol, 2005; 45:1753-1756, doi:10.1016/j.jacc.2004.10.079
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Enhanced Shear-Induced Platelet Aggregation in Patients Who Experience Subacute Stent Thrombosis

A Case-Control Study

Nadine Ajzenberg, MD, PhD*,*, Pierre Aubry, MD{dagger}, Marie-Genevieve Huisse, MD*, Agnés Cachier, MD{dagger}, Walid El Amara, MD{dagger}, Laurent J. Feldman, MD, PhD{dagger}, Dominique Himbert, MD{dagger}, Dominique Baruch, MD, PhD{ddagger}, Marie-Claude Guillin, MD, PhD* and Ph. Gabriel Steg, MD{dagger}

* Hématologie et Immunologie, Paris, France
{dagger} Cardiologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
{ddagger} Hôpital de Bicêtre, Le Kremlin Bicêtre, France

Manuscript received September 3, 2004; revised manuscript received October 11, 2004, accepted October 18, 2004.

* Reprint requests and correspondence to: Dr. Nadine Ajzenberg, Service d’Hématologie et Immunologie, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. (Email: nadine.ajzenberg{at}bch.ap-hop-paris.fr).

OBJECTIVES: The goal of this study was to identify differences in shear-induced platelet aggregation (SIPA) between patients who did or did not experience subacute stent thrombosis (SAT).

BACKGROUND: Despite dual antiplatelet therapy, SAT after coronary stenting occurs in approximately 1% of patients. There is no accepted platelet function test to identify patients at risk.

METHODS: We analyzed platelet aggregation in 10 patients who had experienced SAT (cases), 22 stented patients without SAT (controls), and 17 healthy volunteers (normals). All patients except normals were treated with both aspirin and clopidogrel.

RESULTS: Shear-induced platelet aggregation was higher in cases than in controls at both shear rates of 200 s–1 (40.9 ± 12.2% vs. 18.2 ± 18%, p = 0.013) and 4,000 s–1 (57.4 ± 16.4% vs. 23.4 ± 21.2%, p = 0.009). Moreover, SIPA in cases was significantly higher than in normals both at 200 s–1 (p = 0.013) and 4,000–1 (p = 0.009).

CONCLUSIONS: Shear-induced platelet aggregation is increased in patients experiencing SAT compared with controls receiving dual antiplatelet therapy and to normals receiving no antiplatelet therapy, which suggests increased intrinsic patient-related platelet reactivity in patients with SAT. The predictive value of SIPA for SAT requires prospective investigation.

Abbreviations and Acronyms
  ADP = adenosine diphosphate
  DSP = disappearance of single platelets
  PCI = percutaneous coronary intervention
  PRP = platelet-rich plasma
  SAT = subacute stent thrombosis
  SIPA = shear-induced platelet aggregation
  vWF = von Willebrand factor


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