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J Am Coll Cardiol, 2007; 49:657-666, doi:10.1016/j.jacc.2006.10.050 (Published online 25 January 2007).
© 2007 by the American College of Cardiology Foundation
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Increased Risk in Patients With High Platelet Aggregation Receiving Chronic Clopidogrel Therapy Undergoing Percutaneous Coronary Intervention

Is the Current Antiplatelet Therapy Adequate?

Kevin P. Bliden, BS, Joseph DiChiara, BS, Udaya S. Tantry, PhD, Ashwani K. Bassi, MD, Srivasavi K. Chaganti, MD and Paul A. Gurbel, MD1,*

Sinai Center for Thrombosis Research, Baltimore, Maryland.


Figure 1
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Figure 1 Thrombelastograph PlateletMapping Analysis Parameters

MAThrombin = measure of maximum thrombin-induced platelet-fibrin clot strength; MAFibrin = contribution of fibrin to clot strength; MAADP or AA = represents clot strength after adenosine diphosphate (ADP) or arachidonic acid (AA) stimulation.

 

Figure 2
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Figure 2 Relation of HPR to Ischemic Events

(A) Graph demonstrating percentage of patients with and without ischemic events displaying high on-treatment platelet reactivity (HPR) as measured by 5 µmol/l adenosine diphosphate (ADP)-induced light transmittance aggregometry. Dashed line indicates cut point for HPR. (B) Graph demonstrating percentage of patients with and without ischemic events displaying HPR as measured by 2-µmol/l ADP-induced thrombelastography. Dashed line indicates cut point for HPR.

 

Figure 3
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Figure 3 Linear Regression Model Representing the Correlation Between LTA and TEG

ADP = adenosine diphosphate; LTA = light transmittance aggregometry; TEG = thrombelastograph.

 

Figure 4
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Figure 4 Cumulative Event Occurrence Over 1 Year

Graph demonstrating cumulative event occurrence over 365 days.

 

Figure 5
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Figure 5 Combined Receiver-Operator Curve for LTA and TEG

Combined receiver-operating characteristic curve for 5-µmol/l ADP-induced LTA and 2-µmol/l ADP-induced TEG at baseline. An area of 0.862 and an area of 0.881 were observed below the curves of LTA and TEG, respectively, with p = 0.0001 for both areas. AUC = area under the curve; other abbreviations as in Figure 3.

 

Figure 6
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Figure 6 A Comparison of Platelet Reactivity With and Without Eptifibatide

(A) Graph demonstrating mean 5 µmol/l ADP-induced platelet aggregation with and without eptifibatide measured by LTA at baseline, 3 h and 18 to 24 h after percutaneous coronary intervention (PCI). *p < 0.0001 for the change in platelet aggregation in patients receiving eptifibatide versus no eptifibatide. {dagger}p = 0.0004 for platelet aggregation 3 h after PCI in patients receiving eptifibatide versus baseline. (B) Graph demonstrating mean 2 µmol/l ADP-induced platelet aggregation with and without eptifibatide measured by TEG at baseline, 3 h and 18 to 24 h after PCI. *p < 0.0001 for change in platelet aggregation in patients receiving eptifibatide versus no eptifibatide. Abbreviations as in Figure 3.

 





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