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, MD*
Sinai Center for Thrombosis Research, Baltimore, Maryland
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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.
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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.
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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.
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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.  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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