Background

In patients with acute coronary syndrome (ACS), current international guidelines recommend newer potent and predictable P2Y₁₂ inhibitors as first-line treatment despite a greater bleeding risk compared with clopidogrel.

Aim

To determine if platelet function testing can predict bleeding in real-life patients with ACS treated with newer P2Y₁₂ inhibitors.

Methods

In this retrospective study, all consecutive adults admitted to the Lariboisière University Hospital for ACS, whatever the P2Y₁₂ inhibitor prescribed, who had platelet function testing (vasodilator-stimulated phosphoprotein phosphorylation [VASP] index and aggregation tests) during the initial hospital stay were included. Follow-up was performed to record bleeding events according to the Bleeding Academic Research Consortium (BARC) classification.

Results

A total of 364 patients were included, treated with ticagrelor (n = 123), prasugrel (n = 105) or clopidogrel (n = 136); 42.3% after an ST-segment elevation myocardial infarction, 27.1% after a non-ST-segment elevation myocardial infarction and 30.6% with unstable angina. Mean age was 64 ± 11 years. Median VASP index was significantly lower with the newer P2Y₁₂ inhibitors (14% under ticagrelor, 14% under prasugrel) than with clopidogrel (42%). Despite these differences in the degree of platelet inhibition, the occurrence of bleeding (BARC 2–5) during follow-up was 7.7% overall, and was similar for all P2Y₁₂ inhibitors (ticagrelor 8.9%; prasugrel 6.6%; clopidogrel 7.4%). For each P2Y₁₂ inhibitor, it was impossible to determine a VASP index threshold under which bleeding was significantly greater during follow-up. Similarly, ADP-induced aggregation was more profoundly inhibited by ticagrelor and prasugrel than by clopidogrel, but this did not allow a threshold to be set for increased haemorrhagic risk.

Conclusions

Despite the substantial occurrence of bleeding in patients with ACS during follow-up, neither the VASP index nor platelet aggregation test results measured at the acute phase were helpful in predicting bleeding risk. Whether platelet function testing could be helpful later in the course of treatment remains to be evaluated.

中文翻译：

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在 P2Y12 抑制剂下的急性期血小板功能测试是否有助于预测现实生活中急性冠状动脉综合征患者的出血？雪崩研究

背景

在急性冠状动脉综合征 (ACS) 患者中，尽管与氯吡格雷相比出血风险更大，但目前的国际指南推荐更新的有效且可预测的 P2Y ₁₂抑制剂作为一线治疗。

目标

_{确定血小板功能测试是否可以预测接受新型 P2Y 12}抑制剂治疗的真实 ACS 患者的出血情况。

方法

在这项回顾性研究中，所有连续入院的因 ACS 入院的成人，无论处方的 P2Y ₁₂抑制剂如何，在初始住院期间进行了血小板功能测试（血管扩张剂刺激的磷蛋白磷酸化 [VASP] 指数和聚集测试）。 . 根据出血学术研究联盟 (BARC) 分类进行随访以记录出血事件。

结果

共纳入 364 例患者，分别接受替格瑞洛 ( n  =  123)、普拉格雷 ( n  =  105) 或氯吡格雷 ( n  =  136) 治疗；ST 段抬高型心肌梗死后为 42.3%，非 ST 段抬高型心肌梗死后为 27.1%，不稳定型心绞痛为 30.6%。平均年龄为 64  ±  11 岁。较新的 P2Y ₁₂抑制剂（替格瑞洛组为 14%，普拉格雷组为 14%）的 VASP 指数中值显着低于氯吡格雷组（42%）。尽管血小板抑制程度存在这些差异，但随访期间的出血发生率（BARC 2-5）总体为 7.7%，所有 P2Y _{12的发生率相似}抑制剂（替格瑞洛 8.9%；普拉格雷 6.6%；氯吡格雷 7.4%）。对于每种 P2Y ₁₂抑制剂，无法确定 VASP 指数阈值，在该阈值下，随访期间出血量显着增加。类似地，替格瑞洛和普拉格雷比氯吡格雷更能抑制 ADP 诱导的聚集，但这并没有为出血风险增加设定阈值。

结论

尽管随访期间 ACS 患者大量发生出血，但在急性期测量的 VASP 指数和血小板聚集测试结果均无助于预测出血风险。血小板功能测试在治疗后期是否有帮助仍有待评估。