European Heart Journal Advance Access published online on July 9, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn311
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A threshold of platelet reactivity for ischaemic events?
Departemenet de cardiologie
Hopital universitaire nord
Chmin des bourrely
Marseille 13015
France
Faculte de pahramcie
Unite INSERM UMRS 608
Marseille
France
Tel: +33 2022850348
Fax: +33 1133491967/989
Email: laurentbonello{at}yahoo.fr
Laboratoire d'hématologie
hopital de la conception
Marseille
France
Faculte de pahramcie
Unite INSERM UMRS 608
Marseille
France
Laboratoire d'hématologie
hopital de la conception
Marseille
France
Faculte de pahramcie
Unite INSERM UMRS 608
Marseille
France
Departemenet de cardiologie
Hopital universitaire nord
Marseille
France
We read with great interest the paper from Price et al.1 The finding of a cut-off value of platelet reactivity to predict ischaemic events in patients undergoing percutaneous coronary intervention (PCI) represents an important confirmation of previously published studies.2,3 We would like to address a few comments to the authors.
The loading regimen in both groups should be reported. In fact, describing the rate of patients receiving a 600 mg loading dose or under chronic clopidogrel therapy in each group (the high and low reactivity groups) is of critical interest. It is well known that the use of a 600 mg loading dose before PCI not only decreases the platelet reactivity but also improves clinical outcome.4,5 Therefore, a difference in the loading regimen between the two groups could represent a major confounder in the present study.
Why did the author choose to report platelet reactivity result using PRU since the manufacturer instruction advice was to use the percentage of P2Y12 ADP receptor inhibition?
Finally, a limitation of the platelet reactivity assay tested in the present study (VerifyNow P2Y12) seems to be that it cannot be used during GP IIb/IIIa inhibitors infusion which represents as much as 15% of the study population. This could also be a concern if this platelet assay was to be used routinely because these patients are those who have the higher risk of recurrent ischaemic events.
References
- Price MJ, Endemann S, Gollapudi RR, Valencia R, Stinis CT, Levisay JP, Ernst A, Sawhney NS, Schatz RA, Teirstein PS. Prognostic significance of post-clopidogrel platelet reactivity assessed by a point-of-care assay on thrombotic events after drug-eluting stent implantation. Eur Heart J (2008) 29:992–1000.
[Abstract/Free Full Text] - Bonello L, Paganelli F, Arpin-Bornet M, Auquier P, Sampol J, Dignat-George F, Barragan P, Camoin-Jau L. Vasodilator-stimulated phosphoprotein phosphorylation analysis prior to percutaneous coronary intervention for exclusion of postprocedural major adverse cardiovascular events. J Thromb Haemost (2007) 5:1630–1636.[CrossRef][Web of Science][Medline]
- Frere C, Cuisset T, Quilici J, Camoin L, Carvajal J, Morange PE, Lambert M, Juhan-Vague I, Bonnet JL, Alessi MC. ADP-induced platelet aggregation and platelet reactivity index VASP are good predictive markers for clinical outcomes in non-ST elevation acute coronary syndrome. Thromb Haemost (2007) 98:838–843.[Web of Science][Medline]
- ALBION Trial Investigators. A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial. J Am Coll Cardiol (2006) 48:931–938.
[Abstract/Free Full Text] - ARMYDA (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study group. Prospective, multicenter, randomized, double blind trial investigating influence on PCI outcome of additional 600 mg clopidogrel load in patients on chronic therapy—'ARMYDA-Reload'. (2008) Presented at the ACC-SCAI meeting: Chicago.
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