Details

Autor(en) / Beteiligte

• Giustino, Gennaro, MD
• Kirtane, Ajay J., MD, SM
• Baber, Usman, MD, MS
• Généreux, Philippe, MD
• Witzenbichler, Bernhard, MD
• Neumann, Franz-Josef, MD
• Weisz, Giora, MD
• Maehara, Akiko, MD
• Rinaldi, Michael J., MD
• Metzger, D. Christopher, MD
• Henry, Timothy D., MD
• Cox, David A., MD
• Duffy, Peter L., MD
• Mazzaferri, Ernest L., MD
• Brodie, Bruce R., MD
• Stuckey, Thomas D., MD
• Gurbel, Paul A., MD
• Dangas, George D., MD, PhD
• Francese, Dominic P., MPH
• Ozan, M. Ozgu, MS
• Mehran, Roxana, MD
• Stone, Gregg W., MD

Titel

Impact of Anemia on Platelet Reactivity and Ischemic and Bleeding Risk (From the Assessment of Dual Antiplatelet Therapy With Drug-eluting Stents [ADAPT-DES] Study)

Ist Teil von

• The American journal of cardiology, 2015

Erscheinungsjahr

2015

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Anemic patients remain at increased risk of ischemic and bleeding events. Whether or not the effects of hemoglobin levels on thrombotic and bleeding risk are independent of platelet reactivity on clopidogrel, however, remains unknown. Patients from the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) study were categorized by the presence of anemia at baseline, defined according the World Health Organization criteria. Platelet reactivity was measured with VerifyNow assay; high platelet reactivity (HPR) on clopidogrel was defined as platelet reactive units value >208. Out of 8413 patients included in the study cohort, 1816 (21.6%) had anemia. HPR was more prevalent in patients with anemia (58.3% vs 38.4%; p<0.001), an association that persisted following multivariable adjustment. Patients with anemia had higher 2-year rates of major adverse cardiac events (MACE; 9.5% vs 5.6%; p<0.0001), major bleeding (11.8% vs 7.7%; p<0.0001), and all-cause mortality (4.0% vs 1.4%; p<0.0001); however, following adjustment for baseline clinical confounders, including HPR, anemia was no longer associated with MACE (adjusted hazard ratio [HR]: 1.22; 95% confidence interval [CI]: 0.98–1.51; p=0.07), but was still significantly associated with all-cause mortality (adjusted HR: 1.61; 95% CI: 1.23–2.12; p<0.0001) and major bleeding (adjusted HR: 1.42; 95% CI: 1.20–1.68; p<0.0001). In conclusion, anemia independently correlated with HPR. After PCI with drug-eluting stents, anemia at baseline was significantly associated with higher 2-year hemorrhagic and mortality risk; conversely, its association with ischemic risk was attenuated following multivariable adjustment, including HPR.