Lower achieved platelet reactivity associated with better cardiovascular
Compared to patients who had persistently high platelet reactivity, those who achieved low platelet reactivity, according to the VerifyNow P2Y12 Test, had a reduced incidence of cardiovascular death, heart attack and stent thrombosis, as indicated by a clinical trial presented today at the ESC Congress 2011.
These findings were part of a secondary analysis of the Gauging Responsiveness with A VerifyNow P2Y12 Assay- Impact on Thrombosis and Safety (GRAVITAS) trial, the largest prospective trial to date to test the clinical efficacy of antiplatelet therapy modification, based on platelet reactivity testing. The GRAVITAS trial, published in the Journal of the American Medical Association in March 2011, was a randomized comparison of double-dose clopidogrel versus the standard 75mg dose in ~2200 patients receiving drug-eluting stents and who were identified as having high on-treatment platelet reactivity (ie., were "non-responders") by the VerifyNow P2Y12 Test. The trial's primary results showed that there was no reduction in cardiovascular events with double-dose therapy, leading many to postulate that platelet reactivity may not be a modifiable risk factor for cardiovascular events.
In the current analysis, researchers looked at achievement of a different level of platelet reactivity than used in the original study design and determined the clinical importance of platelet reactivity over time. "We looked at the cardiovascular risk in patients who achieved a level of platelet reactivity of less than 208 P2Y12 Reaction Units (PRU), the platelet reactivity result provided by the test used in the GRAVITAS trial," stated Dr. Matthew Price, the study's principal investigator. "Patients who got below this level of platelet reactivity, whether at discharge or 30 days after PCI, had significantly better cardiovascular outcomes -- approximately half the risk of cardiovascular death, myocardial infarction or stent thrombosis.
This suggests that it may be important not only to know a patient's platelet reactivity at the time of discharge, but also to ensure that low platelet reactivity is achieved throughout the course of their treatment. Importantly, we saw this effect even after adjustment for other clinical risk factors, so our observation applies both to traditionally 'low-risk' patients such as those undergoing elective PCI as well as patients presenting with acute coronary syndromes."
"These findings from this secondary analysis also help explain why we may not have seen a benefit of double-dose clopidogrel in the primary results of GRAVITAS" concluded Dr. Price. "It turns out that less than half the patients on the double-dose reached this 'safe' level of 208 PRU."
Dr. Price also indicated that this is still the tip of the iceberg as to what we may learn from GRAVITAS. Data from whole exome DNA sequencing are being analyzed to comprehensively investigate the influence of genetic variation on platelet reactivity in the GIFT Exome sub-study. Data are also being analyzed to determine the impact of aspirin responsiveness on clinical outcomes to further understand how physicians may be able to optimize the care of their patients receiving dual antiplatelet therapy.
Provided by European Society of Cardiology
- Antiplatelets: 1 person, 1 dose? Apr 14, 2011 | not rated yet | 0
- Study examines outcomes of high-dose antiplatelet drug after stent placement Mar 15, 2011 | not rated yet | 0
- Platelet function tests may provide modest benefit in predicting cardiac outcomes Feb 23, 2010 | not rated yet | 0
- Half of patients undergoing cerebrovascular stent placement respond poorly to clopidogrel Feb 05, 2008 | not rated yet | 0
- Genetic variation associated with poorer response, cardiovascular outcomes with use of clopidogrel Aug 25, 2009 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
1 hour ago Alright, so in Pathfinder (like Dungeons and Dragons) there's a spell that allows you to lift/move stuff within 25 ft with 5 pounds of force. A...
3 hours ago So energy can only be converted... So when you squeeze the bulb on a blood pressure cuff, you are applying kinetic energy. Then the cuff fills with...
How does momentum, inertia and drag affect the motion of an object?
6 hours ago How does momentum and inertia affect changes in speed, when considering acceleration from thrust, or from decelleration from drag? Say, for a...
What is Time-Varying Voltage?
7 hours ago In circuits, we have no problem saying that the voltage difference between two point is [itex]\cos(\omega t)[/itex], but what does that actually...
Contextual Relationships Between Momentum, Energy, and Force.
9 hours ago *I apologize in advance for the length of this post, if you wish to reduce reading skip to paragraph 5. Or if you are super lazy, the final...
Barometric pressure and the math behind it. Very interesting, I think.
10 hours ago Hey guys, I was actually researching the life of Edmond Halley and discovered that he discovered the relationship between barometric pressure and the...
- More from Physics Forums - Classical Physics
More news stories
(HealthDay)—Blood levels of free fatty acids are associated with insulin resistance during young adulthood and cardiovascular risk factors in later adulthood, according to a study published online May 13 ...
Cardiology 16 hours ago | not rated yet | 0 |
An experimental, inexpensive iPhone application transmitted diagnostic heart images faster and more reliably than emailing photo images, according to a research study presented at the American Heart Association's Quality ...
Cardiology 17 hours ago | not rated yet | 0
Extracorporeal membrane oxygenation (ECMO), a procedure traditionally used during cardiac surgeries and in the ICU that functions as an artificial replacement for a patient's heart and lungs, has also been used to resuscitate ...
Cardiology 19 hours ago | not rated yet | 0
Age has little to do with how patients should be treated after suffering a stroke, according to new research from the University of Georgia.
Cardiology 20 hours ago | not rated yet | 0 |
Depressed middle-aged women have almost double the risk of having a stroke, according to research published in Stroke: Journal of the American Heart Association.
Cardiology May 16, 2013 | not rated yet | 0
Big names in medicine are set to give an upbeat assessment of the war on AIDS on Tuesday, 30 years after French researchers identified the virus that causes the disease.
2 hours ago | not rated yet | 0
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
3 hours ago | not rated yet | 0 |
The neural machinery underlying our olfactory sense continues to be an enigma for neuroscience. A recent review in Neuron seeks to expand traditional ideas about how neurons in the olfactory bulb might encode information about ...
14 hours ago | not rated yet | 0 |
(Medical Xpress)—What if the quality of your work depends more on your focus on the piano keys or canvas or laptop than your musical or painting or computing skills? If target users can be convinced, they ...
15 hours ago | 3.7 / 5 (3) | 0 |
In 2008 researchers from the University of Southern Denmark showed that the drug thioridazine, which has previously been used to treat schizophrenia, is also a powerful weapon against antibiotic-resistant bacteria such as ...
12 hours ago | 3.7 / 5 (3) | 0 |
(Medical Xpress)—Working with lab mice models of multiple sclerosis (MS), UC Davis scientists have detected a novel molecular target for the design of drugs that could be safer and more effective than current FDA-approved ...
12 hours ago | 5 / 5 (2) | 0 |