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Dose of aspirin does not inluence laboratory antiplatelet efficacy of P2Y12 inhibitors

Session Poster Session 6

Speaker Zuzana Motovska

Event : ESC Congress 2013

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Antiplatelet Agents
  • Session type : Poster Session

Authors : Z Motovska (Prague,CZ), M Ondrakova (Prague,CZ), L Dusek (Brno,CZ), J Knot (Prague,CZ), J Ulman (Prague,CZ), F Bednar (Prague,CZ), P Widimsky (Prague,CZ)

Authors:
Z. Motovska1 , M. Ondrakova2 , L. Dusek3 , J. Knot1 , J. Ulman2 , F. Bednar1 , P. Widimsky1 , 1Third Medical Faculty of Charles Univ. and Royal Vineyards Univ. Hospital - Prague - Czech Republic , 2Royal Vineyards Univ. Hospital - Prague - Czech Republic , 3Masaryk University, Faculty of Medicine, Institute for Biostatistics and Analysis - Brno - Czech Republic ,

Citation:
European Heart Journal ( 2013 ) 34 ( Abstract Supplement ), 884

Background: Prespecified subgroup analysis of PLATO trial showed a significantly lower effect of ticagrelor in North America than in the rest of the world. It was suggested that the aspirin dose may alter ticagrelor's effectiveness.

Aim: The study aimed to assess whether dose of aspirin influences laboratory efficacy of P2Y12 inhibitors.

Methods: The study group consisted of 645 consecutive patients (67.2±12.1 years, 64.5% men, 34.4% STEMI, 29.3% NSTE-ACS) who were undergoing stent implantation in a tertiary care institution (Cardiocentre Univ. Hospital Prague, Czech Rep). Inhibition of P2Y12 signaling was tested by VASP index 20±4 h after loading dose of a P2Y12 inhibitor (600mg clopidogrel/60mg prasugrel/180mg ticarelor). High on-treatment platelet reactivity was defined as a VASP index ≥50%.

Results: Results are presented in Table 1.

Conclusion: Our study did not demonstrate any significant association between dose of aspirin and laboratory efficacy of P2Y12 inhibitors. There was also no evidence of an administration-time dependent impact of aspirin on laboratory efficacy of P2Y12 inhibitors.

Table 1
VASP %1p2VASP %p3
<50%≥50%Mean (SD)
ClopidogrelN=606N=362N=244N=606
Aspirin chronic
  No326 (53.8%)195 (53.9%)131 (53.7%)1.043.0 (22.7)0.8
  Yes280 (46.2%)167 (46.1%)113 (46.3%)43.4 (22.3)
Dose
  ≤100275 (98.2%)163 (97.6%)112 (99.1%)0.343.4 (22.4)0.9
  >1005 (1.8%)4 (2.4%)1 (0.9%)42.6 (23.3)
Aspirin before PCI
  No171 (28.2%)104 (28.7%)67 (27.5%)0.742.3 (22.7)0.6
  Yes435 (71.8%)258 (71.3%)177 (72.5%)43.5 (22.5)
Dose
  ≤500288 (66.2%)173 (67.1%)115 (65.0%)0.743.3 (22.3)0.8
  >500147 (33.8%)85 (32.9%)62 (35.0%)44.0 (23.0)
Aspirin during PCI
  No580 (95.7%)345 (95.3%)235 (96.3%)0.643.3 (22.6)0.5
  Yes26 (4.3%)17 (4.7%)9 (3.7%)40.2 (19.9)
Dose
  ≤5005 (19.2%)3 (17.6%)2 (22.2%)0.843.4 (24.4)0.7
  >50021 (80.8%)14 (82.4%)7 (77.8%)39.5 (19.3)
Prasugrel/TicagrelorN=39N=34N=5
Aspirin chronic
  No35 (89.7%)30 (88.2%)5 (100.0%)0.324.7 (20.9)0.1
  Yes4 (10.3%)4 (11.8%)0 (0.0%)6.7 (4.4)
Aspirin before PCI
  No7 (17.9%)6 (17.6%)1 (20.0%)0.919.4 (16.9)0.6
  Yes32 (82.1%)28 (82.4%)4 (80.0%)23.7 (21.5)
Dose
  ≤5004 (12.5%)4 (14.3%)0 (0.0%)0.36.7 (4.4)0.1
  >50028 (87.5%)24 (85.7%)4 (100.0%)26.1 (21.9)
1Categorical parameters were described by total N, absolute and relative frequencies; 2statistical significance of differences was tested using maximum likelihood chi-square; 3statistical significance of differences was tested using independent t-test for continuous variables.

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