Featured Research

from universities, journals, and other organizations

Drug-eluting stents, heart attack and bleeding risks: One-year results of ADAPT-DES trial

Date:
July 26, 2013
Source:
Cardiovascular Research Foundation
Summary:
Patients who receive a drug-eluting stent and demonstrate high platelet reactivity on clopidogrel are more likely to have blood clots form on the stent and to suffer a heart attack; however, these patients are less likely to develop bleeding complications.

Patients who receive a drug-eluting stent (DES) and demonstrate high platelet reactivity on clopidogrel are more likely to have blood clots form on the stent and to suffer a heart attack; however, these patients are less likely to develop bleeding complications.

One-year results of the ADAPT-DES trial will be published online July 26, 2013, in The Lancet. The findings were first presented at last year's Transcatheter Cardiovascular Therapeutics (TCT) annual scientific symposium.

ADAPT-DES is the largest study ever to explore the overall treatment implications of platelet reactivity on patient outcomes after successful coronary drug-eluting stent implantation. Researchers investigated the relationship between platelet reactivity during dual therapy with aspirin and clopidogrel and clinical outcomes such as stent thrombosis, major bleeding, and other adverse events.

The study enrolled 8,583 patients at 11 sites in the US and Germany who underwent a percutaneous coronary intervention (PCI) with at least one drug-eluting stent between January 7, 2008, and September 16, 2010. Researchers assessed platelet reactivity with the VerifyNow Aspirin, P2Y12, and IIb/IIIa tests. Patients were followed for one year to determine the relationship between platelet reactivity and subsequent events. At one year, stent thrombosis had occurred in 70 patients (0.8 percent), heart attack in 269 (3.1 percent), major bleeding in 531 (6.2 percent), and death in 161 (1.9 percent).

Platelet reactivity units (PRU), an index of platelet inhibition to clopidogrel, were measured by the VerifyNow P2Y12 test. High platelet reactivity, defined as a PRU of greater than 208, was present in 42.7 percent of patients. At one year, researchers found that high platelet reactivity was significantly associated with stent thrombosis (1.3 percent vs. 0.5 percent) and heart attack (3.9 percent vs. 2.7 percent), but was also found to be protective against major bleeding (5.6 percent vs. 6.7 percent). High platelet reactivity was also associated with one-year mortality (2.4 percent vs. 1.5 percent). However, because high platelet reactivity is also associated with other patient risk factors and baseline characteristics, multivariable modeling was also performed; it showed no independent association between high platelet reactivity and mortality.

"Results from the ADAPT-DES registry definitely demonstrate that high platelet reactivity after implantation of drug-eluting stents is an independent predictor of one-year stent thrombosis and heart attack, but it is also protective against major bleeding, both of which impact mortality," said lead investigator Gregg W. Stone, MD. Dr Stone is professor of medicine at Columbia University College of Physicians and Surgeons and Director of Cardiovascular Research and Education at the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center. Dr. Stone is also co-director of the Medical Research and Education Division at the Cardiovascular Research Foundation (CRF).

"Because of the counteracting effects of ischemia and bleeding, platelet reactivity was not an independent predictor of one-year mortality. Therefore, overcoming high platelet reactivity with more potent antiplatelet agents is unlikely to improve survival unless the beneficial effect of reducing stent thrombosis and heart attack can be separated from the likely increase in bleeding that results from greater platelet inhibition," said Dr. Stone.

Dr. Stone added: "Platelet reactivity on aspirin was unrelated to stent thrombosis, heart attack, or death, but may be related to bleeding. This raises questions as to the utility of aspirin in patients treated with drug-eluting stents."


Story Source:

The above story is based on materials provided by Cardiovascular Research Foundation. Note: Materials may be edited for content and length.


Journal Reference:

  1. Gregg W Stone, Bernhard Witzenbichler, Giora Weisz, Michael J Rinaldi, Franz-Josef Neumann, D Christopher Metzger, Timothy D Henry, David A Cox, Peter L Duffy, Ernest Mazzaferri, Paul A Gurbel, Ke Xu, Helen Parise, Ajay J Kirtane, Bruce R Brodie, Roxana Mehran, Thomas D Stuckey. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. The Lancet, 2013; DOI: 10.1016/S0140-6736(13)61170-8

Cite This Page:

Cardiovascular Research Foundation. "Drug-eluting stents, heart attack and bleeding risks: One-year results of ADAPT-DES trial." ScienceDaily. ScienceDaily, 26 July 2013. <www.sciencedaily.com/releases/2013/07/130726112207.htm>.
Cardiovascular Research Foundation. (2013, July 26). Drug-eluting stents, heart attack and bleeding risks: One-year results of ADAPT-DES trial. ScienceDaily. Retrieved October 21, 2014 from www.sciencedaily.com/releases/2013/07/130726112207.htm
Cardiovascular Research Foundation. "Drug-eluting stents, heart attack and bleeding risks: One-year results of ADAPT-DES trial." ScienceDaily. www.sciencedaily.com/releases/2013/07/130726112207.htm (accessed October 21, 2014).

Share This



More Health & Medicine News

Tuesday, October 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

How Nigeria Beat Its Ebola Outbreak

How Nigeria Beat Its Ebola Outbreak

Newsy (Oct. 20, 2014) The World Health Organization has declared Nigeria free of Ebola. Health experts credit a bit of luck and the government's initial response. Video provided by Newsy
Powered by NewsLook.com
Another Study Suggests Viagra Is Good For The Heart

Another Study Suggests Viagra Is Good For The Heart

Newsy (Oct. 20, 2014) An ingredient in erectile-dysfunction medications such as Viagra could improve heart function. Perhaps not surprising, given Viagra's history. Video provided by Newsy
Powered by NewsLook.com
Ebola Worries End for Dozens on U.S. Watch Lists

Ebola Worries End for Dozens on U.S. Watch Lists

Reuters - US Online Video (Oct. 20, 2014) Forty-three people who had contact with Thomas Eric Duncan, the first person diagnosed with Ebola in the U.S., were cleared overnight of twice-daily monitoring after 21 days of showing no symptoms. Rough Cut (no reporter narration). Video provided by Reuters
Powered by NewsLook.com
CDC Calls for New Ebola Safety Guidelines

CDC Calls for New Ebola Safety Guidelines

AP (Oct. 20, 2014) Centers for Disease Control and Prevention Director Dr. Tom Frieden laid out new guidelines for health care workers when dealing with the deadly Ebola virus including new precautions when taking off personal protective equipment. (Oct. 20) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins