Biomarkers of platelet activation and cardiovascular risk in the DAPT trial.

Journal of Thrombosis and Thrombolysis
David D BergMichelle L O'Donoghue

Abstract

Prolonged use of dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) has been shown to reduce the risk of major adverse cardiovascular events (MACE), but with increased bleeding. It remains unknown whether biomarkers of platelet activation may be useful for identifying patients at increased risk of MACE. The DAPT study was a randomized trial of 12 versus 30 months of DAPT in patients who underwent PCI. Serum biomarkers [myeloid-related protein (MRP)-8/14, P-selectin, soluble CD-40 ligand (sCD40L)] were assessed in 1399 patients early post-PCI. On-treatment platelet reactivity index (PRI) using VASP phosphorylation was assessed in 443 patients randomized to continued DAPT at 1 year. MACE was defined as CV death, MI, or ischemic stroke. Multivariable models were adjusted for baseline characteristics, index event, and stent type. A stepwise increase in the risk of MACE was observed with increasing tertiles of both MRP-8/14 and P-selectin (p-trend = 0.04 for both). After multivariable adjustment, the adjusted HR (95% CI) for MACE in patients in the top tertile was 1.94 (1.14-3.30) for MRP-8/14 and 1.62 (0.99-2.64) for P-selectin. In contrast, baseline sCD40L was not associated with CV risk. Among patients...Continue Reading

Associated Clinical Trials

References

Oct 15, 1996·Proceedings of the National Academy of Sciences of the United States of America·A D MichelsonC R Valeri
Feb 7, 2001·Circulation·P M RidkerN Rifai
Mar 21, 2003·The New England Journal of Medicine·Christopher HeeschenUNKNOWN CAPTURE Study Investigators
Oct 6, 2007·Journal of Thrombosis and Thrombolysis·Benjamin A OlenchockDavid A Morrow
Nov 18, 2014·The New England Journal of Medicine·Laura MauriUNKNOWN DAPT Study Investigators
Mar 30, 2016·JAMA : the Journal of the American Medical Association·Robert W YehUNKNOWN DAPT Study Investigators
Feb 1, 2019·Circulation·Emelia J BenjaminUNKNOWN American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee

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Citations

Jan 15, 2021·Arteriosclerosis, Thrombosis, and Vascular Biology·Joseph E Aslan

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