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ȣ - 550778 176 |
| Predictors of Mid-Term Major Bleeding after Drug Eluting Stent Implantation : Can Platelet Function Test Has a Role ? |
| 동아대학교병원 순환기내과¹, 임상시험센터² |
| 조용락¹ , 김무현¹ ², 장홍철², 김보성¹, 서정민¹, 이동현¹, 박경일¹, 박종성¹, 박태호¹, 김영대¹ |
Background: The bleeding episodes after drug eluting stent implantation are one of the controversial issues because it is related to the chronic use of antiplatelet therapy. Residual platelet reactivity maybe one of the key factor, which is important in acute phase as well as chronic phase in the development of these episodes. Objective: We sought to investigate the influence of acute phase residual platelet activity to predict mid-term bleeding events. Methods: We had analyzed 435 consecutive patients who underwent drug eluting stents implantation. Platelet function tests (light transmission aggregometry and VeryfyNow assay) were carried out after PCI, mostly within 24 hrs. Major bleeding was defined as fatal hemorrhage, symptomatic intracranial hemorrhage, retroperitoneal hemorrhage, intraocular bleeding leading to significant vision loss, hemorrhage requiring surgical intervention, Hb drop of 3 g/dL (each transfusion unit counting for 1.0 g/dL Hb), blood transfusion of 2 units RBC or equivalent whole blood. Logistic regression analysis was done using clinical parameters as well residual platelet activity cutoff values. All statistical analyses were carried out using SAS version 9.1.3 and MedCalc version 11.6.1 statistical softwares. Results: 6 month major bleeding occurred in 21 patients (5.0%). Maximal 10µM ADP induced aggregation<10% by LTA and VeryfyNow<180 PRU was predictors in univariate analysis. By mutivariate logistic regression analysis, Maximal 10µM ADP induced aggregation<10% by LTA was the only predictor of major bleeding (table). Conclusion: Low residual platelet activity defined by maximal platelet aggregation by LTA can predict 6 month major bleeding.
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Table. Results from logistic regression for Major bleeding
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Univariate |
Multivariate |
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Variable |
OR |
95% CI |
P value |
OR |
95% CI |
P value |
|
Sex (male vs. female) |
0.97 |
(0.38-2.45) |
0.94 |
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Age, yrs (≥65 vs. <65) |
1.31 |
(0.54-3.17) |
0.55 |
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Statin use (yes vs. no) |
0.82 |
(0.30-2.29) |
0.71 |
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CCBDHP (yes vs. no) |
1.49 |
(0.48-4.57) |
0.49 |
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Cilostazol (yes vs. no) |
1.18 |
(0.39-3.60) |
0.78 |
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DM (yes vs. no) |
0.65 |
(0.25-1.71) |
0.38 |
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Smoking (yes vs. no) |
1.45 |
(0.59-3.58) |
0.42 |
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LTA (≥10 vs. <10) |
0.28 |
(0.097-0.82) |
0.020 |
0.28 |
(0.097-0.82) |
0.020 |
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PRU (≥180 vs. <180) |
0.45 |
(0.18-1.13) |
0.088 |
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