Impact of Platelet Reactivity on Long-term Clinical Outcomes and Bleeding Events in Japanese Patients Receiving Antiplatelet Therapy with Aspirin

Keiichiro Yamane; Tomoyuki Ikeda; Ryoji Taniguchi; Shin Watanabe; Mitsunori Kawato; Hirokazu Kondo; Ryutaro Shirakawa; Tomohito Higashi; Masanao Toma; Arata Tabuchi; Toshihiro Tamura; Kanako Takahashi; Haruyo Watanabe; Yuka Yoshikawa; Toru Kita; Takeshi Kimura; Hisanori Horiuchi

doi:10.5551/jat.14100

Original Article

Impact of Platelet Reactivity on Long-term Clinical Outcomes and Bleeding Events in Japanese Patients Receiving Antiplatelet Therapy with Aspirin

Keiichiro Yamane, Tomoyuki Ikeda, Ryoji Taniguchi, Shin Watanabe, Mitsunori Kawato, Hirokazu Kondo, Ryutaro Shirakawa, Tomohito Higashi, Masanao Toma, Arata Tabuchi, Toshihiro Tamura, Kanako Takahashi, Haruyo Watanabe, Yuka Yoshikawa, Toru Kita, Takeshi Kimura, Hisanori Horiuchi

Author information

Keiichiro Yamane
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Tomoyuki Ikeda
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Ryoji Taniguchi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Shin Watanabe
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Mitsunori Kawato
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Hirokazu Kondo
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Ryutaro Shirakawa
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University.
Tomohito Higashi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Masanao Toma
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Arata Tabuchi
Department of Geriatric Medicine, Graduate School of Medicine, Kyoto University.
Toshihiro Tamura
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Kanako Takahashi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Haruyo Watanabe
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Yuka Yoshikawa
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Toru Kita
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital.
Takeshi Kimura
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Hisanori Horiuchi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University.

Keywords: Antiplatelet therapy, Aspirin, Clinical outcome, Bleeding, Aspirin low responder

JOURNAL OPEN ACCESS

2012 Volume 19 Issue 12 Pages 1142-1153

DOI https://doi.org/10.5551/jat.14100

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Abstract

Aim: Aspirin is an antiplatelet drug widely used for the prevention of cardiovascular disease; however, it is known to increase bleeding events. A low response to aspirin was reported to correlate with poor prognosis in patients undergoing antiplatelet therapy with aspirin. The aim of this study was to evaluate the impact of the antiplatelet activity of aspirin on cardiovascular and bleeding events in Japanese patients.
Methods: We analyzed the clinical course of 239 Japanese patients undergoing antiplatelet therapy with aspirin for a median of 64 months in this study. Their residual platelet reactivity was examined at enrollment and after 2 years. The co-primary endpoints were the occurrence of major adverse cardiac and cerebrovascular events (MACCEs) and bleeding events.
Results: The annual incidence of MACCEs and major bleeding events was 3.7% and 0.48%, respectively. With defined criteria, 67 patients (28%) were classified as low responders based on the platelet aggregability measured at enrollment. Low response to aspirin was not associated with increased MACCEs, while it clearly increased MACCEs in patients less than 70 years old (low responders 36.9% vs. responders 14.8%, log rank p=0.008). Five major types of bleeding occurred in the responders, but not in low responders, although the difference was not statistically significant (p= 0.07).
Conclusion: Low response to aspirin was not associated with the increase of long-term MACCEs, while it increased MACCEs in patients less than 70 years old; however, it tended to decrease major bleeding events in Japanese patients.

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