028 Prevalence and characteristics of dual non responsiveness to aspirin and clodiprogel in a cohort of 430 stable cardiovascular patients. Insight from the adrie study on stable cardiovascular patients

BackgroundResidual platelet reactivity (RPR) has been shown to be related to adverse cardiovascular events. However, assessment of residual platelet reactivity was often evaluated in heterogeneous populations including both patients with stable disease and acute coronary syndrome.ObjectivesWe aim to delineate determinants of RPR in a cohort of stable cardiovascular patients.MethodsWe included 750 stable cardiovascular patients treated for at least one month with aspirin (n=213), clopidogrel (n=107) or both (n=425). We evaluated RPR using collagen platelet aggregation (CPA), collagen being a stimulus not directly involved in the specific pathways of aspirin and clopidogrel.ResultsMean age was 65±12 years, 76% were male; the mean duration of the CV disease was 1.6 years. CPA ranged from 6% to 96% in our population. CPA was of 41+/-16, 61+/-14 and 28+/-15% in aspirin, clopidogrel and dual treatment groups, respectively (P<0.001). In univariate analysis of relevant biological and clinical parameters, antiplatelet drug treatment pattern (P<0.001), diabetes (P=0.006), hypertension (P=0.01) and a pain-free walking distance < 200m (P=0.02) were associated with CPA. Multivariate analysis showed that antiplatelet drug treatment pattern (P<0.0001) and diabetes (P=0.0007) were independent factors associated with CPA.ConclusionAspirin had a more pronounced effect on CPA than clopidogrel in stable cardiovascular patients. Even after adjustment for antiplatelet drug pattern, diabetes remains an independent factor associated with CPA. These results give new insight into the controversy about the beneficial effect of antiplatelet drugs in this particular group of patient

Antiplatelet drug response status does not predict recurrent ischemic events in stable cardiovascular patients: results of the Antiplatelet Drug Resistances and Ischemic Events study

The biological response to antiplatelet drugs has repeatedly been shown to predict the recurrence of major adverse cardiovascular events (MACEs). However, most studies involved coronary artery disease patients with recent vessel injury shortly after the initiation of antiplatelet therapy. Data on stable cardiovascular patients are scarce, and the added predictive value of specific assays (the vasodilator phosphoprotein assay for the clopidogrel response and serum thromboxane B2 for the aspirin response) and aggregation-based assays relative to common predictors has rarely been addressed