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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAn analysis from the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents [ADAPT-DES; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00638794\u0026amp;atom=%2Fspmdc%2F12%2F17%2F22.atom\u0022\u003ENCT00638794\u003C\/a\u003E] trial showed that hyporesponsiveness to clopidogrel was not independently predictive of mortality at 1-year after percutaneous coronary intervention with a drug-eluting stent. Although hyporesponsiveness to clopidogrel was associated with increased risk of stent thrombosis and myocardial infarction, it was also associated with a reduced risk of major bleeding, which has been strongly related to mortality.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAn analysis from the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents [ADAPT-DES; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00638794\u0026amp;atom=%2Fspmdc%2F12%2F17%2F22.atom\u0022\u003ENCT00638794\u003C\/a\u003E] trial showed that hyporesponsiveness to clopidogrel was not independently predictive of mortality at 1-year after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES). Although hyporesponsiveness to clopidogrel was associated with increased risk of stent thrombosis and myocardial infarction (MI), it was also associated with a reduced risk of major bleeding, which has been strongly related to mortality, explained Gregg W. Stone, MD, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe trial enrolled 8583 patients at 11 sites in the United States and Germany between January 2008 and September 2010. All patients had PCI with implantation of \u22651 (noninvestigational) DES. Dr. Stone said the patients in the study represented a \u201creal-world population,\u201d with about one-third having diabetes, one-quarter having a previous MI, and \u0026gt;50% having undergone a previous revascularization procedure.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe number of platelet reactivity units (PRU) and aspirin reactivity units (ARU) were assessed with the VerifyNow P2Y12 and Aspirin assays, respectively. Approximately 43% of patients were found to be hyporesponders to clopidogrel, defined as PRU \u0026gt;208. Hyporesponsiveness to aspirin, defined as a score of \u0026gt;550 ARU, was found in 5.6% of patients.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe first results of ADAPT-DES were presented last year when Dr. Stone reported that hyporesponsiveness to clopidogrel was significantly related to stent thrombosis within 30 days after PCI. The current analysis was designed to evaluate the impact of clopidogrel hyporesponsiveness on patient outcomes after 1 year of follow-up.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAt 1 year, 74 stent thrombosis events had occurred in 70 patients (0.84%), MI had occurred in 224 patients (2.6%), major bleeding had occurred in 531 patients (6.2%), and 161 patients had died (1.9%). The rate of stent thrombosis was significantly higher for patients who were hyporesponsive to clopidogrel than for those with a PRU \u2264208 (1.3% vs 0.5%; HR, 2.54; 95% CI, 1.55 to 4.16; p=0.0001). The rate of MI was also significantly higher for the group with hyporesponsiveness (3.9% vs 2.7%; HR, 1.47; 95% CI, 1.15 to 1.87; p=0.002).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EIn contrast, patients with hyporesponsiveness to clopidogrel had significantly lower rates of major bleeding (5.6% vs 6.7%; HR, 0.83; 95% CI, 0.69 to 0.99; p=0.04; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E)\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/22\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022ADAPT-DES: MI and Major Bleeding According to Post-PCI PRU.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-241609955\u0022 data-figure-caption=\u0022ADAPT-DES: MI and Major Bleeding According to Post-PCI PRU.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/22\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/22\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/22\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14279\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EADAPT-DES: MI and Major Bleeding According to Post-PCI PRU.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EMI=myocardial infarction; PCI=percutaneous coronary intervention; PRU=platelet reactivity units; Reproduced with permission from GW Stone, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EHyporesponsiveness to aspirin predicted a slightly lower risk of bleeding but did not predict a difference in stent thrombosis, MI, or mortality. Dr. Stone noted that this finding raises the question of whether aspirin is of benefit for patients treated with a DES.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EUnivariable analysis showed that hyporesponsiveness to clopidogrel was significantly associated with mortality, with a rate of 2.4% for patients with a PRU \u0026gt;208 compared with 1.5% for those patients with a PRU \u003Cspan class=\u0022underline\u0022\u003E\u0026lt;\u003C\/span\u003E208 (HR, 1.62; 95% CI, 1.18 to 2.22; p=0.002). However, he added that a number of factors associated with hyporesponsiveness are also associated with mortality (eg, age and diabetes). To address this issue, he and his coinvestigators performed a propensity adjustment for hyporesponsiveness to clopidogrel. A multivariable propensity score adjusted risk model demonstrated no independent association between hyporesponsiveness to clopidogrel and mortality (adjusted HR, 1.20; 95% CI, 0.85 to 1.70; p=0.30). Stent thrombosis, MI, and major bleeding remained significantly associated with hyporesponsiveness to clopidogrel in this analysis (p=0.001, p=0.01, and p=0.002, respectively).\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EDr. Stone said that many more deaths were associated with major bleeding than with stent thrombosis and MI combined. He added that a complete effect in reversing hyporesponsiveness to clopidogrel would cause 4 bleeding events for every stent thrombosis prevented. He and his coinvestigators concluded that the findings suggest that the use of potent antiplatelet agents to overcome hyporesponsiveness to clopidogrel is unlikely to improve survival unless the beneficial effects of reducing stent thrombosis and MI can be uncoupled from the likely increase in bleeding.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/17\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn7cb\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn7cb\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}