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• W3134798512 abstract "We read with great interest the prospective study by Asher et al. [[1]Asher E. Abu-Much A. Bragazzi N.L. Younis A. Younis A. Masalha E. et al.CHADS2 and CHA2DS2-VASc scores as predictors of platelet reactivity in acute coronary syndrome.J Cardiol. 2020; https://doi.org/10.1016/j.jjcc.2020.09.010Abstract Full Text Full Text PDF Scopus (6) Google Scholar] which evaluated whether CHADS2 and CHA2DS2-VASc scores could predict platelet reactivity in 291 patients with acute coronary syndrome (ACS). All patients received dual antiplatelet therapy (DAPT) with loading and maintenance doses of aspirin and clopidogrel following percutaneous coronary intervention (PCI). Asher et al. [[1]Asher E. Abu-Much A. Bragazzi N.L. Younis A. Younis A. Masalha E. et al.CHADS2 and CHA2DS2-VASc scores as predictors of platelet reactivity in acute coronary syndrome.J Cardiol. 2020; https://doi.org/10.1016/j.jjcc.2020.09.010Abstract Full Text Full Text PDF Scopus (6) Google Scholar] found that high CHADS2 and CHA2DS2-VASc scores correlated with high on-treatment platelet reactivity (HPR), whilst low scores correlated with optimal platelet reactivity (OPR) (p = 0.01 for both). These findings suggest that platelet function testing (PFT) could be used to optimize DAPT in patients following PCI, thereby improving outcomes by preventing both ischemic and hemorrhagic events in HPR and OPR cases, respectively. Similarly, Zhao et al. [[2]Zhao X. Li Q. Tu C. Zeng Y. Ye Y. High glycated albumin is an independent predictor of low response to clopidogrel in ACS patients: A cross-sectional study.Cardiovasc Diabetol. 2020; 19: 171Crossref PubMed Scopus (9) Google Scholar] evaluated 1021 patients with ACS who received aspirin and clopidogrel following PCI. Glycated albumin level was used to categorize patients into two groups, whereby a level of >15.5% was used to indicate the development of early-phase diabetes. P2Y12 inhibition was subsequently assessed in patients 12 hours after they had taken clopidogrel. The authors found that high glycated albumin level (>15.5%) was independently associated with a low responsiveness to clopidogrel, and this was significantly higher than in patients with a glycated albumin level of ≤15.5% (p = 0.002). In addition, Zhao et al. [[2]Zhao X. Li Q. Tu C. Zeng Y. Ye Y. High glycated albumin is an independent predictor of low response to clopidogrel in ACS patients: A cross-sectional study.Cardiovasc Diabetol. 2020; 19: 171Crossref PubMed Scopus (9) Google Scholar] noted that whilst glycated albumin level correlated with a history of diabetes mellitus (DM), a background of DM did not have an impact on the interaction of glycated albumin with clopidogrel (r = 0.622, p = 0.000). These findings suggest that glycated albumin, an indicator of short-term (2–4 week) glycemic control, is a useful clinical biomarker for predicting platelet reactivity. Therefore, poorly controlled diabetes in the acute setting may be a major determinant for predicting responsiveness to clopidogrel in ACS patients. Furthermore, this may be more significant than a history of diabetes alone, a risk factor included in the CHADS2 and CHA2DS2-VASc scoring systems. Wang et al. [[3]Wang J. Abdus S. Tan C. Gu Q. Yang M. Wang G. et al.Serum uric acid level negatively correlated with the prevalence of clopidogrel low response in patients undergoing antiplatelet treatment with aspirin and clopidogrel.Nutr Metab Cardiovasc Dis. 2020; 30: 2215-2220Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] demonstrated in a 2569 patient study that serum uric acid (SUA) levels were independently and negatively correlated with platelet reactivity. Adenosine diphosphate-induced platelet aggregation was measured to determine platelet reactivity, which was higher in patients with normal SUA levels and lower in patients with hyperuricemia (p = 0.032). Thus, a high SUA concentration was found to be associated with a decreased risk of low responsiveness to clopidogrel (OR = 0.995; CI: 0.995-0.997, p = 0.001). CHADS2 and CHA2DS2-VASc scores do not include SUA levels and therefore, Asher et al. [[1]Asher E. Abu-Much A. Bragazzi N.L. Younis A. Younis A. Masalha E. et al.CHADS2 and CHA2DS2-VASc scores as predictors of platelet reactivity in acute coronary syndrome.J Cardiol. 2020; https://doi.org/10.1016/j.jjcc.2020.09.010Abstract Full Text Full Text PDF Scopus (6) Google Scholar] and future studies may consider incorporating patient SUA levels with CHADS2 and CHA2DS2-VASc scores to adjust antiplatelet treatment plans. Furthermore, Zhu et al. [[4]Zhu P. Tang X.-F. Song Y. Zhang Y. Gao L.-J. Gao Z. et al.Association of lipoprotein(a) with platelet aggregation and thrombogenicity in patients undergoing percutaneous coronary intervention.Platelets. 2020; https://doi.org/10.1080/09537104.2020.1802412Crossref Scopus (2) Google Scholar] assessed 6601 patients who had undergone PCI followed by DAPT, demonstrating that increased levels of lipoprotein(a) were significantly associated with HPR (p <0.001). In addition, patients with increased plasma lipoprotein(a) also had an increased risk of major adverse cardiovascular and cerebrovascular events despite DAPT (p >0.042). It is therefore reasonable to assume that patients with increased plasma lipoprotein(a) levels could benefit from platelet function testing to determine optimal treatment with prasugrel or ticagrelor and appropriate de-escalation to clopidogrel. We recommend that Asher et al. [[1]Asher E. Abu-Much A. Bragazzi N.L. Younis A. Younis A. Masalha E. et al.CHADS2 and CHA2DS2-VASc scores as predictors of platelet reactivity in acute coronary syndrome.J Cardiol. 2020; https://doi.org/10.1016/j.jjcc.2020.09.010Abstract Full Text Full Text PDF Scopus (6) Google Scholar] and future studies include lipoprotein(a) levels along with CHADS2 and CHA2DS2-VASc scores when evaluating patient suitability for ticagrelor and prasugrel after PCI. In conclusion, Asher et al. [[1]Asher E. Abu-Much A. Bragazzi N.L. Younis A. Younis A. Masalha E. et al.CHADS2 and CHA2DS2-VASc scores as predictors of platelet reactivity in acute coronary syndrome.J Cardiol. 2020; https://doi.org/10.1016/j.jjcc.2020.09.010Abstract Full Text Full Text PDF Scopus (6) Google Scholar] successfully demonstrated that CHADS2 and CHA2DS2-VASc scores were predictors of platelet reactivity in a cohort of ACS patients treated with aspirin and clopidogrel following PCI. Further cohort studies and randomized controlled trials are needed to explore whether PFT-guided treatment using CHADS2 and CHA2DS2-VASc scores can prevent major life-threatening bleeds and reduce the incidence of both stent thrombosis-related and -unrelated myocardial infarction in high-risk ACS patients. However, the findings of the aforementioned studies suggest that platelet reactivity is complex and multi-factorial. The use of a machine learning algorithm to incorporate the components of CHADS2 and CHA2DS2-VASc scores together with additional markers including glycated albumin, SUA and lipoprotein(a) could help to create a standardized protocol for future clinical benefit." @default.
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• W3134798512 date "2021-07-01" @default.
• W3134798512 modified "2023-10-18" @default.
• W3134798512 title "The use of clinical biomarkers in acute coronary syndrome to predict responsiveness to dual antiplatelet therapy" @default.
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• W3134798512 doi "https://doi.org/10.1016/j.jjcc.2021.01.003" @default.
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