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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=54116#.VO2HpizQrzE
ABSTRACT
Objective:
Clopidogrel therapy is the standard of care in patients with unstable
angina. However, a percentage of subjects are nonresponders to
clopidogrel and this leads to increased adverse outcome. On the other
way round, some responsive patients are exposed to bleeding
complications. Detection of both in daily practice is important in order
to tailor the treatment protocol. In this study we aimed to estimate
the cutoff value of mean platelet volume (MPV) for both platelet
responsiveness and bleeding risks. Methods: The study was planned
as a prospective cohort study. A total number of 230 patients admitted
to our CCU with unstable angina over a period of one year (from June
2013 to May 2014) were enrolled. Exclusion criteria were: severe anemia,
throm-bocytopenia, myelodysplastic syndrome, coagulopathy and recent
blood transfusion. In all patients clopidogrel was initially started and
maintained during the hospital stay. Blood (2 ml) was collected in
dipotassium EDTA tubes from all patients on the first day of admission
by a clean puncture. Samples for MPV analysis were drawn on admission,
and analyzed within 1 hour of admission after sampling by Beckman
Caulter LH 780 Analyzer. Grouping was then done according to MPV of the
patients into group (I) who had a low MPV less than or equal to 7.00 fl,
and group (II) with MPV equal to or higher than 9.00 fl. Demographical
and clinical variables of the patients were recorded. Routine laboratory
parameters were also recorded. Clinical manifestations during the
admission period were meticulously reported. Major complications as
bleeding or, urgent need for percutaneous coronary intervention (PCI)
were also studied. Results: Among the 230 patients analyzed, 175
patients (76%) were found to have MPV ≤7.00 fl (group (I)) and 55
patients (24%) had MPV ≥9.00 fl (group (II)) with mean ± SD MPV (8.4 ±
1.5 fl, vs 11.7 ± 1.2 fl respectively) (p < 0.001). Observation of
clinical course during admission period revealed a statistically more
significant clinical deterioration in group (II) than group (I) and the
presence of more frequent AMI cases in group (II) having a high MPV. A
high cutoff value of 9.7 fl for MPV was detected in prediction of
clopidogrel nonresponsiveness (group (II)) with a sensitivity of 78.2%
and specificity of 66.8%, and a low cutoff value for bleeding tendency
lower than 6.3 fl was detected in group (I) with a sensitivity of 71.4%
and specificity of 62.5%. Conclusion: This study showed that MPV can be
used as a simple bedside predictor for detection of clopidogrel response
in patients with unstable angina. And a cutoff value for both platelet
responsiveness and risk of bleeding is now reached. This may lead to
enhancement in our decision for early intervention and attention for
bleeding risk during clopidogrel therapy.
Cite this paper
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