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Platelet Aggregation and Its Association With Stent Thrombosis and Bleeding in Clopidogrel-Treated Patients
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“Of note, Multiplate results have been shown to bear a good correlation to bleeding and thromboembolic complications in patients undergoing coronary stenting and cardiac surgery.44,45”
From Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients (2012) · cites this paper as [45]
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Research works printed but not linked: 5
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- Sibbing, 2010, Antiplatelet effects of clopidogrel and bleeding in patients undergoing coronary stent placement, J Thromb Haemost, 8, 250, 10.1111/j.1538-7836.2009.03709.x · DOI
- Doyle, 2009, Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice, J Am Coll Cardiol, 53, 2019, 10.1016/j.jacc.2008.12.073 · DOI
- Azar, 1996, Optimal intensity of oral anticoagulant therapy after myocardial infarction, J Am Coll Cardiol, 27, 1349, 10.1016/0735-1097(96)00020-4 · DOI
- Sibbing, 2009, Platelet reactivity after clopidogrel treatment assessed with point-of-care analysis and early drug-eluting stent thrombosis, J Am Coll Cardiol, 53, 849, 10.1016/j.jacc.2008.11.030 · DOI
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“In our study, despite the use of a reduced prasugrel maintenance dose, a higher average residual platelet reactivity, and a lower proportion of subjects showing low residual platelet reactivity (a risk factor that has been associated with bleeding risk [18]), elderly patients experienced more bleeding events than non-…”
BackgroundThe future of platelet function testing to guide therapy in clopidogrel low and enhanced responders
Bernlochner, I., Byrne, R. A., Kastrati, A., & Sibbing, D. (2011) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.11.80 · Cited by 4
Self-citationFunctional testing methods for the antiplatelet effect of P2Y12 receptor antagonists.
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Diagnosis and Management of High Platelet Reactivity on Treatment with Clopidogrel
Cattaneo, M. (2012) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-0032-1326785 · Cited by 9
Xu, L., Hu, X., Zhang, S., Li, J., Zhu, H., Xu, K., Chen, J., & Li, C. (2016) · Chinese Medical Journal · doi:10.4103/0366-6999.179786 · Cited by 7
“CLR is an independent risk factor for adverse clinical outcomes.[3,23,24] Theoretically, any intensified antiplatelet therapy that improves the platelet response should improve the patient’s clinical outcome.”
BackgroundAlfredsson, J., Lindahl, T. L., Gustafsson, K. M., Janzon, M., Jonasson, L., Logander, E., Nilsson, L. E., & Swahn, E. (2015) · Thrombosis Research · doi:10.1016/j.thromres.2015.05.021 · Cited by 11
“[24] However, and in spite of a similar rate of HRPR, we found a very low rate of ischemic events.”
ResultII. Looking into the future of platelet transfusion in the presence of P2Y(12) inhibitors.
Tanaka, K., & Subramaniam, K. (2014) · British Journal of Anaesthesia · doi:10.1093/bja/aet584 · Cited by 8
Gresele, P., & Page, C. (2012) · Handbook of Experimental Pharmacology · doi:10.1007/978-3-642-29423-5 · Cited by 8
Antiplatelet therapy for coronary artery disease in 2023: current status and future prospects
Chandiramani, R., Spirito, A., Johnson, J. W., Mehta, A., Vogel, B., FAILLACE, R. T., & Mehran, R. (2023) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2023.2201437 · Cited by 8
“Despite these interesting observations, studies evaluating the implementation of platelet function testing (PFT) in clinical practice were largely unsuccessful [103,105,106] (Figure 3).”
BackgroundHolm, A., Swahn, E., Lawesson, S., Gustafsson, K., Janzon, M., Jonasson, L., Lindahl, T., & Alfredsson, J. (2020) · Platelets · doi:10.1080/09537104.2020.1771550 · Cited by 7
“sis post-PCI [41], whereas LRPR has been associated with an increased risk of bleeding [26].”
BackgroundMonitoring platelet function: what have we learned from randomized clinical trials?
Deharo, P., & Cuisset, T. (2018) · Cardiovascular Diagnosis and Therapy · doi:10.21037/cdt.2018.10.10 · Cited by 8
“Strategies to target a therapeutic window for antiplatelet therapy, with intermediate degree of platelet inhibition (non-HTPR and non-LTPR), that would allow prevention of both ischemic and bleeding events, have been developed (38,39).”
BackgroundCzerwińska-Jelonkiewicz, K., Witkowski, A., Dąbrowski, M., Piotrowski, W., Hryniewiecki, T., & Stępińska, J. (2017) · Archives of Cardiovascular Diseases · doi:10.1016/j.acvd.2017.06.002 · Cited by 7
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Antiplatelet strategies in elderly people: still a long way to go
Sibbing, D., & Maßberg, S. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31387-3 · Cited by 7
Self-citationPrognostic Role of Platelet Reactivity in Patients With Acute Coronary Syndromes
Cavallari, I., Nusca, A., Ricottini, E., & Sciascio, G. D. (2014) · Cardiology in Review · doi:10.1097/crd.0000000000000034 · Cited by 7
Monitoring Aspirin and Clopidogrel Response: Testing Controversies and Recommendations
Karathanos, A., & Geisler, T. (2013) · Molecular Diagnosis & Therapy · doi:10.1007/s40291-013-0022-y · Cited by 6
“Other populations that could benefit from platelet function monitoring are elderly patients which have been reported to present a high rate of HPR [128] and in general individuals who are at a high risk of bleeding but at the same time at an increased risk of thrombosis [129, 130].”
BackgroundUtility of Platelet Function Testing in Cardiac Surgery in 2021
Görlinger, K., & Gandhi, A. (2021) · Journal of Cardiac Critical Care TSS · doi:10.1055/s-0041-1732839 · Cited by 6
Jin, L.-J., Yu, H.-M., Dong, T.-M., Zhang, B., Yan, H., Liao, H.-T., & Zou, X. (2017) · Heart, Lung and Circulation · doi:10.1016/j.hlc.2016.05.113 · Cited by 6
“[6,26,27] defined an optimal therapeutic window for P2Y12 receptor inhibition of 189-467 aggregation units min using a multiplate analyser, which supports defining approximately one-third of patients as patients at risk of bleeding.”
MethodClinical Impact of Genetically Determined Platelet Reactivity
Laine, M., Arméro, S., Peyrol, M., Sbragia, P., Thuny, F., Paganelli, F., & Bonello, L. (2013) · Journal of Cardiovascular Translational Research · doi:10.1007/s12265-012-9421-4 · Cited by 6
Entfernung eines Periduralkatheters unter dualer Antiplättchentherapie nach akutem Koronarsyndrom
Limper, U., & Lynch, J. (2012) · Der Anaesthesist · doi:10.1007/s00101-012-2067-4 · Cited by 6
Platelet function monitoring in patients on clopidogrel: What should we learn from GRAVITAS?
Aradi, D., & Komócsi, A. (2012) · Platelets · doi:10.3109/09537104.2011.610475 · Cited by 6
“[42] have demonstrated the presence of a therapeutic window after thienopyridine administration by the VerifyNow (86-238 PRU) and Multiplate (19-47 U) assays, respectively.”
MethodOrban, M., Byrne, R., Hausleiter, J., Laugwitz, K., & Sibbing, D. (2011) · Thrombosis and Haemostasis · doi:10.1160/th11-04-0267 · Cited by 6
“Peri-procedural assessment of P2Y12-mediated platelet inhibition due to thienopyridine treatment has been shown to be highly predictive for early thrombotic events after the procedure including the occurrence of stent thrombosis (1).”
BackgroundMethodInfluentialSelf-citationDe-Escalation of Treatment With Oral P2Y12 Receptor Inhibitors: Current Status and Perspectives
Alexopoulos, D., Lianos, I., Vlachakis, P., Sfantou, D., Dragona, V.-M., & Varlamos, C. (2019) · Journal of Cardiovascular Pharmacology and Therapeutics · doi:10.1177/1074248418823724 · Cited by 5
Alfredsson, J., Swahn, E., Gustafsson, K. M., Janzon, M., Jonasson, L., Logander, E., Nilsson, L. E., & Lindahl, T. L. (2018) · Platelets · doi:10.1080/09537104.2018.1479519 · Cited by 10
Prise en charge du risque hémorragique associé aux agents antiplaquettaires
Martin, A., Houssany-Pissot, S., Zlotnik, D., Taylor, G., & Godiér, A. (2017) · La Revue de Médecine Interne · doi:10.1016/j.revmed.2017.01.013 · Cited by 8
Gerinnungsdiagnostik und -therapie bei Leberinsuffizienz
Bienholz, A., Canbay, A., & Saner, F. (2016) · Medizinische Klinik - Intensivmedizin und Notfallmedizin · doi:10.1007/s00063-015-0027-x · Cited by 5
Low On‐Treatment Platelet Reactivity Predicts Long‐Term Risk of Bleeding After Elective PCI
Čolić, M., Čalija, B., Milosavljevic, B., Grdinić, A., Angelkov, L., Sagić, D., Kružliak, P., Marinković, J., Babić, R., & Mrdović, I. (2015) · Journal of Interventional Cardiology · doi:10.1111/joic.12251 · Cited by 6
Platelet function testing to time surgery in patients on dual antiplatelet therapy?
Mahla, E., Raggam, R., & Toller, W. (2013) · Hämostaseologie · doi:10.5482/hamo-13-06-0032 · Cited by 5
“For example, the predictive cutoff for surgery-related bleeding of 31 U (comparing to 310 AU × min) as suggested in the former study (37) was substantially higher than a suggested cutoff of 188 AU x min for procedure-related bleeding in patients undergoing PCI (42, 43).”
MethodLarge interventricular septal aneurysm with thrombo-embolism in a healthy woman.
Sy, A. M., & Sahni, G. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr087 · Cited by 5
Oestreich, J., Steinhubl, S., Ferraris, S., & Akers, W. S. (2011) · Thrombosis and Haemostasis · doi:10.1160/th10-09-0603 · Cited by 5
Self-citationPlatelet phenotypes and practical aspects of platelet function testing in cardiology
Kobalava, Z. D., Pisaryuk, A. S., Андреевна, Ф. А., Tukhsanboev, E. S., Boldyreva, A. A., Lazutova, D. P., Meray, I. A., & Panteleev, M. A. (2023) · Rational Pharmacotherapy in Cardiology · doi:10.20996/1819-6446-2023-2981 · Cited by 5
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Microvesicles from patients with acute coronary syndrome enhance platelet aggregation
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Self-citationOptimizing selection of P2Y 12 inhibiting therapy: clopidogrel, prasugrel or ticagrelor
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“Achieving OPR is associated with the most favorable safety and efficacy profile, minimizing the likelihood of adverse outcomes (Figure 2) [16,29,101,105,106].”
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Genetic testing to guide therapy? Not for ticagrelor!
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“A large variability in platelet reactivity is shown for clopidogrel, the most commonly used P2Y12 receptor antagonist, with a relevant impact on ischaemic but also bleeding complications.(1,2) The large variability of platelet response is mainly explained by the fact that clopidogrel is a pro-drug which needs two step…”
BackgroundSelf-citationPerioperativer Umgang mit Thrombozytenaggregationshemmern
Wagner, J., Lock, J., Luber, V., Dietz, U., Lichthardt, S., Matthes, N., Krajinovic, K., Germer, C., Knop, S., & Wiegering, A. (2018) · Der Chirurg · doi:10.1007/s00104-017-0525-x · Cited by 3
Platelet Function Measurement in Elective Percutaneous Coronary Intervention Patients
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“A potential therapeutic window was first demonstrated with impedance aggregometry (8).”
BackgroundWhole Blood Assay: Thromboelastometry – Basics
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Modulation of Antiplatelet Therapy in PCI-Treated Patients
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“In patients with ischemic heart disease, high treatment platelet reactivity (HPR) has been found to be significantly associated with cardiovascular events on P2Y12 inhibitor therapy [1, 2].”
BackgroundPlatelet Function Testing and Genotyping for Tailoring Treatment in Complex PCI Patients
Μούλιας, Α., Papageorgiou, A., & Alexopoulos, D. K. (2021) · US Cardiology Review · doi:10.15420/usc.2020.33 · Cited by 1
“27 30 However, a PFT-guided de-escalation approach was found to be non-inferior for the primary endpoint of net clinical benefit (cardiovascular death, MI, stroke or bleeding grade ≥2 according to Bleeding Academic Research Consortium [BARC] criteria) compared with potent platelet inhibition for 12…”
Assessment of Steady-State Clopidogrel Reactivity by Using Platelet Reactivity Units
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Clopidogrel Response Variability: Etiology and Clinical Relevance
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“, 5-year) adverse events in AMI patients using the readily available Multiplate® analyzer (8).”
MethodThe role of laboratory monitoring in antiplatelet therapy.
Cattaneo, M. (2012) · Handbook of Experimental Pharmacology · doi:10.1007/978-3-642-29423-5_19 · Cited by 2
“In contrast, only recently this important clinical issue has started to be addressed for some tests of platelet function used for tailoring clopidogrel therapy (Bonello et al. 2010; Campo et al. 2011; Sibbing et al. 2010), and the cut-off values for both the risk of thrombosis (see later) and the risk of bleeding are…”
BackgroundMichailidis, N., Pallikarou, M., Manolopoulos, V. G., Moschovidis, V., Ziakas, A., Ragia, G., & Kassimis, G. (2026) · Pharmacogenomics · doi:10.1080/14622416.2026.2648609 · Cited by 1
Rotational Thromboelastometry (ROTEM®)
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Tailoring of antiplatelet therapy in a patient with bleeding and PCI: a double-edged sword?
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Assessing post-treatment platelet reactivity: a focus on patient selection and setting
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Bleeding and Thrombosis Risk Matters
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Bedside Monitoring of Antiplatelet Therapy for Coronary Stenting
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Ticagrelor versus clopidogrel in STEMI post-PCI: A mixed-design meta-analysis of efficacy and safety
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“[28] The moderate heterogeneity ( I 2 = 27”
InfluentialEx Vivo Thrombocyte Function and Its Response to NO/Sildenafil in Patients Undergoing Hemodialysis
Bonell, V., Schmaderer, C., Lorenz, G., Günthner, R., Angermann, S., Bachmann, Q., Küchle, C., Renders, L., Heemann, U. W., Kessler, T., et al. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14145156
“To minimize confounding, we excluded participants with potential causes of platelet dysfunction such as hematological disorders, liver cirrhosis, active infections, or ADP receptor antagonist therapy [33].”
Gaussem, P., Jourdi, G., & Ajzenberg, N. (2022) · EMC - Tratado de Medicina · doi:10.1016/s1636-5410(15)70944-x
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Therapeutic Window of P2Y12 Inhibition: Should the Current Limits Be Modified?
Lozano, Í., de Prado, A. P., Hernández, J. M. D. L. T., Blanco, B. G. D., & Rumoroso, J. (2019) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2019.09.025
Reply: Therapeutic Window of P2Y12 Inhibition: Should the Current Limits Be Modified?
Sibbing, D., & Angiolillo, D. (2019) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2019.10.015
Self-citationShalaev, S., & Safiullina, Z. (2018) · Kardiologiia · doi:10.18087/cardio.2018.3.10099
“образованием, так и с кровотечениями [6].”
In dubious battle: bleeding versus ischemic events
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VerifyNow P2Y12 and Plateletworks Assays
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Vasodilator‐Stimulated Phosphoprotein (VASP) Assay
Laine, M., Paganelli, F., & Bonello, L. (2014) · doi:10.1002/9781118493984.ch8
Pharmacodynamics- and Pharmacogenetics-Guided Antiplatelet Therapy
Tello-Montoliu, A., & Angiolillo, D. (2014) · doi:10.1201/b15465-24
Ticagrelor in Acute Coronary Syndromes
Howard, C. (2015) · doi:10.26686/wgtn.17014211
“111 5.5 CONCLUSION .......................................................................................................................... 112 REFERENCES ................................................................................................................................ 113 x Abbreviations ACS- acute co…”
MethodInfluentialResidual platelet reactivity in atherosclerosis and its impact on patient outcomes
Johnston, L. R. (2014) · doi:10.26686/wgtn.17007475.v1
“Maori and Pacific Islanders had higher residual platelet reactivity (50 AU (35-70) versus 38 AU (250-570), p = 0.”
BackgroundPerioperative Considerations and Management in Patients with Intravascular Stents
Lynch, I. P., Emmert, D. A., & Wall, M. (2011) · doi:10.1016/j.aan.2011.07.003
Metadata
- Authors
- Sibbing, D., Steinhubl, S. R., Schulz, S., Schömig, A., & Kastrati, A.
- Corresponding author
- Sibbing, Dirk
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2010-07
- Volume
- 56
- Issue
- 4
- Pages
- 317-318
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W81845835
- Cited by
- 208
- References
- 0
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 6 · 2022: 2 · 2021: 6 · 2020: 3 · 2019: 12 · 2018: 7 · 2017: 10 · 2016: 15 · 2015: 23 · 2014: 20 · 2013: 33 · 2012: 32
- FWCI
- 20.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Hematology › Platelet Disorders and Treatments
- Keywords
- platelet aggregation, clopidogrel, stent thrombosis, hemorrhage, clopidogrel resistance, interindividual variability, antiplatelet therapy, percutaneous coronary intervention
- MeSH terms
- Clopidogrel, Coronary Thrombosis, Hemorrhage, Humans, Platelet Aggregation, Ticlopidine, Time Factors, Receptors, Purinergic P2, Drug-Eluting Stents, Purinergic P2 Receptor Antagonists, Receptors, Purinergic P2Y12
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