Adenosine diphosphate–induced platelet-fibrin clot strength: A new thrombelastographic indicator of long-term poststenting ischemic events

Background Poststenting ischemic events occur despite dual-antiplatelet therapy, suggesting that a one size fits all antithrombotic strategy has significant limitations. Ex vivo platelet function measurements may facilitate risk stratification and personalized antiplatelet therapy. Methods We investigated the prognostic utility of the strength of adenosine diphosphate (ADP)–induced (MA ADP ) and thrombin-induced (MA THROMBIN ) platelet-fibrin clots measured by thrombelastography and ADP-induced light transmittance aggregation (LTA ADP ) in 225 serial patients after elective stenting treated with aspirin and clopidogrel. Ischemic and bleeding events were assessed over 3 years. Results Overall, 59 (26%) first ischemic events occurred. Patients with ischemic events had higher MA ADP , MA THROMBIN , and LTA ADP ( P ADP >47 mm had the best predictive value of long-term ischemic events compared with other measurements ( P P ADP >47 mm, MA THROMBIN >69 mm, and LTA ADP >34% as significant independent predictors of first ischemic events at the 3-year time point, with hazard ratios of 10.3 ( P P P ADP ≤31 as a predictive value for bleeding. Conclusion This study is the first demonstration of the prognostic utility of MA ADP in predicting long-term event occurrence after stenting. The quantitative assessment of ADP-stimulated platelet-fibrin clot strength measured by thrombelastography can serve as a future tool in investigations of personalized antiplatelet treatment designed to reduce ischemic events and bleeding.