| Title: |
Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: a PLATO substudy |
| Authors: |
Sumaya, W; Wallentin, L; James, SK; Siegbahn, A; Gabrysch, K; Bertilsson, M; Himmelmann, A; Ajjan, RA; Storey, RF |
| Publisher Information: |
Oxford University Press |
| Publication Year: |
2018 |
| Collection: |
White Rose Research Online (Universities of Leeds, Sheffield & York) |
| Description: |
Aims: To determine whether fibrin clot properties are associated with clinical outcomes following acute coronary syndrome (ACS). Methods and results: Plasma samples were collected at hospital discharge from 4354 ACS patients randomized to clopidogrel or ticagrelor in the PLATelet inhibition and patient Outcomes (PLATO) trial. A validated turbidimetric assay was employed to study plasma clot lysis time and maximum turbidity (a measure of clot density). One-year rates of cardiovascular (CV) death, spontaneous myocardial infarction (MI) and PLATO-defined major bleeding events were assessed after sample collection. Hazard ratios (HRs) were estimated using Cox proportional hazards models. After adjusting for CV risk factors, each 50% increase in lysis time was associated with CV death/spontaneous MI [HR 1.17, 95% confidence interval (CI) 1.05–1.31; P < 0.01] and CV death alone (HR 1.36, 95% CI 1.17–1.59; P < 0.001). Similarly, each 50% increase in maximum turbidity was associated with increased risk of CV death (HR 1.24, 95% CI 1.03–1.50; P=0.024). After adjustment for other prognostic biomarkers (leukocyte count, high-sensitivity C-reactive protein, high-sensitivity troponin T, cystatin C, N-terminal pro B-type natriuretic peptide, and growth differentiation factor-15), the association with CV death remained significant for lysis time (HR 1.2, 95% CI 1.01–1.42; P = 0.042) but not for maximum turbidity. These associations were consistent regardless of randomized antiplatelet treatment (all interaction P > 0.05). Neither lysis time nor maximum turbidity was associated with major bleeding events. Conclusion: Fibrin clots that are resistant to lysis independently predict adverse outcome in ACS patients. Novel therapies targeting fibrin clot properties might be a new avenue for improving prognosis in patients with ACS. |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| ISSN: |
0195-668X |
| Relation: |
https://eprints.whiterose.ac.uk/id/eprint/133073/7/ehy013.pdf; Sumaya, W, Wallentin, L, James, SK et al. (6 more authors) (2018) Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: a PLATO substudy. European Heart Journal, 39 (13). pp. 1078-1085. ISSN: 0195-668X |
| Availability: |
https://eprints.whiterose.ac.uk/id/eprint/133073/; https://eprints.whiterose.ac.uk/id/eprint/133073/7/ehy013.pdf |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.A73F80AF |
| Database: |
BASE |