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Wang X, Li L, Cui J, Cheng M, Liu M. Myopenic Obesity Determined by Fat Mass Percentage Predicts Risk of Aspirin-Induced Bleeding in Chinese Older Adults. Clin Interv Aging 2023; 18:585-595. [PMID: 37077535 PMCID: PMC10108865 DOI: 10.2147/cia.s405559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/07/2023] [Indexed: 04/21/2023] Open
Abstract
Background Body mass index (BMI) correlates with aspirin-induced bleeding risk. However, skeletal muscle mass (SMM) loss and fat gain commonly occur with aging, making BMI not a reasonable marker of bleeding risk in older individuals. In the present study, we aimed to investigate the prognostic value of myopenic obesity based on the percent of fat mass (%FM) for aspirin-induced bleeding in Chinese patients over 60 years old. Methods We prospectively analyzed 185 patients taking aspirin for primary and secondary prevention of cardiovascular diseases. Body composition parameters were estimated using bioelectrical impedance analysis. We defined myopenic obesity (MO) as a height-adjusted appendicular SMM <7.0 kg/m2 in males and <5.7 kg/m2 in females with a %FM >29% in males and >41% in females or a BMI ≥25 kg/m2. The patients were categorized into four groups by the presence or absence of myopenia and obesity. Results Based on the %FM grouping, the bleeding risk was significantly higher in the MO group, followed by the nonmyopenic obesity, myopenic nonobesity, and nonmyopenic nonobesity groups (P = 0.044). No statistically significant differences in the probability of bleeding events were observed among the four BMI-based groups (P = 0.502). Multivariate Cox analysis indicated that MO (hazard ratio [HR] 2.724, 95% confidence interval [CI] 1.073-6.918, P = 0.035), aspirin dose (100 vs 50 mg/day, HR 2.609, 95% CI 1.291-5.273, P = 0.008), concomitant use of histamine-2 receptor antagonists and proton pump inhibitors (HR 1.777, 95% CI 1.007-3.137, P = 0.047), and hemorrhage history (HR 2.576, 95% CI 1.355-4.897, P = 0.004) were associated with bleeding events independently. Conclusion %FM-based MO was an independent predictor of aspirin-induced bleeding in older Chinese individuals. Reducing %FM rather than BMI should be an optimal strategy for the management of myopenic obesity.
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Affiliation(s)
- Xiting Wang
- Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Li Li
- Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Jing Cui
- Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Mei Cheng
- Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Meilin Liu
- Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China
- Correspondence: Meilin Liu, Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China, Email
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Wang X, Chen X, Liu W, Liang W, Liu M. Rationale and Design of LAPIS: A Multicenter Prospective Cohort Study to Investigate the Efficacy and Safety of Low-Dose Aspirin in Elderly Chinese Patients. Int J Gen Med 2022; 15:8333-8341. [DOI: 10.2147/ijgm.s391259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
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Ma L, Chen W, Pan Y, Yan H, Li H, Meng X, Wang Y, Wang Y. Comparison of VerifyNow, thromboelastography, and PL-12 in patients with minor ischemic stroke or transient ischemic attack. Aging (Albany NY) 2021; 13:8396-8407. [PMID: 33686963 PMCID: PMC8034945 DOI: 10.18632/aging.202650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022]
Abstract
High on-treatment platelet reactivity (HOPR) is associated with stroke recurrence. It is important to find a reliable method to assess HOPR. We aimed to compare the correlations between VerifyNow™ system, thromboelastography (TEG), and Aggrestar platelet function analyzer (PL-12) on platelet activity in patients with minor ischemic stroke or transient ischemic attack (TIA) after dual antiplatelet therapy for 7 days. About 276 patients were included. Spearman’s correlation coefficient and the kappa coefficient were adopted to evaluate associations among the three test methods. An obvious correlation between VerifyNow and TEG on HOPR-ADP (r=0.64, p<0.001) was found. The correlations of HOPR-ADP between PL-12 and the other two platelet function analyzers were moderate (PL-12 versus VerifyNow, r=0.47, p<0.001; PL-12 versus TEG, r=0.25, p<0.001). The correlations of HOPR-AA were limited among these three platelet function analyzers (VerifyNow versus TEG, r=0.09, p=0.14; VerifyNow versus PL-12, r=0.15, p=0.01; PL-12 versus TEG, r=0.10, p=0.09). Correlations among different platelet function analyzers were varied. VerifyNow and TEG were more correlative than PL-12 on HOPR-ADP. The consistence of HOPR-AA was limited among VerifyNow, TEG and PL-12. The proportion of stroke recurrence and composite events in patients with HOPR-ADP assessing by PL-12 was higher than VerifyNow and TEG.
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Affiliation(s)
- Lin Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Centre for Human Brain Projection, Capital Medical University, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Centre for Human Brain Projection, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Centre for Human Brain Projection, Capital Medical University, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Centre for Human Brain Projection, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Centre for Human Brain Projection, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Centre for Human Brain Projection, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Centre for Human Brain Projection, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Centre for Human Brain Projection, Capital Medical University, Beijing, China
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Yoshimura M, Sumita K, Fujii S, Miki K, Aizawa Y, Fujita K, Yamamoto S, Nemoto S, Maehara T. Periprocedural Variability of Platelet Functions in Carotid Artery Stenting: An Analysis Using VerifyNow. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:505-516. [PMID: 37502767 PMCID: PMC10370580 DOI: 10.5797/jnet.oa.2020-0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/31/2020] [Indexed: 07/29/2023]
Abstract
Objective The assessment of platelet functions is necessary to prevent both thromboembolic and hemorrhagic complications under dual antiplatelet therapy (DAPT). Using the VerifyNow (Accumetrics, Inc., San Diego, CA, USA) assay, this study aimed to reveal time-dependent changes in platelet functions after carotid artery stenting (CAS). Methods We enrolled retrospectively 43 patients who underwent CAS under DAPT. Aspirin reaction unit (ARU) and P2Y12 reaction unit (PRU) values were determined on the day before and on days 1, 3, and 7 after the procedure. Multiple comparison tests (MCTs) were performed among ARU and PRU measurement points, and the proportions of hypo- and hyper-responses were compared. Results The median ARU values were 408 (interquartile range: 392-497) before CAS and 418 (405-470) on day 1, 405 (393.0-460.5) on day 3, and 402 (388.5-477.5) on day 7 (not significant in MCTs). The percentages of hypo-responses were 16.3%, 7.0%, 2.3%, and 7.0%, respectively (p = 0.11). The significantly different median PRU values were 173 (116.5-209.5), 233 (166.5-273.5), 139 (70.5-205.5), and 51 (9.0-79.5), respectively. The median PRU was before the procedure within the therapeutic range but exceeded the upper cutoff on day 1 and was below the lower cutoff on day 7. The percentages of hypo-responses were 14.0%, 51.2%, 18.6%, and 11.6%, respectively (p <0.001) and the percentages of hyper-responses were 9.3%, 2.3%, 23.3%, and 62.8%, respectively (p <0.001). Conclusion In the periprocedural CAS period, ARU values were stable, but PRU values showed time-dependent changes. PRU values were above the therapeutic range the day after CAS but decreased below this range on day 7.
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Affiliation(s)
- Masataka Yoshimura
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Kazutaka Sumita
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoko Fujii
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazunori Miki
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Aizawa
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyohei Fujita
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Yamamoto
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Shigeru Nemoto
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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Relation of High Lipoprotein (a) Concentrations to Platelet Reactivity in Individuals with and Without Coronary Artery Disease. Adv Ther 2020; 37:4568-4584. [PMID: 32889667 PMCID: PMC7547998 DOI: 10.1007/s12325-020-01483-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Lipoprotein (a) [Lp(a)] is a risk factor for coronary artery disease (CAD). To the best of our knowledge, this is the first study addressing the relationship between Lp(a) and platelet reactivity in primary and secondary prevention. METHODS Lp(a) was evaluated in 396 individuals with (82.3%) and without (17.7%) obstructive CAD. The population was divided into two groups according to Lp(a) concentrations with a cutoff value of 50 mg/dL. The primary objective was to evaluate the association between Lp(a) and adenosine diphosphate (ADP)-induced platelet reactivity using the VerifyNow™ P2Y12 assay. Platelet reactivity was also induced by arachidonic acid and collagen-epinephrine (C-EPI) and assessed by Multiplate™, platelet function analyzer™ 100 (PFA-100), and light transmission aggregometry (LTA) assays. Secondary objectives included the assessment of the primary endpoint in individuals with or without CAD. RESULTS Overall, 294 (74.2%) individuals had Lp(a) < 50 mg/dL [median (IQR) 13.2 (5.8-27.9) mg/dL] and 102 (25.8%) had Lp(a) ≥ 50 mg/dL [82.5 (67.6-114.5) mg/dL], P < 0.001. Univariate analysis in the entire population revealed no differences in ADP-induced platelet reactivity between individuals with Lp(a) ≥ 50 mg/dL (249.4 ± 43.8 PRU) versus Lp(a) < 50 mg/dL (243.1 ± 52.2 PRU), P = 0.277. Similar findings were present in individuals with (P = 0.228) and without (P = 0.669) CAD, and regardless of the agonist used or method of analysis (all P > 0.05). Finally, multivariable analysis did not show a significant association between ADP-induced platelet reactivity and Lp(a) ≥ 50 mg/dL [adjusted OR = 1.00 [(95% CI 0.99-1.01), P = 0.590]. CONCLUSION In individuals with or without CAD, Lp(a) ≥ 50 mg/dL was not associated with higher platelet reactivity.
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