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Olgar Y, Durak A, Degirmenci S, Tuncay E, Billur D, Ozdemir S, Turan B. Ticagrelor alleviates high-carbohydrate intake induced altered electrical activity of ventricular cardiomyocytes by regulating sarcoplasmic reticulum-mitochondria miscommunication. Mol Cell Biochem 2021; 476:3827-3844. [PMID: 34114148 DOI: 10.1007/s11010-021-04205-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/03/2021] [Indexed: 12/17/2022]
Abstract
Metabolic syndrome (MetS) is associated with additional cardiovascular risk in mammalians while there are relationships between hyperglycemia-associated cardiovascular dysfunction and increased platelet P2Y12 receptor activation. Although P2Y12 receptor antagonist ticagrelor (Tica) plays roles in reduction of cardiovascular events, its beneficial mechanism remains poorly understood. Therefore, we aimed to clarify whether Tica can exert a direct protective effect in ventricular cardiomyocytes from high-carbohydrate diet-induced MetS rats, at least, through affecting sarcoplasmic reticulum (SR)-mitochondria (Mit) miscommunication. Tica treatment of MetS rats (150 mg/kg/day for 15 days) significantly reversed the altered parameters of action potentials by reversing sarcolemmal ionic currents carried by voltage-dependent Na+ and K+ channels, and Na+/Ca2+-exchanger in the cells, expressed P2Y12 receptors. The increased basal-cytosolic Ca2+ level and depressed SR Ca2+ load were also reversed in Tica-treated cells, at most, though recoveries in the phosphorylation levels of ryanodine receptors and phospholamban. Moreover, there were marked recoveries in Mit structure and function (including increases in both autophagosomes and fragmentations) together with recoveries in Mit proteins and the factors associated with Ca2+ transfer between SR-Mit. There were further significant recoveries in markers of both ER stress and oxidative stress. Taken into consideration the Tica-induced prevention of ER stress and mitochondrial dysfunction, our data provided an important document on the pleiotropic effects of Tica in the electrical activity of the cardiomyocytes from MetS rats. This protective effect seems through recoveries in SR-Mit miscommunication besides modulation of different sarcolemmal ion-channel activities, independent of P2Y12 receptor antagonism.
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Affiliation(s)
- Yusuf Olgar
- Faculty of Medicine, Department of Biophysics, Ankara University, Ankara, Turkey
| | - Aysegul Durak
- Faculty of Medicine, Department of Biophysics, Ankara University, Ankara, Turkey
| | - Sinan Degirmenci
- Faculty of Medicine, Department of Biophysics, Ankara University, Ankara, Turkey
| | - Erkan Tuncay
- Faculty of Medicine, Department of Biophysics, Ankara University, Ankara, Turkey
| | - Deniz Billur
- Faculty of Medicine, Department of Histology and Embryology, Ankara University, Ankara, Turkey
| | - Semir Ozdemir
- Faculty of Medicine, Department of Biophysics, Akdeniz University, Antalya, Turkey.
| | - Belma Turan
- Faculty of Medicine, Department of Biophysics, Ankara University, Ankara, Turkey.
- Faculty of Medicine, Department of Biophysics, Lokman Hekim University, Ankara, Turkey.
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Ostrowska M, Kubica J, Adamski P, Kubica A, Eyileten C, Postula M, Toma A, Hengstenberg C, Siller-Matula JM. Stratified Approaches to Antiplatelet Therapies Based on Platelet Reactivity Testing. Front Cardiovasc Med 2019; 6:176. [PMID: 31850373 PMCID: PMC6901499 DOI: 10.3389/fcvm.2019.00176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/14/2019] [Indexed: 01/17/2023] Open
Abstract
Antiplatelet therapy with P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor, cangrelor) is a cornerstone of medical therapy after percutaneous coronary interventions. Significant prevalence of high on-treatment platelet reactivity (HTPR) on clopidogrel treatment led to introduction of more potent P2Y12 inhibitors: prasugrel (a third generation thienopyridine), ticagrelor, and cangrelor (cyclopentyl-triazolo-pyrimidines). Nevertheless, more potent platelet inhibition and resulting low on-treatment platelet reactivity (LTPR) has led to increased risk of major bleeding events. These limitations resulted in a need for an individualized antiplatelet therapy approach. This review discusses the current role and future perspectives of diagnostic tools such as platelet function testing to optimize antiplatelet therapy with a focus on deescalating therapies to reduce bleeding risks.
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Affiliation(s)
- Małgorzata Ostrowska
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Adamski
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Aldona Kubica
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
| | - Aurel Toma
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Jolanta M Siller-Matula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland.,Department of Cardiology, Medical University of Vienna, Vienna, Austria
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van der Meijden PEJ, Henskens YMC, ten Cate-Hoek AJ, Cate HT, Vries MJA. Assessment of bleeding risk in patients with coronary artery disease on dual antiplatelet therapy. Thromb Haemost 2017; 115:7-24. [DOI: 10.1160/th15-04-0355] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/29/2015] [Indexed: 12/14/2022]
Abstract
SummaryPatients with coronary artery disease are usually treated with dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. Patients on DAPT are at risk of both ischaemic and bleeding events. Although side-lined for a long time, real-life studies have shown that both the incidence and the associated morbidity and mortality of outof-hospital bleeding are high. This indicates that prevention of (postinterventional) bleeding is as important as prevention of ischaemia. For this purpose it is crucial to reliably identify patients with a high bleeding risk. In order to postulate an algorithm, which could help identifying these patients, we performed a systematic review to determine the value of previously proposed prognostic modalities for bleeding. We searched and appraised the following tools: platelet function tests, genetic tests, bleeding scores and questionnaires and haemostatic tests. Most studies indicated that low on-treatment platelet reactivity (LTPR), as measured by several platelet function tests, and the carriage of CYP2C19*17 allele were independent risk factors for bleeding. A bleeding score also proved to be helpful in identifying patients at risk. No studies on haemostatic tests were retrieved. Several patient characteristics were also identified as independent predictors of bleeding, such as older age, female sex and renal failure. Combining these risk factors we propose an algorithm that would hypothetically facilitate identification of those patients at highest risk, warranting prevention measures for bleeding. This could be a starting point for further research concerning the topic.
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Aitmokhtar O, Paganelli F, Benamara S, Azaza A, Bonello L, Hamza O, Seddiki S, Benathmane T, Saidane M, Bouzid A, Kara M, Sik A, Azzouz A, Harbi F, Monsuez JJ, Benkhedda S. Impact of platelet inhibition level on subsequent no-reflow in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 2017; 110:626-633. [DOI: 10.1016/j.acvd.2016.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/17/2016] [Accepted: 12/22/2016] [Indexed: 10/19/2022]
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Connor DE, Ly K, Aslam A, Boland J, Low J, Jarvis S, Muller DW, Joseph JE. Effects of antiplatelet therapy on platelet extracellular vesicle release and procoagulant activity in health and in cardiovascular disease. Platelets 2016; 27:805-811. [PMID: 27310292 DOI: 10.1080/09537104.2016.1190008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Dual antiplatelet therapy with aspirin and clopidogrel is commonly used to prevent recurrent ischemic events in patients with cardiovascular disease. Whilst their effects on platelet reactivity are well documented, it is unclear, however, whether antiplatelet therapy inhibits platelet extracellular vesicle (EV) release. The aim of this study was to investigate the effects of antiplatelet therapy on platelet EV formation and procoagulant activity. Blood samples from 10 healthy controls not receiving antiplatelet therapy were incubated in vitro with aspirin or a P2Y12 inhibitor (MeSAMP). Blood samples from 50 patients receiving long-term dual antiplatelet therapy and undergoing coronary angiography were also studied. Platelet reactivity was assessed by Multiplate™ impedance aggregometry. Platelet EV formation and procoagulant activity of pretreated and untreated blood samples in response to arachidonic acid (AA), adenosine diphosphate (ADP), ADP+PGE1, and thrombin receptor-activating peptide (TRAP) stimulation were assessed by flow cytometry and Procoag-PL assays, respectively. Incubation of normal platelets with aspirin significantly inhibited AA-induced platelet reactivity, EV formation, and procoagulant activity, whilst MeSAMP significantly inhibited platelet reactivity and EV formation in response to AA, ADP, and TRAP, but had minimal effect on procoagulant activity. Most patients receiving dual antiplatelet therapy showed an appropriate reduction in platelet reactivity in response to their treatment; however there was not complete inhibition of increased platelet and EV procoagulant activity in response to ADP, AA, or TRAP. In addition, we could not find any correlation between platelet reactivity and procoagulant activity in patients receiving dual antiplatelet therapy.
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Affiliation(s)
- David E Connor
- a Blood, Stem Cell and Cancer Research Unit , St Vincent's Centre for Applied Medical Research , Darlinghurst , NSW , Australia.,b St Vincent's Clinical School, Faculty of Medicine , University of New South Wales , Randwick , NSW , Australia
| | - Ken Ly
- a Blood, Stem Cell and Cancer Research Unit , St Vincent's Centre for Applied Medical Research , Darlinghurst , NSW , Australia
| | - Anoosha Aslam
- a Blood, Stem Cell and Cancer Research Unit , St Vincent's Centre for Applied Medical Research , Darlinghurst , NSW , Australia.,b St Vincent's Clinical School, Faculty of Medicine , University of New South Wales , Randwick , NSW , Australia
| | - John Boland
- c Department of Cardiology , St Vincent's Hospital , Darlinghurst , NSW , Australia
| | - Joyce Low
- d Haemostasis Laboratory, SydPath , St Vincent's Hospital , Darlinghurst , NSW , Australia
| | - Susan Jarvis
- d Haemostasis Laboratory, SydPath , St Vincent's Hospital , Darlinghurst , NSW , Australia
| | - David W Muller
- b St Vincent's Clinical School, Faculty of Medicine , University of New South Wales , Randwick , NSW , Australia.,c Department of Cardiology , St Vincent's Hospital , Darlinghurst , NSW , Australia
| | - Joanne E Joseph
- a Blood, Stem Cell and Cancer Research Unit , St Vincent's Centre for Applied Medical Research , Darlinghurst , NSW , Australia.,b St Vincent's Clinical School, Faculty of Medicine , University of New South Wales , Randwick , NSW , Australia.,d Haemostasis Laboratory, SydPath , St Vincent's Hospital , Darlinghurst , NSW , Australia
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Platelet reactivity in MitraClip patients. Vascul Pharmacol 2016; 77:54-9. [DOI: 10.1016/j.vph.2015.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/21/2015] [Accepted: 07/02/2015] [Indexed: 02/01/2023]
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Ou W, He Y, Li A, Liu B, Jin L. Genotype Frequencies of CYP2C19, P2Y 12 and GPIIIa Polymorphisms in Coronary Heart Disease Patients of Han Ethnicity, and Their Impact on Clopidogrel Responsiveness. Int Heart J 2016; 57:586-92. [DOI: 10.1536/ihj.16-006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Wenchao Ou
- Department of Cardiology, Guang-zhou Institute of Cardiovascular Diseases, The Second Affiliated Hospital of Guangzhou Medical University
| | - Yongcong He
- Department of Cardiology, Guangdong No. 2 Provincial People’s Hospital
| | - Aiqun Li
- Department of Cardiology, Guang-zhou Institute of Cardiovascular Diseases, The Second Affiliated Hospital of Guangzhou Medical University
| | - Benrong Liu
- Department of Cardiology, Guang-zhou Institute of Cardiovascular Diseases, The Second Affiliated Hospital of Guangzhou Medical University
| | - Lijun Jin
- Department of Cardiology, Guang-zhou Institute of Cardiovascular Diseases, The Second Affiliated Hospital of Guangzhou Medical University
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Polzin A, Dannenberg L, Sophia Popp V, Kelm M, Zeus T. Antiplatelet effects of clopidogrel and aspirin after interventional patent foramen ovale/ atrium septum defect closure. Platelets 2015; 27:317-21. [PMID: 26556101 DOI: 10.3109/09537104.2015.1096335] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The optimal antiplatelet therapy after patent foramen ovale (PFO)/ atrium septum defect (ASD) closure is a matter of discussion. It is challenging as inter-individual responses to antiplatelet medication vary significantly and common complications are bleeding and ischemic events. In this study, we aimed to analyze the incidence of high on-treatment platelet reactivity (HTPR) to antiplatelet medication in patients undergoing PFO/ASD closure as well as clinical complications and thrombus formation on the occluder during six-month follow-up. This hypothesis generating pilot study was observed, which included 140 patients undergoing PFO/ASD closure. The primary endpoint was pharmacodynamic response to antiplatelet medication. A composite of death, myocardial infarction, bleeding, stroke and thrombus formation on the occluder during six-month follow-up was the secondary endpoint. HTPR to clopidogrel was analyzed using the vasodilator-stimulated protein phosphorylation (VASP), HTPR to aspirin by light-transmission aggregometry (LTA). In 71% of patients HTPR to clopidogrel was detected, HTPR to aspirin in only 4%. We observed 12 complications, 9 bleeding events (including 3 major bleeding events) and 3 transient ischemic attacks. No stroke and no thrombus formation on the occluder occurred. The primary endpoint was not associated with the secondary endpoint. The incidence of HTPR to clopidogrel in PFO/ASD closure patients is very high. Despite this high incidence, no stroke or thrombus formation on the occluder occurred at all. This leads to the hypothesis, that the benefit of additional clopidogrel medication is questionable and has to be investigated in large-scale clinical trials.
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Affiliation(s)
- Amin Polzin
- a Division of Cardiology, Pulmonology, and Vascular Medicine , Heinrich Heine University Medical Center Düsseldorf , Düsseldorf , Germany
| | - Lisa Dannenberg
- a Division of Cardiology, Pulmonology, and Vascular Medicine , Heinrich Heine University Medical Center Düsseldorf , Düsseldorf , Germany
| | - Valérie- Sophia Popp
- a Division of Cardiology, Pulmonology, and Vascular Medicine , Heinrich Heine University Medical Center Düsseldorf , Düsseldorf , Germany
| | - Malte Kelm
- a Division of Cardiology, Pulmonology, and Vascular Medicine , Heinrich Heine University Medical Center Düsseldorf , Düsseldorf , Germany
| | - Tobias Zeus
- a Division of Cardiology, Pulmonology, and Vascular Medicine , Heinrich Heine University Medical Center Düsseldorf , Düsseldorf , Germany
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Jiang XL, Samant S, Lesko LJ, Schmidt S. Clinical pharmacokinetics and pharmacodynamics of clopidogrel. Clin Pharmacokinet 2015; 54:147-66. [PMID: 25559342 DOI: 10.1007/s40262-014-0230-6] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute coronary syndromes (ACS) remain life-threatening disorders, which are associated with high morbidity and mortality. Dual antiplatelet therapy with aspirin and clopidogrel has been shown to reduce cardiovascular events in patients with ACS. However, there is substantial inter-individual variability in the response to clopidogrel treatment, in addition to prolonged recovery of platelet reactivity as a result of irreversible binding to P2Y12 receptors. This high inter-individual variability in treatment response has primarily been associated with genetic polymorphisms in the genes encoding for cytochrome (CYP) 2C19, which affect the pharmacokinetics of clopidogrel. While the US Food and Drug Administration has issued a boxed warning for CYP2C19 poor metabolizers because of potentially reduced efficacy in these patients, results from multivariate analyses suggest that additional factors, including age, sex, obesity, concurrent diseases and drug-drug interactions, may all contribute to the overall between-subject variability in treatment response. However, the extent to which each of these factors contributes to the overall variability, and how they are interrelated, is currently unclear. The objective of this review article is to provide a comprehensive update on the different factors that influence the pharmacokinetics and pharmacodynamics of clopidogrel and how they mechanistically contribute to inter-individual differences in the response to clopidogrel treatment.
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Affiliation(s)
- Xi-Ling Jiang
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, University of Florida at Lake Nona (Orlando), 6550 Sanger Road, Room 467, Orlando, FL, 32827, USA
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Vries MJA, van der Meijden PEJ, Henskens YMC, ten Cate-Hoek AJ, ten Cate H. Assessment of bleeding risk in patients with coronary artery disease on dual antiplatelet therapy. Thromb Haemost 2015. [DOI: 10.1160/th-15-04-0355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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11
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Bagoly Z, Homoródi N, Kovács EG, Sarkady F, Csiba L, Édes I, Muszbek L. How to test the effect of aspirin and clopidogrel in patients on dual antiplatelet therapy? Platelets 2015; 27:59-65. [DOI: 10.3109/09537104.2015.1031098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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High on-treatment platelet reactivity in transcatheter aortic valve implantation patients. Eur J Pharmacol 2015; 751:24-7. [DOI: 10.1016/j.ejphar.2015.01.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/12/2015] [Accepted: 01/16/2015] [Indexed: 11/19/2022]
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13
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Bonello L, Frère C, Paganelli F, Laine M. With Age Comes Wisdom. J Am Coll Cardiol 2014; 63:518-9. [DOI: 10.1016/j.jacc.2013.09.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
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Bonello L, Frère C, Paganelli F, Laine M. The Impact of the Environment on Diseases and Drugs. J Am Coll Cardiol 2013; 62:513-5. [DOI: 10.1016/j.jacc.2013.04.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
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Bagoly Z, Sarkady F, Magyar T, Kappelmayer J, Pongrácz E, Csiba L, Muszbek L. Comparison of a new P2Y12 receptor specific platelet aggregation test with other laboratory methods in stroke patients on clopidogrel monotherapy. PLoS One 2013; 8:e69417. [PMID: 23844259 PMCID: PMC3699657 DOI: 10.1371/journal.pone.0069417] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/10/2013] [Indexed: 12/25/2022] Open
Abstract
Background Clinical studies suggest that 10-50% of patients are resistant to clopidogrel therapy. ADP induced platelet aggregation, a widely used test to monitor clopidogrel therapy, is affected by aspirin and is not specific for the P2Y12 receptor inhibited by clopidogrel. Objectives To develop a P2Y12-specific platelet aggregation test and to compare it with other methods used for monitoring clopidogrel therapy. Patients/Methods Study population included 111 patients with the history of ischemic stroke being on clopidogrel monotherapy and 140 controls. The effect of clopidogrel was tested by a newly developed ADP(PGE1) aggregation test in which prostaglandin E1 treated platelets are used. Results of conventional ADP induced platelet aggregation, VerifyNow P2Y12 assay and ADP(PGE1) aggregation were compared to those obtained by flow cytometric analysis of vasodilator stimulated phosphoprotein (VASP) phosphorylation. Reference intervals for all assays were determined according to the guidelines of Clinical Laboratory Standards Institute. Results The P2Y12-specificity of ADP(PGE1) test was proven by comparing it with ADP aggregation in the presence of P2Y1 antagonist, adenosine 3’, 5’-diphosphate. The method was not influenced by aspirin treatment. Approximately 50% of patients were clopidogrel resistant by conventional ADP aggregation and VerifyNow tests. The ADP(PGE1) method and the VASP phosphorylation assay identified 25.9% and 11.7% of patients as non-responders, respectively. ADP(PGE1) aggregation showed good correlation with VASP phosphorylation and had high diagnostic efficiency. Conclusion The new ADP(PGE1) method is a reliable test for monitoring P2Y12 receptor inhibition by platelet aggregation. As a subset of patients are non-responders, monitoring clopidogrel therapy by adequate methods is essential.
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Affiliation(s)
- Zsuzsa Bagoly
- Clinical Research Center, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - Ferenc Sarkady
- Clinical Research Center, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - Tünde Magyar
- Department of Neurology, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - János Kappelmayer
- Institute of Laboratory Medicine, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | | | - László Csiba
- Department of Neurology, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - László Muszbek
- Clinical Research Center, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
- Thrombosis and Haemostasis Research Group of the Hungarian Academy of Sciences, Debrecen, Hungary
- * E-mail:
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Laine M, Toesca R, Berbis J, Frere C, Barnay P, Pansieri M, Peyre JP, Michelet P, Bessereau J, Camilleri E, Helaf O, Camaleonte M, Paganelli F, Dignat-George F, Bonello L. Platelet reactivity evaluated with the VASP assay following ticagrelor loading dose in acute coronary syndrome patients undergoing percutaneous coronary intervention. Thromb Res 2013; 132:e15-8. [DOI: 10.1016/j.thromres.2013.04.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/27/2013] [Accepted: 04/29/2013] [Indexed: 11/29/2022]
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Apostolakis S, Lip GYH, Shantsila E. Pharmacokinetic considerations for antithrombotic therapies in stroke. Expert Opin Drug Metab Toxicol 2013; 9:1335-47. [DOI: 10.1517/17425255.2013.808331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hasan MS, Basri HB, Hin LP, Stanslas J. Genetic polymorphisms and drug interactions leading to clopidogrel resistance: why the Asian population requires special attention. Int J Neurosci 2012; 123:143-54. [PMID: 23110469 DOI: 10.3109/00207454.2012.744308] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ischemic heart disease and stroke are the two leading causes of death worldwide. Antiplatelet therapy plays the most significant role in the management of these cardiovascular and cerebrovascular occlusive events to prevent recurrent ischemic attack. Clopidogrel, an antiplatelet drug, is widely prescribed either alone or in combination with aspirin as dual antiplatelet therapy for the prevention of vascular occlusive events. The antiplatelet response to clopidogrel varies widely. Hyporesponders and nonresponders are likely to have adverse cardiovascular events during follow-up. Some drugs, such as proton pump inhibitors (omeprazole), calcium channel blockers, selective serotonin reuptake inhibitors (nefazadone), coumarin derivatives (phenprocoumon), benzodiazepines, sulfonylurea, erythromycin, and itraconazole, decrease the antiplatelet effect of clopidogrel when administered concomitantly. Decreased response to clopidogrel is common among Asians due to genetic polymorphisms associated with clopidogrel resistance, and it is nearly 70% in some of the Asian communities. It is necessary to study Asian populations, because there are a large number of Asians throughout the world due to increased migration. Current guidelines do not make genetic testing or platelet response testing mandatory prior to clopidogrel prescription. Therefore, it is important for clinicians treating Asian patients to keep in mind the interindividual variability in response to clopidogrel when prescribing the drug.
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Affiliation(s)
- Md Shariful Hasan
- Neurology Unit, Department of Medicine and Institute of Gerontology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia.
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