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Pallangyo P, Bhalia SV, Komba M, Mkojera ZS, Mayala HA, Kifai E, Kisenge PR. A nightmare of clopidogrel resistance in a resource-limited setting: case report of subacute stent thrombosis. Egypt Heart J 2023; 75:85. [PMID: 37823944 PMCID: PMC10570241 DOI: 10.1186/s43044-023-00408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Stent thrombosis, a life-threatening complication of percutaneous coronary intervention (PCI) continues to occur despite effective antiplatelet regimens and improved stenting methods. Noncompliance with dual antiplatelet therapy is the most common etiology; however, in spite of timely and their optimum administration the rates of recurrent myocardial infarction (MI) and stent thrombosis remain high. Clopidogrel resistance is increasingly evoked with elevated risk of anterothrombotic events particularly in the setting of stent implantation. In this case report, we present a case of subacute stent thrombosis associated with clopidogrel resistance in a resource-constrained setting. CASE PRESENTATION A 60 year old man with a long standing history of hypertension presented with a 6-month history of progressive shortness of breath. Initial electrocardiogram (ECG) revealed T-wave inversion on lateral leads and echocardiogram revealed akinetic basal lateral wall and hypokinetic mid lateral wall with reduced systolic functions. An elective coronary angiography (CAG) revealed a 90% stenosis of mid left anterior descending (LAD) artery and an 80% stenosis on the proximal left circumflex artery. He underwent a successful PCI with a drug-eluting stent implantation to mid LAD. He was discharged in a stable state 48 h post revascularization with dual antiplatelet (clopidogrel and acetylsalicylic acid). Seven days later, he presented with a crushing substernal chest pain. Cardiac enzymes were elevated and ECG revealed anterior ST-elevation MI. An emergency CAG revealed a high thrombus burden with 100% occlusion of mid LAD. Following unsuccessful ballooning, intravenous and intracoronary thrombolysis with tenecteplase was given. A TIMI II flow was achieved and the patient was sent to the coronary care unit. However, 14 h later there was yet a new onset of severe chest pain. A 12-lead ECG previewed anterior ST-elevation MI and the cardiac enzymes were high. Urgent CAG revealed in-stent thrombotic total occlusion of mid LAD. A stent in stent was then implanted and TIMI III flow was restored. Clopidogrel resistance was suspected and the patient was transitioned to ticagrelol. There were no further ischemic events during the remainder of hospitalization and the patient was discharged in a hemodynamically stable state three days later. During follow-up after one and three months, he was fairly stable without any further cardiac events. CONCLUSIONS Owing to clopidogrel resistance, stent thrombosis in the setting of dual antiplatelet therapy compliance may occur. While in a situation of clopidogrel resistance newer and more potent antiplatelet drugs should be used, their availability and cost remains a significant barrier particularly in the developing world. Nonetheless, a high index of suspicion and timely revascularization is fundamental to restore patency of the thrombosed vessel and confer better risk-adjusted survival rates.
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Affiliation(s)
- Pedro Pallangyo
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
| | - Smita V Bhalia
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Makrina Komba
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Zabella S Mkojera
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Henry A Mayala
- Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Engerasiya Kifai
- Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Peter R Kisenge
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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He M, Yan W, Zhang Y, Kong Y, Han X, Ren J, Zhao Z, Liu G, Shi J, Li Y. Effects of ticagrelor monotherapy vs. clopidogrel monotherapy on platelet reactivity: a randomized, crossover clinical study (SINGLE study). Platelets 2022; 33:1146-1152. [PMID: 35379064 DOI: 10.1080/09537104.2022.2052036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Increasing clinical trials demonstrated that the discontinuation of aspirin while maintaining a P2Y12 inhibitor monotherapy could decrease the risk of bleeding without losing the antithrombotic effect. However, no data are available on the platelet reactivity of patients undergoing ticagrelor monotherapy vs. clopidogrel. Therefore, we performed this study to observe the efficacy of ticagrelor monotherapy vs. clopidogrel in Chinese patients with chronic coronary syndrome. This randomized, single-blinded, crossover trial enrolled 50 patients who were administered with ticagrelor (90 mg twice daily for 2 weeks) or clopidogrel (75 mg once daily for 2 weeks). Followed by a 2-week washout period, the two groups of patients underwent a crossover trial. Light transmission aggregometry (LTA) and thromboelastography (TEG) assays were used to test platelet reactivity. The platelet aggregation rate (PAgR) of ADP and AA was significantly lower with ticagrelor than clopidogrel (PAgR of ADP, 27.30% (7.30%-42.635%) vs. 35.55% (12.03%-69.25%), P = .0254; PAgR of AA, 77.80% (21.60%-86.43%) vs. 83.10% (67.13%-87.20%), P = .0400). There was no significant difference in PAgR of collagen and epinephrine between the two groups. The TEG assay showed that ADP and AA, which induced the inhibition of platelet aggregation, were significantly higher in the ticagrelor group than those in the clopidogrel group [ADP%, 69.00% (59.68%-88.95%) vs. 60.55% (35.98%-78.35%), P = .0020; AA%, 53.65% (22.75%-79.28%) vs. 15.15% (5.75%-70.25%), P = .0127]. High on-treatment platelet reactivity (HTPR) on ADP was 2.17% with ticagrelor and 19.57% with clopidogrel. HTPR on AA was 50.00% with ticagrelor and 69.57% with clopidogrel. Ticagrelor and clopidogrel caused the inhibition of ADP and AA-induced platelet aggregation. Moreover, ticagrelor monotherapy had a stronger inhibitory effect than clopidogrel monotherapy (except on collagen and epinephrine).
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Affiliation(s)
- Meijiao He
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China
| | - Wei Yan
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China
| | - Yun Zhang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China
| | - Yihui Kong
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China
| | - Xuejie Han
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China
| | - Jie Ren
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China
| | - Zhongyang Zhao
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China
| | - Guangzhong Liu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China
| | - Jing Shi
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China
| | - Yue Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China.,Institute of Metabolic Disease, Heilongjiang Academy of Medical Science, Harbin, P.R. China.,Heilongjiang Key Laboratory for Metabolic Disorder & Cancer Related Cardiovascular Diseases, Harbin, P.R. China
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Mao S, Sarkar A, Wang Y, Song C, LeVine D, Wang X, Que L. Microfluidic chip grafted with integrin tension sensors for evaluating the effects of flowing shear stress and ROCK inhibitor on platelets. LAB ON A CHIP 2021; 21:3128-3136. [PMID: 34180491 PMCID: PMC8353964 DOI: 10.1039/d1lc00259g] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
Integrins are key players in platelet adhesion and aggregation. Integrin molecular tensions, the forces transmitted by integrin molecules, are regulated by both mechanical and biochemical cues, and the outside-in and inside-out signaling has been extensively studied. While the mechanical properties of platelets at static status have been studied by atomic force microscopy, traction force microscopy and tension sensors, the biomechanical properties of flowing platelets remain elusive. Herein, we report microfluidic chips grafted with integrin tension sensors for microfluidic-force mapping in platelets. Specifically, the process of integrin αIIbβ3 mediating tension transmission and platelet adhesion under low flow rates has been obtained, and the process of platelet clustering at post-stenotic regions has been demonstrated. We found that flowing shear force can postpone the integrin-mediated tension transmission and platelet adhesion. We further evaluated the effect of Y-27632, a ROCK inhibitor that has been proven to reduce integrin-mediated platelet adhesion, at a series of concentrations and demonstrated that microfluidic chips with integrin tension sensors are sensitive to the concentration-dependent effects of Y-27632. Given their low cost and scalable throughput, these chips are ideal technical platforms for biological studies of platelets at flowing status and for platelet inhibitor or potential antiplatelet drug screening.
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Affiliation(s)
- Subin Mao
- Electrical and Computer Engineering Department, Iowa State University, Ames, USA50011.
| | - Anwesha Sarkar
- Electrical and Computer Engineering Department, Iowa State University, Ames, USA50011. and Department of Physics and Astronomy, Iowa State University, Ames, USA50011.
| | - Yongliang Wang
- Department of Physics and Astronomy, Iowa State University, Ames, USA50011.
| | - Chao Song
- Electrical and Computer Engineering Department, Iowa State University, Ames, USA50011.
| | - Dana LeVine
- Veterinary Clinical Sciences, Iowa State University, Ames, USA50011
| | - Xuefeng Wang
- Department of Physics and Astronomy, Iowa State University, Ames, USA50011.
| | - Long Que
- Electrical and Computer Engineering Department, Iowa State University, Ames, USA50011.
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Mencarini T, Roka-Moiia Y, Bozzi S, Redaelli A, Slepian MJ. Electrical impedance vs. light transmission aggregometry: Testing platelet reactivity to antiplatelet drugs using the MICELI POC impedance aggregometer as compared to a commercial predecessor. Thromb Res 2021; 204:66-75. [PMID: 34147831 DOI: 10.1016/j.thromres.2021.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/08/2021] [Accepted: 05/26/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Patients' responses to antiplatelet therapy significantly vary, with individuals showing high residual platelet reactivity associated with thrombosis. To personalize thrombosis management, platelet function testing has been suggested as a promising tool able to monitor the antithrombotic effect of antiplatelet agents in real-time. We have prototyped the MICELI, a miniature and easy-to-use electrical impedance aggregometer (EIA), measuring platelet aggregation in whole blood. Here, we tested the capability of the MICELI aggregometer to quantify platelet reactivity on antiplatelet agents, as compared with conventional light-transmission aggregometry (LTA). METHODS Platelet aggregation in ACD-anticoagulated whole blood and platelet-rich plasma of healthy donors (n = 30) was evaluated. The effect of clopidogrel, ticagrelor, cangrelor, cilostazol, and tirofiban on ADP-induced aggregation was tested, while aspirin was evaluated with arachidonic acid and collagen. Platelet aggregation was recorded using the MICELI or BioData PAP-8E (Bio/Data Corp.) aggregometers. RESULTS The MICELI aggregometer detected an adequate and comparable dose-dependent decrease of platelet aggregation in response to increments of drugs' concentrations, as compared to LTA (the inter-device R2 = 0.79-0.93). Platelet aggregation in platelet-rich plasma recorded by LTA showed higher sensitivity to antiplatelet agents, but it couldn't distinguish between different drug doses as indicated by saturation of the aggregatory response. CONCLUSION Platelet aggregation in whole blood as recorded by EIA represents a better model system for evaluation of platelet reactivity as compared with platelet aggregation in platelet-rich plasma as recorded by LTA, since EIA takes into consideration the modulatory effect of other blood cells on platelet hemostatic function and pharmacodynamics of antiplatelet drugs in vivo. As such, the MICELI impedance aggregometer could be potentially employed for the point-of-care monitoring of platelet function in patients on-treatment for personalized tailoring of their antiplatelet regimen.
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Affiliation(s)
- Tatiana Mencarini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Yana Roka-Moiia
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ, United States of America; Department of Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ, United States of America
| | - Silvia Bozzi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Marvin J Slepian
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ, United States of America; Department of Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ, United States of America.
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Pharmacodynamic effects of indobufen compared with aspirin in patients with coronary atherosclerosis. Eur J Clin Pharmacol 2021; 77:1815-1823. [PMID: 34331551 DOI: 10.1007/s00228-021-03177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to investigate the pharmacodynamic effects of indobufen and low-dose aspirin in patients with coronary atherosclerosis. METHODS In the first phase, 218 patients with coronary atherosclerosis were randomly assigned to receive aspirin 100 mg once daily (standard dose); 100 mg once every 2 days; 100 mg once every 3 days; 50 mg twice daily; 75 mg once daily; 50 mg once daily; or indobufen 100 mg twice daily for 1 month. In the second phase, 20 healthy subjects were treated with indobufen 100 mg twice daily for 1 week followed after a 2-week washout by aspirin 100 mg once daily for 1 week. The primary outcome was arachidonic acid-induced platelet aggregation (PLAA), and the secondary outcomes included plasma thromboxane B2 (TXB2) and urinary 11-dehydro-TXB2 (11-dh-TXB2) levels at the end of each treatment. RESULTS: In the first phase, compared with aspirin 100 mg once daily: all aspirin groups had similar suppression of PLAA whereas indobufen group had significantly less suppressed PLAA. Aspirin given every second or third day, and indobufen produced less suppression of plasma TXB2. All treatment regimens produced similar inhibition of 11-dh-TXB2. In the second phase, compared with aspirin, indobufen produced less suppression of plasma TXB2 at 8 h and 12 h after the last dose. CONCLUSIONS Aspirin 50 mg twice daily, 75 mg once daily, and aspirin 50 mg once daily produce antiplatelet effects that are similar to aspirin 100 mg once daily. Aspirin given less often than once daily and indobufen 100 mg twice daily do not suppress platelets as effectively as aspirin 100 mg once daily.
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Effects of PON1 Gene Promoter DNA Methylation and Genetic Variations on the Clinical Outcomes of Dual Antiplatelet Therapy for Patients Undergoing Percutaneous Coronary Intervention. Clin Pharmacokinet 2019; 57:817-829. [PMID: 28875477 DOI: 10.1007/s40262-017-0595-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND OBJECTIVE The relationship between either paraoxonase 1 (PON1) gene promoter DNA methylation or genetic variations and bleeding or major adverse cardiac events after dual antiplatelet therapy has been incompletely characterized. We aimed to systematically investigate the role of genetic variations and DNA methylation of the PON1 CpG island promoter on the clinical outcomes of dual antiplatelet therapy for patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). METHODS This study included 653 patients with CAD undergoing PCI and receiving dual antiplatelet therapy. Genomic DNAs were isolated from whole blood and were genotyped for the three single nucleotide polymorphisms (SNPs) of the PON1 gene. The DNA methylation levels in the PON1 promoter region were determined by bisulfite sequencing or pyrosequencing at five CpG sites (positions -142, -161, -163, -170, and -184 from the transcription start site). Clopidogrel and its metabolites in plasma were examined using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), and platelet function analysis was performed using the VerifyNow assay. RESULTS Statistically significant associations between methylation levels at five PON1 CpG sites and bleeding were observed: -184 [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.96-1.00, p = 0.028]; -170 (OR 0.99, 95% CI 0.97-1.00, p = 0.048); -163 (OR 0.98, 95% CI 0.96-1.00, p = 0.029); -161 (OR 0.98, 95% CI 0.97-1.00, p = 0.026); and -142 (OR 0.98, 95% CI 0.97-1.00, p = 0.042) at a false discovery rate of <5%. Statistical analysis also revealed that aspirin reaction units (ARUs) were significantly associated with PON1 methylation level at CpG site -163 (p = 0.0342). The ARUs of patients with the PON1 126 CC genotype was 527 ± 94, which was higher than the ARUs (473 ± 89) of patients with the 126 CG genotype (p = 0.0163). Multivariate logistic regression analysis indicated that the PON1 methylation level at CpG site -161 (OR 0.95, 95% CI 0.92-0.98, p = 0.002) and the use of angiotensin-converting enzyme inhibitors (OR 0.48, 95% CI 0.26-0.89, p = 0.021) were associated with a decreased risk of bleeding events. CONCLUSIONS Hypomethylation of CpGs in the PON1 promoter may be a weak, albeit statistically significant, risk factor of bleeding after dual antiplatelet therapy. Further large-scale studies are needed to verify our results.
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Lee J, Cheng N, Tai H, Jimmy Juang J, Wu C, Lin L, Hwang J, Lin J, Chiang F, Tsai C. CYP2C19 Polymorphism is Associated With Amputation Rates in Patients Taking Clopidogrel After Endovascular Intervention for Critical Limb Ischaemia. Eur J Vasc Endovasc Surg 2019; 58:373-382. [DOI: 10.1016/j.ejvs.2019.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 02/12/2019] [Indexed: 02/08/2023]
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The prognostic value of multiple electrode aggregometry and light transmittance aggregometry in stable cardiovascular patients with type 2 diabetes mellitus. Thromb Res 2019; 180:47-54. [PMID: 31202191 DOI: 10.1016/j.thromres.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/15/2019] [Accepted: 06/03/2019] [Indexed: 01/10/2023]
Abstract
AIM Limited data are available regarding the clinical relevance of platelet function measurements in stable patients with coronary artery disease (CAD). Our aim is to evaluate the agreement between multiple electrode aggregometry (MEA) and light transmittance aggregometry (LTA) in detecting clopidogrel low responders and their prognostic value in CAD patients with type 2 diabetes mellitus (T2DM) on dual platelet inhibition. METHODS LTA and MEA were performed in 122 stable cardiovascular patients with T2DM. The upper quartile of patients according to maximum LTA (LTAmax) and MEA measurements were defined as clopidogrel low responders. Agreement between the two methods was evaluated by kappa statistics. We assessed the potential correlation between antiplatelet response and clinical outcome and the optimal cutoff value according to ROC analysis to predict the occurrence of major adverse cardiovascular events (MACE), during 1-year follow-up period. RESULTS Cohen's kappa coefficients (0.214) indicated fair agreement (70.2%) between LTA and MEA. A total of 25 MACE occurred in 108 patients (23.1%). Patients with MACE had higher LTAmax than those without (57.1 ± 16.5 vs 49.3 ± 18.3, respectively, p = 0.023). MEA measurements were similar between patients with and without MACE (30.1 ± 15.4 vs 30.6 ± 20.8, respectively; p = 0.84). Multiple logistic regression showed LTAmax response as an independent predictor of death from cardiovascular causes (Odds Ratio, adjusted:0.2;0.05-0.81). ROC analysis indicated that LTAmax cutoff of 62.5% best predicted death (AUC = 0.67, sensitivity = 78%, specificity = 61.5%). CONCLUSIONS The assessment of platelet responsiveness remains highly test-specific. Our results support the prognostic role of LTA, but not MEA testing, for death risk evaluation in stable cardiovascular T2DM patients.
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Falcinelli E, Iannone A, Mezzasoma AM, Amato L, Fierro T, Guglielmini G, Cagini C, Gresele P. Inhibition of platelet function after ocular administration of non-steroidal anti-inflammatory drugs. Thromb Res 2019; 175:1-5. [PMID: 30660018 DOI: 10.1016/j.thromres.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/19/2018] [Accepted: 01/09/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The use of topical NSAIDs is frequent in ophthalmology to reduce the local inflammatory reaction resulting from surgical procedures. Ocular use of some drugs was previously found to lead to significant systemic absorption with possible systemic effects. NSAIDs may enhance the hemorrhagic risk of anticoagulant and antiplatelet drugs. Aim of our study was to evaluate the systemic effects of two NSAIDs given by eyedrops on platelet COX-1 and on ex vivo and in vivo platelet activation. MATERIALS AND METHODS 20 patients planned to undergo cataract surgery were randomized to the use of an ophthalmic solution containing Diclofenac or Indomethacin. Blood was taken at enrollment (baseline) and after 3 days of therapy (1 drop, 4 times a day). Arachidonic Acid (AA)-induced light transmission aggregometry (LTA), PFA-100® C-EPI, circulating platelet P-Selectin expression by flow cytometry and serum and AA-induced TxB2 production were evaluated before and after eyedrop therapy. RESULTS AA (0.1-0.2 mM)-induced LTA was significantly reduced after ocular indomethacin but not after diclofenac. PFA-100® C-EPI closure time was also significantly prolonged in the indomethacin group but not in the diclofenac group. Circulating platelet P-selectin expression was significantly reduced after treatment with indomethacin compared with diclofenac. Finally, treatment with eyedrop indomethacin, but not with diclofenac, strikingly suppressed AA-induced TxB2 generation, while treatment with diclofenac did not modify it. CONCLUSIONS Our data show that indomethacin administered by ophthalmic eye drops has a relevant systemic antiplatelet effect. This should be taken into account in patients under concurrent therapy with antiplatelet or anticoagulant agents.
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Affiliation(s)
- Emanuela Falcinelli
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Alessia Iannone
- Department of Surgical and Biomedical Science, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Anna Maria Mezzasoma
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Lavinia Amato
- Department of Surgical and Biomedical Science, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Tiziana Fierro
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Giuseppe Guglielmini
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Carlo Cagini
- Department of Surgical and Biomedical Science, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Paolo Gresele
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy.
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Laboratory Monitoring of Antiplatelet Therapy. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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He M, Li D, Zhang Y, Sun D, Liu G, Pan Y, Shi J, Li Y, Yin S, Li Y. Effects of different doses of ticagrelor on platelet aggregation and endothelial function in diabetic patients with stable coronary artery disease. Platelets 2018; 30:752-761. [PMID: 30252571 DOI: 10.1080/09537104.2018.1513479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Meijiao He
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Dan Li
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Yingli Zhang
- Cardiovascular Department, Harbin Red Cross Central Hospital, Harbin, Heilongjiang, P.R. China
| | - Danghui Sun
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Guangzhong Liu
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Yujiao Pan
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Jing Shi
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Yanyan Li
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Shuangli Yin
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Yue Li
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
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Choi SY, Kim MH. Comparison of factors affecting platelet reactivity in various platelet function tests. Platelets 2018; 30:631-636. [PMID: 30059640 DOI: 10.1080/09537104.2018.1499887] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Previous studies have reported that various factors affect ADP-induced platelet reactivity during clopidogrel therapy. The aim of this study was to determine whether clinical and laboratory variables for platelet reactivity during dual antiplatelet therapy (DAPT) are dependent on the assay used. We enrolled 904 patients receiving DAPT following coronary intervention. Platelet reactivity was measured using three methods: the VerifyNow P2Y12 assay, multiple electrode aggregometry (MEA) ADP assay, and the light transmittance aggregometry (LTA) ADP assay at 24-48 h following coronary intervention. The VerifyNow results demonstrated a significant inverse correlation with hematocrit value (r = -0.268, p < 0.0001); however, MEA results had no such correlation with hematocrit (r = 0.044, p = 0.188). There was a positive correlation between the MEA results and platelet count (r = 0.255, p < 0.0001). LTA was weakly influenced by hematocrit (r = -0.064, p = 0.057) and platelet count (r = 0.069, p = 0.040). Gender (odds ratio 1.53, 95% CI 1.10-2.14, p = 0.013) and hematocrit (odds ratio 0.91,95% CI 0.88-0.94, p < 0.0001) were the independent variables for HPR by VerifyNow. Smoking (odds ratio 0.38, 95% CI 0.16-0.94, p = 0.036) and platelet count (odds ratio 1.01, 95% CI 1.00-1.01, p < 0.0001) were independent factors for HPR when using the MEA assay, whereas platelet count (odds ratio 1.00, 95% CI 1.00-1.01, p = 0.006) was identified as the only independent variable for HPR when using LTA. The incidence of HPR and the influencing variables involved are dependent on the platelet function test used.
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Affiliation(s)
- Sun Young Choi
- a Department of Cardiology , Dong-A University Hospital , Busan , South Korea.,b Department of Biomedical Laboratory Science , Daegu Health College , Daegu , South Korea
| | - Moo Hyun Kim
- a Department of Cardiology , Dong-A University Hospital , Busan , South Korea
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13
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Bath PM, May J, Heptinstall S. Clinical utility of remote platelet function measurement using P-selectin: assessment of aspirin, clopidogrel, and prasugrel and bleeding disorders. Platelets 2018; 29:425-430. [DOI: 10.1080/09537104.2018.1445839] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Jane May
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Stan Heptinstall
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Abstract
While there are many bench and bedside tests to assess platelet reactivity, ex vivo light transmission aggregometry (LTA) remains the gold standard. LTA, however, is expensive, time-consuming and requires dedicated equipment and staff, making it impractical in many situations. In addition, there is significant variability between data generated at different testing sites meaning that tests often need to be repeated if a patient is transferred to the care of a different hospital. As such, there is clearly an unmet need for standardization of platelet testing. Using the principles of LTA, aggregometry can be conducted in 96-well plates with readings being made in a standard plate reader. This approach allows for the assessment of multiple concentrations of agonists, since the volume of platelets required for each test is significantly lower than for LTA. Furthermore, the lyophilization of a set panel of agonists to a 96-well plate to produce a stable assay substrate allows the production of portable, standardized plates that can be used to generate reproducible tests at multiple sites. In this review, we will discuss the methods and uses of 96-well plate aggregometry for both research and the clinic.
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Affiliation(s)
- Melissa V Chan
- a Centre for Immunobiology , The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London , London , UK
| | - Paul C Armstrong
- a Centre for Immunobiology , The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London , London , UK
| | - Timothy D Warner
- a Centre for Immunobiology , The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London , London , UK
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15
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Robust and sensitive LC/MS-MS method for simultaneous detection of acetylsalicylic acid and salicylic acid in human plasma. Microchem J 2018. [DOI: 10.1016/j.microc.2016.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Bordet JC, Negrier C, Dargaud Y, Quellec SL. Comparison of current platelet functional tests for the assessment of aspirin and clopidogrel response. Thromb Haemost 2017; 116:638-50. [DOI: 10.1160/th15-11-0870] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/29/2016] [Indexed: 12/18/2022]
Abstract
SummaryThe two most widely used antiplatelet drugs in the world are aspirin and clopidogrel. However, some patients on aspirin and/or clopidogrel therapy do not respond appropriately to either aspirin or clopidogrel. This phenomenon is usually called “aspirin/clopidogrel resistance”. Several platelet function tests have been used in various studies for the assessment of aspirin and clopidogrel resistance in healthy individuals and patients admitted in cardiology departments. An accurate assessment of platelet response to aspirin/clopidogrel could benefit patients by proposing tailored-antiplatelet therapy based on test results. However, there is a clear lack of standardisation of such techniques and their analytical variability may induce misinterpretation. After a quick report of the mechanisms responsible for aspirin/clopidogrel resistance, we describe the pre-analytical aspects and the analytical performances of current platelet function tests (Light-transmission aggregometry, whole-blood aggregometry, VerifyNow®, Platelet Function Analyzer®, thromboelastography, VASP assay) that are used for the assessment of aspirin/clopidogrel resistance in clinical studies. Considering the different variables that have to be taken into account with each of the platelet function tests, a particular attention should be paid when interpreting results.
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17
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Gan YL, Fu JY, Lai OM, Chew BH, Yuen KH, Teng KT, Nesaretnam K, Selvaduray KR, Meganathan P. Effect of palm-based tocotrienols and tocopherol mixture supplementation on platelet aggregation in subjects with metabolic syndrome: a randomised controlled trial. Sci Rep 2017; 7:11542. [PMID: 28912593 PMCID: PMC5599564 DOI: 10.1038/s41598-017-11813-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/30/2017] [Indexed: 02/08/2023] Open
Abstract
Tocotrienols, the unsaturated form of vitamin E, were reported to modulate platelet aggregation and thrombotic mechanisms in pre-clinical studies. Using a Food and Drug Administration (FDA)-approved cartridge-based measurement system, a randomised, double-blind, crossover and placebo-controlled trial involving 32 metabolic syndrome adults was conducted to investigate the effect of palm-based tocotrienols and tocopherol (PTT) mixture supplementation on platelet aggregation reactivity. The participants were supplemented with 200 mg (69% tocotrienols and 31% α-tocopherol) twice daily of PTT mixture or placebo capsules for 14 days in a random order. After 14 days, each intervention was accompanied by a postprandial study, in which participants consumed 200 mg PTT mixture or placebo capsule after a meal. Blood samples were collected on day 0, day 14 and during postprandial for the measurement of platelet aggregation reactivity. Subjects went through a 15-day washout period before commencement of subsequent intervention. Fasting platelet aggregation reactivity stimulated with adenosine diphosphate (ADP) did not show substantial changes after supplementation with PTT mixture compared to placebo (p = 0.393). Concomitantly, changes in postprandial platelet aggregation reactivity remained similar between PTT mixture and placebo interventions (p = 0.408). The results of this study highlight the lack of inhibitory effect on platelet aggregation after short-term supplementation of PTT mixture in participants with metabolic syndrome.
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Affiliation(s)
- Yee-Lin Gan
- Department of Bioprocess Technology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
| | - Ju-Yen Fu
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia.
| | - Oi-Ming Lai
- Department of Bioprocess Technology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Institute of Bioscience, Universiti Putra Malaysia, Selangor, Malaysia
| | - Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Kah-Hay Yuen
- School of Pharmaceuticals Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Kim-Tiu Teng
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
| | - Kalanithi Nesaretnam
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
| | - Kanga Rani Selvaduray
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
| | - Puvaneswari Meganathan
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
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18
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19
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Germanovich K, Femia EA, Cheng CY, Dovlatova N, Cattaneo M. Effects of pH and concentration of sodium citrate anticoagulant on platelet aggregation measured by light transmission aggregometry induced by adenosine diphosphate. Platelets 2017. [PMID: 28643541 DOI: 10.1080/09537104.2017.1327655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The 2013 ISTH-SSC guidelines for the standardization of light transmission aggregometry (LTA) were largely based on expert consensus, as studies directly comparing LTA methodologies were lacking. We experimentally tested the cogency of ISTH-SSC recommendations pertaining to use of anticoagulant, in particular whether: (1) buffered citrate (BC) is preferable to unbuffered citrate (C); (2) the two recommended concentrations of sodium citrate (109 and 129 mM) are equivalent in terms of platelet aggregation (PA). Blood from 16 healthy volunteers was collected into BC and C (109 and 129 mM). PA was measured by LTA in platelet-rich plasma (PRP) stimulated by adenosine diphosphate (ADP) (2 μM) immediately after PRP preparation and up to 4 hr after blood collection; pH and platelet counts in PRP were measured in parallel. pH in PRP increased with time up to about 8 for all anticoagulants, although it was lower in BC than in C at all times. In BC, PA was lower at 45 min, but equivalent at all other times. PA was higher and more stable in sodium citrate 109 mM than in 129 mM at all times. The extent of PA did not change for up to 2 hr after blood collection, and subsequently dramatically decreased. In contrast with ISTH-SSC recommendations, (1) BC does not show advantages compared to C; (2) 109 mM citrate is preferable to 129 mM, because it better supports PA; and (3) LTA studies should be completed within 2 hr of blood collection, instead of the recommended 4 hr.
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Affiliation(s)
- Ksenia Germanovich
- a Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute , Università degli Studi di Milano , Milan , Italy
| | - Eti Alessandra Femia
- a Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute , Università degli Studi di Milano , Milan , Italy
| | - Chun Yan Cheng
- a Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute , Università degli Studi di Milano , Milan , Italy
| | - Natalia Dovlatova
- b Thrombosis and Haemostasis Group, Clinical Neurosciences , University of Nottingham , Nottingham , UK
| | - Marco Cattaneo
- a Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute , Università degli Studi di Milano , Milan , Italy
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20
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Martini D, Rossi S, Biasini B, Zavaroni I, Bedogni G, Musci M, Pruneti C, Passeri G, Ventura M, Di Nuzzo S, Galli D, Mirandola P, Vitale M, Dei Cas A, Bonadonna RC, Del Rio D. Claimed effects, outcome variables and methods of measurement for health claims proposed under European Community Regulation 1924/2006 in the framework of protection against oxidative damage and cardiovascular health. Nutr Metab Cardiovasc Dis 2017; 27:473-503. [PMID: 28434807 DOI: 10.1016/j.numecd.2017.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The high number of negative opinions from the European Food Safety Authority (EFSA) to the requests for authorization of health claims is largely due to the design of human intervention studies, including the inappropriate choice of outcome variables (OVs) and of their methods of measurement (MMs). The present manuscript reports the results of an investigation aimed to collect, collate and critically analyse the information in relation to claimed effects, OVs and MMs, in the context of protection against oxidative damage and cardiovascular health compliant with Regulation 1924/2006. METHODS AND RESULTS Claimed effects, OVs and the related MMs were collected from EFSA Guidance documents and applications for authorization of health claims under Articles 13.5 and 14. The OVs and their MMs were evaluated only if the claimed effect was sufficiently defined and was considered beneficial by EFSA. The collection, collation and critical analysis of the relevant scientific literature consisted in the definition of the keywords, the PubMed search strategies and the creation of databases of references. The critical analysis of the OVs and their MMs was performed on the basis of the literature review and was aimed at defining the appropriateness of OVs and MMs in the context of the specific claimed effects. CONCLUSIONS The information provided in this document could serve to EFSA for the development of further guidance on the scientific requirements for health claims, as well as to the stakeholders for the proper design of human intervention studies aimed to substantiate such health claims.
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Affiliation(s)
- D Martini
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - S Rossi
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - B Biasini
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - I Zavaroni
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - G Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | - M Musci
- Department of Food and Drug, University of Parma, Parma, Italy
| | - C Pruneti
- Department of Medicine and Surgery, Clinical Psychology Unit, University of Parma, Medical School Building, Parma, Italy
| | - G Passeri
- Department of Medicine and Surgery, Building Clinica Medica Generale, University of Parma, Parma, Italy
| | - M Ventura
- Department of Chemistry, Life Sciences and Environmental Sustainability, Laboratory of Probiogenomics, University of Parma, Parma, Italy
| | - S Di Nuzzo
- Department of Medicine and Surgery, Section of Dermatology, University of Parma, Parma, Italy
| | - D Galli
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - P Mirandola
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - M Vitale
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - A Dei Cas
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - R C Bonadonna
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - D Del Rio
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy.
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21
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Sawardekar SB, Patel TC, Uchil D. Comparative evaluation of antiplatelet effect of lycopene with aspirin and the effect of their combination on platelet aggregation: An in vitro study. Indian J Pharmacol 2017; 48:26-31. [PMID: 26997718 PMCID: PMC4778201 DOI: 10.4103/0253-7613.174428] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: The objective was to compare antiplatelet effect of lycopene with aspirin and to study effect of combination of the two on platelet aggregation in vitro, using platelets from healthy volunteers. Materials and Methods: Platelets were harvested; platelet count of platelet-rich plasma adjusted to 2.5 Χ 105/μL. Aspirin (140 μmol/L) and lycopene (4, 6, 8, 10, and 12 μmol/L) were studied in vitro against adenosine-5’- diphosphate (ADP) (2.5 μM/L) and collagen Results: All the concentrations of lycopene (4–12 μmol/L) exhibited reduction in maximum platelet aggregation induced by aggregating agents ADP and collagen (P < 0.01 vs. vehicle) and were comparable with aspirin. Lycopene at concentration 10 μmol/L showed maximum platelet inhibition (47.05% ± 19.56%) against ADP, whereas lycopene at concentration 8 μmol/L showed maximum platelet inhibition (54.26% ± 30.71%) against collagen. Four μmol/L of lycopene combined with 140 μmol/L and 70 μmol/L aspirin showed greater inhibition of platelets as compared to aspirin 140 μmol/L alone, against both ADP and collagen. Conclusion: The study favorably compares lycopene and aspirin with respect to their antiplatelet activities against ADP and collagen. Lycopene can be considered as a potential target for modifying the thrombotic and pro-inflammatory events associated with platelet activation.
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Affiliation(s)
- Swapna B Sawardekar
- Department of Pharmacology and Therapeutics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Tejal C Patel
- Department of Pharmacology and Therapeutics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Dinesh Uchil
- Department of Pharmacology and Therapeutics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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22
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Rollini F, Franchi F, Singh K, Cho JR, Bhatti M, DeGroat C, Hu J, Aggarwal N, Alobaidi Z, Thano E, Ferrante E, Zenni M, Bass TA, Angiolillo DJ. Impact of timing from blood sampling to pharmacodynamic assessment on measures of platelet reactivity in patients treated with P2Y 12 receptor inhibitors. Thromb Haemost 2016; 116:1060-1069. [PMID: 27488362 DOI: 10.1160/th16-05-0377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/11/2016] [Indexed: 11/05/2022]
Abstract
Several platelet function tests (PFT) are available to assess the pharmacodynamic (PD) effects of P2Y12 inhibitors. However, there are technical variances between PFT, and P2Y12 inhibitors differ in pharmacological properties. Manufactures of PFT recommend a time-frame within which assessments needs to be executed. However, if the timing from blood sampling to processing affects PD results is unknown. We conducted a prospective study assessing the impact of timing from blood sampling to processing on PD measures using three different PFT. We studied 60 aspirin-treated patients with coronary artery disease (CAD) on maintenance P2Y12 inhibiting therapy [clopidogrel 75 mg/day (n=20), prasugrel 10 mg/day (n=20) and ticagrelor 90 mg bid (n=20)]. PD assessments (trough levels) were performed by VerifyNow P2Y12 (VN), light transmittance aggregometry (LTA) and vasodilator-stimulated phosphoprotein (VASP) at 30 minutes, 2 and 4 hours post-sampling; VASP was also performed at 24 hours. P2Y12 reaction units (PRU) by VN significantly decreased over time with all P2Y12 inhibitors (clopidogrel p<0.001; prasugrel p=0.016; ticagrelor p<0.001). PRU at 30 minutes and 2 hours were similar, but decreased at 4 hours. LTA showed consistent findings with VN. Conversely, PD measures as assessed by VASP were stable over time (p>0.1 for all P2Y12 inhibitors). In conclusion, in CAD patients on maintenance therapy with P2Y12 inhibitors, timing from blood sampling to processing significantly influences PD measures as assessed by VN and LTA, but not by VASP.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Dominick J Angiolillo
- Dominick J. Angiolillo, MD, PhD, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA, Tel: +1 904 244 3933, Fax: +1 904 244 3102, E-mail:
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23
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Marsousi N, Samer CF, Fontana P, Reny JL, Rudaz S, Desmeules JA, Daali Y. Coadministration of ticagrelor and ritonavir: Toward prospective dose adjustment to maintain an optimal platelet inhibition using the PBPK approach. Clin Pharmacol Ther 2016; 100:295-304. [PMID: 27264793 DOI: 10.1002/cpt.407] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/27/2016] [Accepted: 06/01/2016] [Indexed: 11/09/2022]
Abstract
Ticagrelor is a potent antiplatelet drug metabolized by cytochrome (CYP)3A. It is contraindicated in patients with human immunodeficiency virus (HIV) because of the expected CYP3A inhibition by most protease inhibitors, such as ritonavir and an increased bleeding risk. In this study, a physiologically based pharmacokinetic (PBPK) model was created for ticagrelor and its active metabolite (AM). Based on the simulated interaction between ticagrelor 180 mg and ritonavir 100 mg, a lower dose of ticagrelor was calculated to obtain, when coadministered with ritonavir, the same pharmacokinetic (PK) and platelet inhibition as ticagrelor administered alone. A clinical study was thereafter conducted in healthy volunteers. Observed PK profiles of ticagrelor and its AM were successfully predicted with the model. Platelet inhibition was nearly complete in both sessions despite administration of a fourfold lower dose of ticagrelor in the second session. This PBPK model could be prospectively used to broaden the usage of ticagrelor in patients with ritonavir-treated HIV regardless of the CYP3A inhibition.
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Affiliation(s)
- N Marsousi
- Clinical Pharmacology and Toxicology Service, Geneva University Hospitals, Switzerland.,School of Pharmaceutical Sciences, Geneva University, Switzerland
| | - C F Samer
- Clinical Pharmacology and Toxicology Service, Geneva University Hospitals, Switzerland.,Swiss Center for Applied Human Toxicology (SCAHT), University of Geneva, Switzerland
| | - P Fontana
- Division of Angiology and Haemostasis, Geneva University Hospitals, Switzerland.,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland
| | - J L Reny
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Switzerland
| | - S Rudaz
- School of Pharmaceutical Sciences, Geneva University, Switzerland.,Swiss Center for Applied Human Toxicology (SCAHT), University of Geneva, Switzerland
| | - J A Desmeules
- Clinical Pharmacology and Toxicology Service, Geneva University Hospitals, Switzerland.,School of Pharmaceutical Sciences, Geneva University, Switzerland.,Swiss Center for Applied Human Toxicology (SCAHT), University of Geneva, Switzerland
| | - Y Daali
- Clinical Pharmacology and Toxicology Service, Geneva University Hospitals, Switzerland.,School of Pharmaceutical Sciences, Geneva University, Switzerland.,Swiss Center for Applied Human Toxicology (SCAHT), University of Geneva, Switzerland
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24
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Kim MH, Choi SY, An SY, Serebruany V. Validation of Three Platelet Function Tests for Bleeding Risk Stratification During Dual Antiplatelet Therapy Following Coronary Interventions. Clin Cardiol 2016; 39:385-90. [PMID: 27355612 DOI: 10.1002/clc.22540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/29/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although low platelet reactivity (LPR) is commonly detected during bleeding, a validated threshold for reliable DAPT bleeding risk stratification is lacking. We tested the diagnostic utility of 3 conventional platelet-activity assays to define the predictive value (if any) of LPR for bleeding. HYPOTHESIS We hypothesized whether one of these tests be better than any others for predicting bleeding events. METHODS Patients (n = 800) following drug-eluting stent implantation received DAPT. Bleeding was assessed by Bleeding Academic Research Consortium (BARC) classification and events were collected for 1 year after stenting. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow, and multiple electrode aggregometry (MEA). The LPR values for bleeding event stratification were defined as ≤15% for LTA, ≤139 PRU for VerifyNow, and ≤25 U for MEA. RESULTS Bleeding events occurred in 18 patients (2.3%). All tests distinguished LPR as an independent predictor for bleeding by univariate analysis ([HR]: 5.00, 95% [CI]: 1.8-14.0, P = 0.002 for LTA; HR: 21.3, 95% CI: 6.2-73.0, P < 0.0001 for VerifyNow; and HR: 7.4, 95% CI: 2.2-25.5, P = 0.002 for MEA). Multivariate analysis revealed that only VerifyNow (HR: 11.5, 95% CI: 2.9-45.7, P < 0.0004) remained an independent predictor for bleeding. However, the specificity (81.5%, 60.2%, and 81.7%, respectively) and sensitivity (61.1%, 83.3%, and 83.2%, respectively) of all 3 tests were quite low. CONCLUSIONS Among 3 conventional platelet-activity assays, VerifyNow was better than LTA or MEA for triaging future bleeding risks. However, all 3 tests failed to reliably predict future bleeding.
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Affiliation(s)
- Moo Hyun Kim
- Clinical Trial Center, Dong-A University Hospital, Busan, South Korea.,Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Sun Young Choi
- Clinical Trial Center, Dong-A University Hospital, Busan, South Korea
| | - Soo Yeon An
- Clinical Trial Center, Dong-A University Hospital, Busan, South Korea
| | - Victor Serebruany
- HeartDrug Research Laboratories, Johns Hopkins University, Baltimore, Maryland
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25
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Chinese Herbal Medicine for Aspirin Resistance: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0154897. [PMID: 27153119 PMCID: PMC4859478 DOI: 10.1371/journal.pone.0154897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 04/20/2016] [Indexed: 01/26/2023] Open
Abstract
Objectives To assess the effectiveness and safety of Chinese herbal medicine (CHM) for the treatment of aspirin resistance (AR). Methods A comprehensive research of seven electronic databases was performed for comparative studies evaluating CHM for AR. Two authors independently extracted data and assessed the methodological quality of the included trials using the Cochrane risk of bias tool. Data wasere synthesized by using RevMan 5.3 software. (PROSPERO Registration #CRD42015020182) Results 18 randomized controlled trials (RCTs) involving 1,460 patients were included. 15 RCTs reported significant difference in the reduction of platelet aggregation rate (PAR) induced by adenosine diphosphate (ADP) (P<0.05), and 11 reported significant effect of CHM plus aspirin to reduce PAR induced by arachidonic acid (AA) (P<0.05) compared with aspirin 100mg/d treatment. The pooling data of 3 RCTs showed the thromboxane B2 (TXB2) in patients with CHM plus aspirin versus aspirin were significantly reduced (Random Effect model (RE), Standard Deviation (SD) = -95.93, 95% Confidential Interval (CI)[-118.25,-73.61], P<0.00001). Subgroup analysis showed that TXB2 (Fixed Effect model (FE), SD = -89.23, 95%CI[-121.96,-56.49], P<0.00001) had significant difference in Tongxinluo capsule plus aspirin versus aspirin. 2 RCTs reported the clinical effective rate, and the meta-analysis result showed a significant difference in intervention and control group (FE, Relative Risk (RR) = 1.67, 95%CI[1.15, 2.42], P = 0.007<0.05). In 4 trials, CHM plus aspirin had better effects of reducing the reoccurrence of cerebral infarction than aspirin (FE, RR = 0.24, 95%CI [0.11, 0.49], P<0.0001). And one trial showed that CHM plus aspirin could decrease the National Institutes of Health Stroke Scale (NHISS) score (P<0.05) and increase the Barthel Index (BI) score (P<0.05). 4 trials stated that there were no adverse effects occurred in intervention group, and analysis showed significant difference of CHM or CHM plus aspirin in reducing the occurrence of adverse events (FE, RR = 0.22, 95%CI[0.13, 0.39], P<0.00001). 5 trials claimed that the CHM monotherapy and CHM adjunctive therapy for AR did not add the risk of bleeding (FE, RR = 0.50, 95%CI[0.20, 1.22], P = 0.13>0.05). Conclusions CHM may be effective and safe as an alternative and collaborative therapy for AR. However, the current evidence and potential promising findings should be interpreted with caution due to poor and varying methodological quality of included studies and the heterogeneity of interventions. Thus, further exploration of this strategy with adequately powered RCTs is warranted.
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26
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He M, Liu B, Sun D, Pan Y, Zheng W, Shi J, Zhao S, Dong X, Lu S, Li M, Han Y, Li Y. One-quarter standard-dose ticagrelor better than standard-dose clopidogrel in Chinese patients with stable coronary artery disease: A randomized, single-blind, crossover clinical study. Int J Cardiol 2016; 215:209-13. [PMID: 27128532 DOI: 10.1016/j.ijcard.2016.04.087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 04/11/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Ticagrelor has been demonstrated to provide a more rapid and powerful inhibition of platelet aggregation compared with clopidogrel in coronary artery disease (CAD) patients. In our previous study, we found that half-dose ticagrelor produced similar inhibitory effects on platelet aggregation as standard-dose ticagrelor and exerted significantly stronger effects than clopidogrel in Chinese patients with non-ST-elevation ACS. Therefore, we performed this study to observe the efficacy of one-quarter standard-dose ticagrelor in comparison to standard-dose clopidogrel in Chinese patients with stable CAD. METHODS In a randomized, single-blind, crossover trial, 30 patients with stable CAD were randomized to one-quarter standard-dose ticagrelor (22.5mg BID for 7days) or standard-dose clopidogrel (75mg QD for 7days). Following a 2-week washout period, patients switched regimens. Light transmission aggregometry (LTA) and VerifyNow assay were used to measure platelet function. RESULTS The platelet aggregation rate (PAgR) was obviously lower with ticagrelor than clopidogrel (17.70%±12.67% versus 27.63%±13.10%, P<0.05). The % inhibition levels in the ticagrelor group exhibited significantly greater than that in the clopidogrel group (65.33%±21.31% versus 36.23%±23.01%, P<0.01). PRU values in the ticagrelor group were dramatically lower than that in the clopidogrel group (87.03±51.38 versus 163.77±58.66, P<0.01). High-platelet reactivity (HPR) (≥208 PRU) was 0% with ticagrelor and 16.67% with clopidogrel. CONCLUSIONS One-quarter standard-dose ticagrelor provided greater degree of platelet inhibition than standard-dose clopidogrel in Chinese patients with stable CAD.
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Affiliation(s)
- Meijiao He
- Cardiovascular Department, the First Hospital of Harbin, PR China
| | - Bin Liu
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Danghui Sun
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Yujiao Pan
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Wanbin Zheng
- Cardiovascular Department, the First Hospital of Harbin, PR China
| | - Jing Shi
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Shiqi Zhao
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Xinwen Dong
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Shuang Lu
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Minghui Li
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Yu Han
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Yue Li
- Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China.
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Guo LZ, Kim MH, Kim TH, Park JS, Jin E, Shim CH, Choi SY, Serebruany VL. Comparison of Three Tests to Distinguish Platelet Reactivity in Patients with Renal Impairment during Dual Antiplatelet Therapy. Nephron Clin Pract 2016; 132:191-7. [DOI: 10.1159/000444027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022] Open
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Sakr HI, Alamri HS, Almoghairi AM, Alkhudair AA, AlMasood AS. Prevalence and risk factors of clopidogrel non-response among Saudi patients undergoing coronary angiography. Saudi Med J 2016; 37:166-72. [PMID: 26837400 PMCID: PMC4800916 DOI: 10.15537/smj.2016.2.14263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/03/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of clopidogrel non-response and identify its risk factors among Saudi patients. METHODS This cross-sectional study was conducted at Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia between January and June 2013, to assess the degree of platelet inhibition using the VerifyNow assay (Accumetrics, San Diego, CA, USA) after receiving clopidogrel standard loading dose. Clopidogrel resistance was defined as ≤15% platelet inhibition or greater than 213 P2Y12 reaction units (PRU). RESULTS Three hundred and four patients were included in the study. The mean age was 60.3 ± 11.4 years, and 73% were males. Clopidogrel doses were 300 mg (57%), 600 mg (27%), and 75 mg (16%). All patients used aspirin (81 mg in 94%). Approximately 66% (200/304) showed in vitro clopidogrel non-response, 54% had low platelet inhibitions, and 61% had high post-loading PRU. Using multivariate regression analysis that included all significant characteristics; only diabetes (odds ratio [OR]: 2.36, 95% confidence interval [CI]: 1.30-4.27, p=0.005) and higher preloading PRU (OR: 2.39, 95% CI: 1.40-4.11, p=0.002) remained significantly associated with higher clopidogrel non-response while myocardial infarction (OR: 0.34, 95% CI: 0.15-0.81, p=0.014) remained significantly associated with lower clopidogrel non-response. The associations of morbid obesity and diuretics use with higher clopidogrel non-response were slightly attenuated. CONCLUSION Our findings indicate a high rate of clopidogrel in-vitro non-response among Saudi patients undergoing coronary angiography.
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Affiliation(s)
- Haitham I Sakr
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Gengo F, Westphal ES, Rainka MM, Janda M, Robson MJ, Hourihane JM, Bates V. Platelet response to increased aspirin dose in patients with persistent platelet aggregation while treated with aspirin 81 mg. J Clin Pharmacol 2015; 56:414-21. [DOI: 10.1002/jcph.608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/30/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Fran Gengo
- Dent Neurologic InstituteBuffaloNYUSA
- State University at Buffalo School of Pharmacy and Pharmaceutical SciencesBuffaloNYUSA
| | | | | | - Maria Janda
- State University at Buffalo School of Pharmacy and Pharmaceutical SciencesBuffaloNYUSA
| | - Matthew J. Robson
- Dent Neurologic InstituteBuffaloNYUSA
- Vanderbilt University School of MedicineDepartment of PharmacologyNashvilleTNUSA
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Liu T, Zhang J, Chen X, Feng X, Fu SW, McCaffrey TA, Liu M. Comparison between urinary 11-dehydrothromboxane B2 detection and platelet Light Transmission Aggregometry (LTA) assays for evaluating aspirin response in elderly patients with coronary artery disease. Gene 2015; 571:23-7. [PMID: 26095809 DOI: 10.1016/j.gene.2015.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/19/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
Aspirin is widely used in the primary and secondary prevention of cardiovascular diseases. The aim of our study was to compare between two established methods of aspirin response, urinary 11-dehydrothromboxane B2 (11dhTXB2) and platelet Light Transmission Aggregometry (LTA) assays in elderly Chinese patients with coronary artery disease (CAD), and to investigate the clinical significance of both methods in predicting cardiovascular events. Urinary 11dhTxB2 assay and arachidonic acid-induced (AA, 0.5mg/ml) platelet aggregation by Light Transmission Aggregometry (LTAAA) assay were measured to evaluate aspirin responses. High-on aspirin platelet reactivity (HAPR) was defined as urinary 11dhTxB2>1500pg/mg or AA-induced platelet aggregation≥15.22%-the upper quartile of our enrolled population. The two tests showed a poor correlation for aspirin inhibition (r=0.063) and a poor agreement in classifying HAPR (kappa=0.053). With a mean follow-up time of 12months, cardiovascular events occurred more frequently in HAPR patients who were diagnosed by LTA assay as compared with no-HAPR patients (22.5% versus 10.6%, P=0.039, OR=2.45, 95% CI=1.06-5.63). However, the HAPR status, as determined by urinary 11dTXB2 measurement, did not show a significant correlation with outcomes.
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Affiliation(s)
- Tengfei Liu
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
| | - Jingwei Zhang
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
| | - Xiahuan Chen
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
| | - Xueru Feng
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
| | - Sidney W Fu
- Department of Medicine (Division of Genomic Medicine), The George Washington University School of Medicine and Health Sciences, Washington DC 20037, USA
| | - Timothy A McCaffrey
- Department of Medicine (Division of Genomic Medicine), The George Washington University School of Medicine and Health Sciences, Washington DC 20037, USA
| | - Meilin Liu
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China.
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Hoefer T, Armstrong PC, Finsterbusch M, Chan MV, Kirkby NS, Warner TD. Drug-Free Platelets Can Act as Seeds for Aggregate Formation During Antiplatelet Therapy. Arterioscler Thromb Vasc Biol 2015; 35:2122-33. [PMID: 26272940 PMCID: PMC4587545 DOI: 10.1161/atvbaha.115.306219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/30/2015] [Indexed: 12/27/2022]
Abstract
Supplemental Digital Content is available in the text. Objective— Reduced antiplatelet drug efficacy occurs in conditions of increased platelet turnover, associated with increased proportions of drug-free, that is, uninhibited, platelets. Here, we detail mechanisms by which drug-free platelets promote platelet aggregation in the face of standard antiplatelet therapy. Approach and Results— To model standard antiplatelet therapy, platelets were treated in vitro with aspirin, the P2Y12 receptor blocker prasugrel active metabolite, or aspirin plus prasugrel active metabolite. Different proportions of uninhibited platelets were then introduced. Light transmission aggregometry analysis demonstrated clear positive associations between proportions of drug-free platelets and percentage platelet aggregation in response to a range of platelet agonists. Using differential platelet labeling coupled with advanced flow cytometry and confocal imaging we found aggregates formed in mixtures of aspirin-inhibited platelets together with drug-free platelets were characterized by intermingled platelet populations. This distribution is in accordance with the ability of drug-free platelets to generate thromboxane A2 and so drive secondary platelet activation. Conversely, aggregates formed in mixtures of prasugrel active metabolite–inhibited or aspirin plus prasugrel active metabolite–inhibited platelets together with drug-free platelets were characterized by distinct cores of drug-free platelets. This distribution is consistent with the ability of drug-free platelets to respond to the secondary activator ADP. Conclusions— These experiments are the first to image the interactions of inhibited and uninhibited platelets in the formation of platelet aggregates. They demonstrate that a general population of platelets can contain subpopulations that respond strikingly differently to overall stimulation of the population and so act as the seed for platelet aggregation.
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Affiliation(s)
- Thomas Hoefer
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.)
| | - Paul C Armstrong
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.)
| | - Michaela Finsterbusch
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.)
| | - Melissa V Chan
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.)
| | - Nicholas S Kirkby
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.)
| | - Timothy D Warner
- From The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom (T.H., P.C.A., M.F., M.V.C., T.D.W.); and National Heart and Lung Institute, Imperial College London, London, United Kingdom (N.S.K.).
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Novel whole blood assay for phenotyping platelet reactivity in mice identifies ICAM-1 as a mediator of platelet-monocyte interaction. Blood 2015. [PMID: 26215112 DOI: 10.1182/blood-2015-01-621656] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Testing of platelet function is central to the cardiovascular phenotyping of genetically modified mice. Traditional platelet function tests have been developed primarily for testing human samples and the volumes required make them highly unsuitable for the testing of mouse platelets. This limits research in this area. To address this problem, we have developed a miniaturized whole blood aggregometry assay, based on a readily accessible 96-well plate format coupled with quantification of single platelet depletion by flow cytometric analysis. Using this approach, we observed a concentration-dependent loss of single platelets in blood exposed to arachidonic acid, collagen, U46619 or protease activated receptor 4 activating peptide. This loss was sensitive to well-established antiplatelet agents and genetic manipulation of platelet activation pathways. Observations were more deeply analyzed by flow cytometric imaging, confocal imaging, and measurement of platelet releasates. Phenotypic analysis of the reactivity of platelets taken from mice lacking intercellular adhesion molecule (ICAM)-1 identified a marked decrease in fibrinogen-dependent platelet-monocyte interactions, especially under inflammatory conditions. Such findings exemplify the value of screening platelet phenotypes of genetically modified mice and shed further light upon the roles and interactions of platelets in inflammation.
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Nayak-Rao S. Percutaneous native kidney biopsy in patients receiving antiplatelet agents- is it necessary to stop them routinely? Indian J Nephrol 2015; 25:129-32. [PMID: 26060359 PMCID: PMC4446914 DOI: 10.4103/0971-4065.147374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Percutaneous renal biopsy plays an important role in the investigational approach of the nephrologist. Though the technique and the safety of the procedure has improved over the last two decades it remains an invasive procedure and can be associated with bleeding complications. To minimize the risk of bleeding, it has been the practice of many centers and nephrologists to advise patients receiving antiplatelet agents to discontinue them 5-7 days before planned procedure. This advice is based on opinion and pre-established procedure or norms rather than sound evidence based guidelines. This article aims to be a critical appraisal of this unnecessary and sometimes not so safe practice of routine stoppage of antiplatelet agents prior to kidney biopsy.
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Affiliation(s)
- S Nayak-Rao
- Consultant Nephrologist, Sri Krishna Sevashrama Hospital, Bengaluru, Karnataka, India
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Sheriff J, Girdhar G, Chiu WC, Jesty J, Slepian MJ, Bluestein D. Comparative efficacy of in vitro and in vivo metabolized aspirin in the DeBakey ventricular assist device. J Thromb Thrombolysis 2015; 37:499-506. [PMID: 24043375 DOI: 10.1007/s11239-013-0997-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ventricular assist devices (VADs) are implanted in patients with end-stage heart failure to provide both short- and long-term hemodynamic support. Unfortunately, bleeding and thromboembolic complications due to the severely disturbed, dynamic flow conditions generated within these devices require complex, long-term antiplatelet and anticoagulant therapy. While several studies have examined the effectiveness of one such agent, aspirin, under flow conditions, data comparing the efficacy of in vitro and in vivo metabolized aspirin is lacking. Two sets of studies were conducted in vitro with purified human platelets circulating for 30 min in a flow loop containing the DeBakey VAD (MicroMed Cardiovascular, Houston, TX, USA): (a) 20 μM aspirin was added exogenously in vitro to platelets isolated from aspirin-free subjects, and (b) platelets were obtained from donors 2 h (n = 14) and 20 h (n = 13) after ingestion of 1,000 mg aspirin. Near real-time platelet activation state (PAS) was measured with a modified prothrombinase-based assay. Platelets exposed to aspirin in vitro and in vivo (metabolized) showed 28.2 and 25.3 % reduction in platelet activation rate, respectively, compared to untreated controls. Our results demonstrate that in vitro treatment with antiplatelet drugs such as aspirin is as effective as in vivo metabolized aspirin in testing the effect of reducing shear-induced platelet activation in the VAD. Using the PAS assay provides a practical in vitro alternative to in vivo testing of antiplatelet efficacy, as well as for testing the thrombogenic performance of devices during their research and development.
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Affiliation(s)
- Jawaad Sheriff
- Department of Biomedical Engineering, Stony Brook University, T15-090 Health Sciences Center, Stony Brook, NY, 11794-8151, USA
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Chýlová M, Moťovská Z, Osmančík P, Procházka B, Kalvach P. The effect of different doses and different routes of acetylsalicylic acid administration on platelet aggregation in healthy volunteers and ischemic stroke patients. Transl Stroke Res 2014; 6:160-5. [PMID: 25524214 DOI: 10.1007/s12975-014-0382-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 11/21/2014] [Accepted: 12/05/2014] [Indexed: 11/24/2022]
Abstract
The purpose was to assess the effect of different doses and different routes of acetylsalicylic acid (ASA) administration on platelet aggregation and the comparison between platelet aggregation after the single and the repetitive administration of ASA in healthy individuals and in patients after ischemic stroke. The study group consists of 22 healthy individuals and 30 patients with documented ischemic stroke. Platelet aggregation was measured in healthy individuals: (a) twice before ASA and (b) 2 h after different single doses and different routes of ASA administration-(b1) 500 mg orally, (b2) 500 mg intravenously, and (b3) 100 mg orally. We measured aggregability in healthy individuals after five consecutive days of 100 mg of ASA q.d. and in patients on chronic ASA 100 mg q.d. The VerifyNow was used with results expressed in aspirin reaction units (ARU). In healthy individuals, the dose-(b1) 500 mg orally-reduced the aggregability to mean (SD) 392 (36) ARU (p < 0.001), (b2) 500 mg intravenously to 428 (46) (p < 0.001) and (b3) 100 mg orally to 460 (76) (p < 0.001). The suppression of aggregation after 500 mg was (p = 0.029) higher after the oral compared to intravenous administration, and the same is true for the suppression after single dose of 500 mg orally and 100 mg orally (p = 0.011). Oral dose 100 mg for 5 days in healthy individuals reduced aggregation to 405 (37) and in post-stroke patients to 433 (54). All doses of ASA, both orally and intravenously, have produced a significant reduction of platelet aggregation. Preference of the parenteral to oral application has not been established.
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Affiliation(s)
- Miroslava Chýlová
- Department of Neurology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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36
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Guo LZ, Kim MH, Jin CD, Lee JY, Yi SJ, Park MK, Cho YR, Park TH. Comparison of pharmacodynamics between low dose ticagrelor and clopidogrel after loading and maintenance doses in healthy Korean subjects. Platelets 2014; 26:563-9. [DOI: 10.3109/09537104.2014.959913] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sulfasalazine and its metabolites inhibit platelet function in patients with inflammatory arthritis. Clin Rheumatol 2014; 35:447-55. [DOI: 10.1007/s10067-014-2769-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/21/2014] [Accepted: 08/28/2014] [Indexed: 01/27/2023]
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Abstract
PURPOSE OF REVIEW Haemorrhage from major trauma is a significant cause of death worldwide. The UK Defence Medical Service (UK-DMS) has had significant experience in managing severely injured and shocked trauma casualties over the last decade. This has led to the integration of rotational thromboelastometry (ROTEM) into damage control resuscitation delivered at Camp Bastion Field Hospital in Afghanistan. This review aims to describe the rationale for its use and how its use has evolved by UK-DMS. RECENT FINDINGS Although there is reasonable evidence showing its benefit in cardiac and liver surgery, evidence for its use in trauma is limited. More recent studies and meta-analyses have demonstrated a reduced rate of transfusion and blood loss, but no benefit on mortality. Despite this, there is a growing body of opinion supporting ROTEM use in trauma with European guidelines supporting its use where available. Recent UK-DMS experience has shown that it is a fast, reliable and robust means of identifying transfusion requirements. SUMMARY ROTEM provides a means to rapidly assess coagulation in trauma casualties, allowing targeted use of blood products. It provides information on clot initiation strength and breakdown. However, its use in trauma has still to be fully evaluated.
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Pharmacometabolomics reveals that serotonin is implicated in aspirin response variability. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2014; 3:e125. [PMID: 25029353 PMCID: PMC4120016 DOI: 10.1038/psp.2014.22] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/10/2014] [Indexed: 12/02/2022]
Abstract
While aspirin is generally effective for prevention of cardiovascular disease, considerable variation in drug response exists, resulting in some individuals displaying high on-treatment platelet reactivity. We used pharmacometabolomics to define pathways implicated in variation of response to treatment. We profiled serum samples from healthy subjects pre- and postaspirin (14 days, 81 mg/day) using mass spectrometry. We established a strong signature of aspirin exposure independent of response (15/34 metabolites changed). In our discovery (N = 80) and replication (N = 125) cohorts, higher serotonin levels pre- and postaspirin correlated with high, postaspirin, collagen-induced platelet aggregation. In a third cohort, platelets from subjects with the highest levels of serotonin preaspirin retained higher reactivity after incubation with aspirin than platelets from subjects with the lowest serotonin levels preaspirin (72 ± 8 vs. 61 ± 11%, P = 0.02, N = 20). Finally, ex vivo, serotonin strongly increased platelet reactivity after platelet incubation with aspirin (+20%, P = 4.9 × 10−4, N = 12). These results suggest that serotonin is implicated in aspirin response variability.
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Sevimli S, Karakoyun S, Bakirci EM, Topcu S, Kalkan K, Borekci A, Vançelik S. Impact of -455G/A Polymorphism of the β-Fibrinogen Gene on Platelet Aggregation in Patients With Acute Coronary Syndrome. Clin Appl Thromb Hemost 2014; 20:238-43. [DOI: 10.1177/1076029613508601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We aimed to investigate the association of aspirin and/or clopidogrel low response with −455G/A polymorphism of β-fibrinogen in patients with acute coronary syndrome (ACS). We enrolled 114 consecutive patients (mean age 61 ± 7, 31 female [27.2%], 83 male [72.8%]) with a first ACS. The diagnostic criteria for ACS were based on current guidelines. The -455 G/A β-fibrinogen polymorphism genotype distribution in the patient group was determined as the following: 54.4% GG homozygote, 39.5% GA, and 6.1% AA homozygote. Clopidogrel low response was present in 25 (21.9%) patients, aspirin low response in 21 (18.4%) patients, and dual antiplatelet low response in 9 (7.9%) patients. In our study, no difference was observed in terms of the distribution of -455 G/A β-fibrinogen polymorphism between the groups with and without aspirin and/or clopidogrel or dual antiplatelet low response in the patient group who underwent aspirin and clopidogrel treatment for ACS ( P > .05).
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Affiliation(s)
- Serdar Sevimli
- Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | | | - Eftal Murat Bakirci
- Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Selim Topcu
- Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Abdurrezzak Borekci
- Department of Cardiology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Serhat Vançelik
- Department of Public Health, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Yang Y, Kong D, Wang C, Chen G, Shan F, Qi K, Ma L. Inhibition of platelet activation could decrease thrombotic events in hemodialysis PF4/H antibody-positive patients. Ren Fail 2014; 36:870-6. [PMID: 24665827 DOI: 10.3109/0886022x.2014.899880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Platelet factor 4/heparin (PF4/H) antibody detection is widely used to evaluate the risk of thrombosis in patients undergoing hemodialysis (HD). Most patients who are PF4/H-antibody-positive can survive thrombosis, but the reason has not been clarified. In addition, no valid preventive methods for thrombosis in patients undergoing HD have been confirmed. METHODS A single-center, semi-randomized controlled study was designed. In total, 157 patients fulfilled the inclusion criteria and participated. Patients were first divided according to PF4/H antibody detection and then subdivided randomly according to different anti-platelet agent descriptions. RESULTS (1) PF4/H antibody-positive patients suffered a significantly higher incidence of thrombosis than those who were antibody-negative; (2) PF4/H antibody-positive patients who survived a thrombosis manifested a significantly longer bleeding time and decreased maximum percentage of platelet aggregation inhibition; (3) aspirin and clopidogrel decreased the incidence of thrombosis in PF4/H antibody-positive patients by inhibiting platelet activation. CONCLUSION The PF4/H antibody was effective for prediction of the risk of thrombosis, except in patients with dysfunctional platelets; aspirin manifested effects similar to clopidogrel in terms of prevention of thromboses in PF4/H antibody-positive patients, but costs much less and is therefore recommended.
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Affiliation(s)
- Yang Yang
- Therapeutic Centre of Kidney Diseases, First Affiliated Hospital of Beidaihe Sanatorium of Beijing Military Region , Qinhuangdao, Hebei Province , P.R. China
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Cubero Gómez JM, Navarro Puerto MA, Acosta Martínez J, De Mier Barragán MI, Pérez Santigosa PL, Sánchez Burguillos F, Molano Casimiro F, Pastor Torres L. Assessment methods for aspirin-mediated platelet antiaggregation in type 2 diabetic patients: degree of correlation between 2 point-of-care methods. J Cardiovasc Pharmacol 2014; 64:16-20. [PMID: 24553145 DOI: 10.1097/fjc.0000000000000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS Impaired response to antiplatelet therapy in diabetic patients results in a higher incidence of drug-eluting stent thrombosis. This study determined the prevalence of high on-aspirin (AS) platelet reactivity in type 2 diabetic patients treated with percutaneous coronary intervention (PCI) using the VerifyNow Aspirin Assay (VN) and platelet function analyzer PFA-100 (PFA-100) and analyzed the correlation between both methods. METHODS Type 2 diabetic patients (100) with non-ST-elevation acute coronary syndrome who underwent PCI and Xience V drug-eluting stent implantation were included in this study. After PCI, platelet antiaggregation mediated by acetylsalicylic acid was assessed by VN and PFA-100. The degree of correlation and concordance was then determined. RESULTS When assayed with VN, 7% of the patients were nonresponders to aspirin (aspirin reaction units >550), and when assayed with PFA-10, 41% were nonresponders (closure time <193 seconds). Of the patients, 4% were nonresponders to aspirin according to VN but were sensitive to aspirin according to PFA-100, and 38% were sensitive to aspirin according to VN and nonresponders according to PFA-100. Overall, 55% of the patients were aspirin-sensitive in both methods. The Spearman's coefficient between VN and PFA-100 results was r = 0.09 (P = 0.35). The kappa index value was 0.0062 (P = 0.91). CONCLUSIONS There is no concordance or correlation between the VN and PFA-100 results. Therefore, the use of these analyses should be restricted to clinical research, which limits its application in clinical practice.
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Affiliation(s)
- Jose M Cubero Gómez
- *Department of Cardiology, Hospital Universitario Virgen del Rocio, Seville, Spain; and Departments of †Internal Medicine, ‡Investigation, and §Cardiology, Hospital Universitario Virgen de Valme, Seville, Spain
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Abstract
Aspirin (acetylsalicylic acid) is one of the main therapeutic medications used in the prevention of thromboembolic vascular events. Aspirin exhibits its antiplatelet action by irreversibly inhibiting platelet cyclooxygenase-1 enzyme, thus preventing the production of thromboxane A2 (TXA2). Aspirin resistance, as measured in vitro, is the inability of aspirin to reduce platelet activation and aggregation by failure to suppress the platelet production of TXA2. Laboratory tests of platelet TXA2 production or platelet function dependent on TXA2 can detect aspirin resistance in vitro. The clinical implication of this laboratory definition has not yet been elucidated via prospective trials that have controlled for confounders, such as hypertension, diabetes and dyslipidemia. Large meta-analyses have found low-dose aspirin to be as effective as high-dose aspirin in preventing vascular events, making a dose-dependent improvement in laboratory response clinically irrelevant. Possible causes of aspirin resistance include poor compliance, inadequate dose, drug interactions, genetic polymorphisms of cyclooxygenase-1, increased platelet turnover and upregulation of non-platelet pathways of thromboxane production. However, there is currently no standardized approach to the diagnosis and no proven effective treatment for aspirin resistance. Further research exploring the mechanisms of aspirin resistance is needed in order to better define aspirin resistance, as well as to develop a standardized laboratory test that is specific and reliable, and can correlate with the clinical risk of vascular events. The intent of this paper is to review the literature discussing possible mechanisms, diagnostic testing and clinical trials of aspirin resistance and to discuss its clinical relevance as it pertains to cerebrovascular and cardiovascular disease.
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Affiliation(s)
- Darshana Patel
- Department of Neurlogy, University of Massachusetts Memorial Medical Center, Worcester, MA 01655, USA.
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P V K, Kumar C U, J C S, P U, E C. Effect of Oral Anti-platelet Regimens on Platelet Aggregation using Chronolog Light Transmittance Aggregometry in Coronary Heart Disease Patients: An Observational Study. J Clin Diagn Res 2014; 7:2478-82. [PMID: 24392377 DOI: 10.7860/jcdr/2013/6884.3584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/12/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Coronary heart disease is one of the most common cardiac health problem in India. Anti-platelet therapy is the cornerstone in the management of coronary heart disease. The current study was undertaken to compare the effect of different oral anti-platelet regimens on percentage inhibition of platelet aggregation in coronary heart disease patients using chronolog light transmittance aggregometry. MATERIAL AND METHODS Blood samples of 215 consecutive patients diagnosed of coronary heart disease (Male: Female ratio- 142: 73) with mean age of 55.2 ±10.3 years, who underwent platelet aggregation test were analysed. Patients were either on aspirin, clopidogrel, prasugrel, cilostazol or a combination of these drugs in different dosages. Of the 215 coronary heart disease patients, 35, 115 and 65 patients were on single, dual and triple anti-platelet drug regimen respectively. RESULTS The Percentage Inhibition of Platelet Aggregation (%IPA) in patients on dual anti-platelet regimen was highest i.e., 65.14 ± 23.23 as compared to 48.89 ± 22.16 in patients on monotherapy and 62.14 ± 21.64 in patients on triple anti-platelet regimen. Percentage of responders (> 40% inhibition of platelet aggregation) were 54.28%, 73.91% and 64.61% in single, dual and triple drug regimens respectively. Among responders on dual anti-platelet regimen, 64.7% were on aspirin + prasugrel and 35.3% were on aspirin + clopidogrel. The Percentage Inhibition of platelet aggregation in diabetics on dual anti-platelet regimen was 71.69 ± 17.54 as compared to 56.14 ± 23.29 in diabetics on triple anti-platelet regimen. CONCLUSION Dual anti-platelet therapy containing prasugrel was found to be more effective than dual anti-platelet therapy containing clopidogrel on background aspirin therapy and triple anti-platelet therapy in terms of percentage inhibition of platelet aggregation in coronary heart disease patients especially those with concomitant diabetes, however this conclusion needs to be further confirmed by large-scale randomized clinical trials.
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Affiliation(s)
- Kishan P V
- DM Residents, Clinical Pharmacology & Therapeutics, Nizam's Institute of Medical Sciences , Panjagutta, Hyderabad, India
| | - Uday Kumar C
- DM Residents, Clinical Pharmacology & Therapeutics, Nizam's Institute of Medical Sciences , Panjagutta, Hyderabad, India
| | - Shobha J C
- Professor & HOD, Clinical Pharmacology & Therapeutics, Nizam's Institute of Medical Sciences , Panjagutta, Hyderabad, India
| | - Usharani P
- Additional Professor, Clinical Pharmacology & Therapeutics, Nizam's Institute of Medical Sciences , Panjagutta, Hyderabad, India
| | - Chandrasekhar E
- Lab Analyst, Clinical Pharmacology & Medical Research Laboratory, Nizam's Institute of Medical Sciences , Panjagutta, Hyderabad, India
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Affiliation(s)
- Matthew D. Linden
- The Centre for Microscopy; Characterisation and Analysis; The University of Western Australia; Nedlands WA 6009 Australia
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Dharmasaroja PA, Sae-Lim S. Comparison of aspirin response measured by urinary 11-dehydrothromboxane B2 and VerifyNow aspirin assay in patients with ischemic stroke. J Stroke Cerebrovasc Dis 2013; 23:953-7. [PMID: 24126290 DOI: 10.1016/j.jstrokecerebrovasdis.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/01/2013] [Accepted: 08/08/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We looked for the prevalence of aspirin nonresponders, compared the results of 2 tests assessing aspirin responses-measurement of urinary 11-dehydrothromboxane B2 (dTXB2) and VerifyNow Aspirin assay-in patients with ischemic stroke, and examined the relationship of aspirin nonresponse and the outcomes of the patients. METHODS One hundred one patients with ischemic stroke were prospectively included. Aspirin response was assessed by urinary dTXB2 measurement and VerifyNow Aspirin assay. The Spearman correlation coefficients and kappa statistics were calculated to assess correlation and agreement between the 2 tests. The measured outcome was the occurrence of cardiovascular events and death. RESULTS Prevalence of aspirin nonresponders was 40% and 6%, if they were measured by urinary dTXB2 and VerifyNow Aspirin assay, respectively. Poor correlation in the results between the 2 tests was found (r = .135, P = .190). The degree of agreement between the 2 tests in relation to resistance status was weak (kappa = .032, P = .590). With a mean follow-up time of 17 months, the outcomes occurred significantly higher in aspirin nonresponders who were diagnosed by urinary dTXB2 measurement as compared with patients with aspirin response (18% versus 2%, odds ratio 8.8, 95% confidence interval 1.18-65.4, P = .037). CONCLUSIONS Our research confirmed poor correlation and lack of agreement between the 2 tests. Only aspirin nonresponders who were diagnosed by dTXB2 measurement were related to having cardiovascular events and death. Further research is still needed to identify the best method of diagnosis of aspirin nonresponders.
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Affiliation(s)
- Pornpatr A Dharmasaroja
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
| | - Suvaraporn Sae-Lim
- Research Unit, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Weigand A, Boos AM, Ringwald J, Mieth M, Kneser U, Arkudas A, Bleiziffer O, Klumpp D, Horch RE, Beier JP. New aspects on efficient anticoagulation and antiplatelet strategies in sheep. BMC Vet Res 2013; 9:192. [PMID: 24088206 PMCID: PMC3851128 DOI: 10.1186/1746-6148-9-192] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 09/26/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND After addressing fundamental questions in preclinical models in vitro or in small animals in vivo, the translation into large animal models has become a prerequisite before transferring new findings to human medicine. Especially in cardiovascular, orthopaedic and reconstructive surgery, the sheep is an important in vivo model for testing innovative therapies or medical devices prior to clinical application. For a wide variety of sheep model based research projects, an optimal anticoagulation and antiplatelet therapy is mandatory. However, no standardised scheme for this model has been developed so far. Thus the efficacy of antiplatelet (acetylsalicylic acid, clopidogrel, ticagrelor) and anticoagulant (sodium enoxaparin, dabigatran etexilate) strategies was evaluated through aggregometry, anti-factor Xa activity and plasma thrombin inhibitor levels in sheep of different ages. RESULTS Responses to antiplatelet and anticoagulant drugs in different concentrations were studied in the sheep. First, a baseline for the measurement of platelet aggregation was assessed in 20 sheep. The effectiveness of 225 mg clopidogrel twice daily (bid) in 2/5 sheep and 150 mg bid in 3/5 lambs could be demonstrated, while clopidogrel and its metabolite carboxylic acid were detected in every plasma sample. High dose ticagrelor (375 mg bid) resulted in sufficient inhibition of platelet aggregation in 1/5 sheep, while acetylsalicylic acid did not show any antiplatelet effect. Therapeutic anti-factor Xa levels were achieved with age-dependent dosages of sodium enoxaparin (sheep 3 mg/kg bid, lambs 5 mg/kg bid). Administration of dabigatran etexilate resulted in plasma concentrations similar to human ranges in 2/5 sheep, despite receiving quadruple dosages (600 mg bid). CONCLUSION High dosages of clopidogrel inhibited platelet aggregation merely in a low number of sheep despite sufficient absorption. Ticagrelor and acetylsalicylic acid cannot be recommended for platelet inhibition in sheep. Efficient anticoagulation can be ensured using sodium enoxaparin rather than dabigatran etexilate in age-dependent dosages. The findings of this study significantly contribute to the improvement of a safe and reliable prophylaxis for thromboembolic events in sheep. Applying these results in future translational experimental studies may help to avoid early dropouts due to thromboembolic events and associated unnecessary high animal numbers.
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Affiliation(s)
- Annika Weigand
- Department of Plastic and Hand Surgery, University Hospital of Erlangen Friedrich-Alexander University of Erlangen-Nürnberg, Krankenhausstr, 12, Erlangen D-91054, Germany.
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Kinsella JA, Tobin WO, Cox D, Coughlan T, Collins R, O’Neill D, Murphy RP, McCabe DJ. Prevalence of Ex Vivo High On-treatment Platelet Reactivity on Antiplatelet Therapy after Transient Ischemic Attack or Ischemic Stroke on the PFA-100® and VerifyNow®. J Stroke Cerebrovasc Dis 2013; 22:e84-92. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 07/12/2012] [Accepted: 07/13/2012] [Indexed: 11/29/2022] Open
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Zhang HZ, Kim MH, Jeong YH. Predictive values of post-clopidogrel platelet reactivity assessed by different platelet function tests on ischemic events in East Asian patients treated with PCI. Platelets 2013; 25:292-9. [PMID: 23971791 DOI: 10.3109/09537104.2013.815341] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract An accumulating number of studies are revealing that platelet reactivity above specific cut-off scores leads to exponentially increased rates of post-percutaneous coronary intervention (PCI) ischemic events. To evaluate the optimal predictive values for three different platelet function measurement assays of platelet reactivity on early clinical outcomes in Korean patients undergoing PCI, we enrolled 228 patients receiving clopidogrel prior to PCI. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow P2Y12 assay, and multiple electrode platelet aggregometry (MEA). The primary endpoint was the 30-day occurrence of ischemic events after PCI. MACE occurred in 36 patients (15.8%), including 35 patients (15.4%) with periprocedural MI and the death of one patient (0.4%). ADP-induced LTA and VerifyNow values (pre- and post-PCI) were significantly higher in patients with the subsequent occurrence of periprocedural MI, but the MEA assay data (PCI and post-PCI) displayed no significant differences (pre-PCI p=0.25 and post-PCI p=0.33). ROC curve analysis demonstrated HPR values for LTA (pre-PCI, >66% and post-PCI, >53 %, all p<0.001), VerifyNow (pre-PCI, >347 PRU and post-PCI >272 PRU, all p<0.001) and MEA (pre-PCI, >50 U and post-PCI >39 U, all p>0.05). The platelet reactivity measurements by LTA and the VerifyNow assay can discriminate the risk of 30-day ischemic events after PCI. The predictive cut-off values for adverse events are dependent on sampling time.
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Affiliation(s)
- Hong-Zhe Zhang
- Department of Cardiology, Dong-A University Hospital , Busan , South Korea
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Chronic kidney disease is associated with increased platelet activation and poor response to antiplatelet therapy. Nephrol Dial Transplant 2013; 28:2116-22. [DOI: 10.1093/ndt/gft103] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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