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Yu R, Yu Q, Li Z, Li J, Yang J, Hu Y, Zheng N, Li X, Song Y, Li J, Chen X, Du W, Su J. Transcriptome-wide map of N6-methyladenosine (m6A) profiling in coronary artery disease (CAD) with clopidogrel resistance. Clin Epigenetics 2023; 15:194. [PMID: 38098098 PMCID: PMC10722764 DOI: 10.1186/s13148-023-01602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Clopidogrel resistance profoundly increases the risk of major cardiovascular events in coronary artery disease (CAD) patients. Here, we comprehensively analyse global m6A modification alterations in clopidogrel-resistant (CR) and non-CR patients. METHODS After RNA isolation, the RNA transcriptome expression (lncRNA, circRNA, and mRNA) was analysed via RNA-seq, and m6A peaks were identified by MeRIP-seq. The altered m6A methylation sites on mRNAs, lncRNAs, and circRNAs were identified, and then, GO and KEGG pathway analyses were performed. Through joint analysis with RNA-seq and MeRIP-seq data, differentially expressed mRNAs harbouring differentially methylated sites were identified. The changes in m6A regulator levels and the abundance of differentially methylated sites were measured by RT-PCR. The identification of m6A-modified RNAs was verified by m6A-IP-qPCR. RESULTS The expression of 2919 hypermethylated and 2519 hypomethylated mRNAs, 192 hypermethylated and 391 hypomethylated lncRNAs, and 375 hypermethylated and 546 hypomethylated circRNAs was shown to be altered in CR patients. The m6A peaks related to CR indicated lower mark density at the CDS region. Functional enrichment analysis revealed that inflammatory pathways and insulin signalling pathways might be involved in the pathological processes underlying CR. The expression of mRNAs (ST5, KDM6B, GLB1L2, and LSM14B), lncRNAs (MSTRG.13776.1 and ENST00000627981.1), and circRNAs (hsa_circ_0070675_CBC1, hsa-circRNA13011-5_CBC1, and hsa-circRNA6406-3_CBC1) was upregulated in CR patients, while the expression of mRNAs (RPS16 and CREG1), lncRNAs (MSTRG.9215.1), and circRNAs (hsa_circ_0082972_CBC1) was downregulated in CR patients. Moreover, m6A regulators (FTO, YTHDF3, and WTAP) were also differentially expressed. An additional combined analysis of gene expression and m6A peaks revealed that the expression of mRNAs (such as ST5, LYPD2, and RPS16 mRNAs) was significantly altered in the CR patients. CONCLUSION The expression of m6A regulators, the RNA transcriptome, and the m6A landscape was altered in CR patients. These findings reveal epitranscriptomic regulation in CR patients, which might be novel therapeutic targets in future.
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Affiliation(s)
- Ruoyan Yu
- Department of Cardiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, People's Republic of China
| | - Qinglin Yu
- Department of Traditional Chinese Internal Medicine, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China
| | - Zhenwei Li
- Department of Cardiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, People's Republic of China
| | - Jiyi Li
- Department of Cardiology, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, People's Republic of China
| | - Jin Yang
- Department of Geriatrics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China
| | - Yingchu Hu
- Department of Cardiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, People's Republic of China
| | - Nan Zheng
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, People's Republic of China
| | - Xiaojin Li
- Department of Geriatrics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China
| | - Yudie Song
- Department of Cardiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China
| | - Jiahui Li
- Department of Cardiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China
| | - Xiaomin Chen
- Department of Cardiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China.
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, People's Republic of China.
| | - Weiping Du
- Department of Cardiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China.
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, People's Republic of China.
| | - Jia Su
- Department of Cardiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People's Republic of China.
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, People's Republic of China.
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Heart Lung Transplant 2023; 42:e1-e64. [PMID: 36805198 DOI: 10.1016/j.healun.2022.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Card Fail 2023; 29:304-374. [PMID: 36754750 DOI: 10.1016/j.cardfail.2022.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Li J, Yang J, Yu Q, Chen L, Shi X, Su J, Zhu K. The DNAm levels of CREB5 (cg11301281) were associated with clopidogrel resistance. J Clin Lab Anal 2022; 36:e24690. [PMID: 36087301 PMCID: PMC9550965 DOI: 10.1002/jcla.24690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/06/2022] [Accepted: 08/24/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose Clopidogrel resistance (CR) is mostly caused by interindividual variability of the platelet inhibition of clopidogrel, which may induce cardiovascular events. The aim of this research was to evaluate whether DNAm levels of CREB5 (cg01534253) are involved in CR among acute coronary syndrome (ACS) patients treated with clopidogrel. Methods 72 patients(36 CR and 36 non‐CR) who underwent ACS were included in this study. The VerifyNow P2Y12 assay was selected to evaluate residual platelet reactivity, and bisulfite pyrosequencing methods was used to examine DNA methylation levels on cg01534253. Secondly, CREB5 mRNA expression was analyzed via quantitative real‐time PCR. Last, we employed logistic regression to test the interaction between genetic factors of CREB5 methylation and multiple clinical variables in CR patients. Results Subunit analysis indicated that for patients whose HbA1c levels were ≥6.5% or whose GLU levels were ≥7 mmol/L, lower methylation of cg01534253 indicated a poorer clopidogrel response. In addition, CREB5 mRNA expression was increased in CR patients with GLU levels ≥7 mmol/L. Moreover, regression analysis indicated that the values of albumin and uric acid were correlated with the incidence of CR. Conclusions Our findings were likely to provide fresh understanding for the new mechanism of platelet inhibition failure and promote individualized antiplatelet therapy.
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Affiliation(s)
- Jiyi Li
- Department of Cardiology, Yuyao People's Hospital of Zhejiang Province, Ningbo, China
| | - Jin Yang
- Department of Cardiology, Ningbo, China
| | - Qinglin Yu
- Department of Traditional Chinese Internal Medicine, Ningbo, China
| | - Lian Chen
- Department of Cardiology, Yuyao People's Hospital of Zhejiang Province, Ningbo, China
| | - Xiliang Shi
- Department of Cardiology, Yuyao People's Hospital of Zhejiang Province, Ningbo, China
| | - Jia Su
- Department of Cardiology, Ningbo, China
| | - Keqi Zhu
- Department of Traditional Chinese Internal Medicine, Ningbo, China
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Mao J, Zhu K, Long Z, Zhang H, Xiao B, Xi W, Wang Y, Huang J, Liu J, Shi X, Jiang H, Lu T, Wen Y, Zhang N, Meng Q, Zhou H, Ruan Z, Wang J, Luo C, Xi X. Targeting the RT loop of Src SH3 in Platelets Prevents Thrombosis without Compromising Hemostasis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2103228. [PMID: 35023301 PMCID: PMC8895158 DOI: 10.1002/advs.202103228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/30/2021] [Indexed: 05/05/2023]
Abstract
Conventional antiplatelet agents indiscriminately inhibit both thrombosis and hemostasis, and the increased bleeding risk thus hampers their use at more aggressive dosages to achieve adequate effect. Blocking integrin αIIbβ3 outside-in signaling by separating the β3/Src interaction, yet to be proven in vivo, may nonetheless resolve this dilemma. Identification of a specific druggable target for this strategy remains a fundamental challenge as Src SH3 is known to be responsible for binding to not only integrin β3 but also the proteins containing the PXXP motif. In vitro and in vivo mutational analyses show that the residues, especially E97, in the RT loop of Src SH3 are critical for interacting with β3. DCDBS84, a small molecule resulting from structure-based virtual screening, is structurally validated to be directed toward the projected target. It specifically disrupts β3/Src interaction without affecting canonical PXXP binding and thus inhibits the outside-in signaling-regulated platelet functions. Treatment of mice with DCDBS84 causes a profound inhibition of thrombosis, equivalent to that induced by extremely high doses of αIIbβ3 antagonist, but does not compromise primary hemostasis. Specific targets are revealed for a preferential inhibition of thrombosis that may lead to new classes of potent antithrombotics without hemorrhagic side effects.
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Affiliation(s)
- Jianhua Mao
- State Key Laboratory of Medical GenomicsShanghai Institute of HematologyCollaborative Innovation Center of HematologyRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China
| | - Kongkai Zhu
- Drug Discovery and Design Centerthe Center for Chemical BiologyState Key Laboratory of Drug ResearchShanghai Institute of Materia MedicaChinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghai201203China
| | - Zhangbiao Long
- State Key Laboratory of Medical GenomicsShanghai Institute of HematologyCollaborative Innovation Center of HematologyRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China
| | - Huimin Zhang
- Drug Discovery and Design Centerthe Center for Chemical BiologyState Key Laboratory of Drug ResearchShanghai Institute of Materia MedicaChinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghai201203China
- School of Life Science and TechnologyShanghai Tech UniversityShanghai201210China
| | - Bing Xiao
- State Key Laboratory of Medical GenomicsShanghai Institute of HematologyCollaborative Innovation Center of HematologyRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China
| | - Wenda Xi
- Shanghai Institute of HypertensionRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China
| | - Yun Wang
- State Key Laboratory of Medical GenomicsShanghai Institute of HematologyCollaborative Innovation Center of HematologyRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China
| | - Jiansong Huang
- State Key Laboratory of Medical GenomicsShanghai Institute of HematologyCollaborative Innovation Center of HematologyRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China
| | - Jingqiu Liu
- Drug Discovery and Design Centerthe Center for Chemical BiologyState Key Laboratory of Drug ResearchShanghai Institute of Materia MedicaChinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghai201203China
| | - Xiaofeng Shi
- State Key Laboratory of Medical GenomicsShanghai Institute of HematologyCollaborative Innovation Center of HematologyRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China
| | - Hao Jiang
- Drug Discovery and Design Centerthe Center for Chemical BiologyState Key Laboratory of Drug ResearchShanghai Institute of Materia MedicaChinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghai201203China
| | - Tian Lu
- Drug Discovery and Design Centerthe Center for Chemical BiologyState Key Laboratory of Drug ResearchShanghai Institute of Materia MedicaChinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghai201203China
| | - Yi Wen
- Drug Discovery and Design Centerthe Center for Chemical BiologyState Key Laboratory of Drug ResearchShanghai Institute of Materia MedicaChinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghai201203China
| | - Naixia Zhang
- Drug Discovery and Design Centerthe Center for Chemical BiologyState Key Laboratory of Drug ResearchShanghai Institute of Materia MedicaChinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghai201203China
| | - Qian Meng
- Drug Discovery and Design Centerthe Center for Chemical BiologyState Key Laboratory of Drug ResearchShanghai Institute of Materia MedicaChinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghai201203China
| | - Hu Zhou
- Drug Discovery and Design Centerthe Center for Chemical BiologyState Key Laboratory of Drug ResearchShanghai Institute of Materia MedicaChinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghai201203China
| | - Zheng Ruan
- State Key Laboratory of Medical GenomicsShanghai Institute of HematologyCollaborative Innovation Center of HematologyRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China
| | - Jin Wang
- State Key Laboratory of Medical GenomicsShanghai Institute of HematologyCollaborative Innovation Center of HematologyRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China
| | - Cheng Luo
- Drug Discovery and Design Centerthe Center for Chemical BiologyState Key Laboratory of Drug ResearchShanghai Institute of Materia MedicaChinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghai201203China
- School of Life Science and TechnologyShanghai Tech UniversityShanghai201210China
- School of Pharmaceutical Science and TechnologyHangzhou Institute for Advanced StudyUCASHangzhou310024China
| | - Xiaodong Xi
- State Key Laboratory of Medical GenomicsShanghai Institute of HematologyCollaborative Innovation Center of HematologyRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025China
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Zhong H, Waresi M, Zhang W, Han L, Zhao Y, Chen Y, Zhou P, Chang L, Pan G, Wu B, Li J, Zhang S, Shi H, Luo X, Gao W, Qi Z, Ding Z. NOD2-mediated P2Y 12 upregulation increases platelet activation and thrombosis in sepsis. Biochem Pharmacol 2021; 194:114822. [PMID: 34748820 DOI: 10.1016/j.bcp.2021.114822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/14/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Platelets from septic patients exhibit increased reactivity. However, the underlying mechanism of sepsis-induced platelet hyperactivity is still not completely understood. OBJECTIVE P2Y12 is a central receptor for platelet activation. In this study, we investigated the role of platelet P2Y12 in platelet hyperactivity during sepsis. METHODS We measured platelet P2Y12 expression and aggregation in response to ADP in septic patients and cecal ligation and puncture (CLP)-treated mice. We also detected the downstream signaling of P2Y12 in resting platelets from patients and mice with sepsis. The role of nucleotide-binding oligomerization domain 2 (NOD2)/RIP2/NF-κB/P65 pathway in sepsis-induced platelet P2Y12 high expression was also investigated. Finally, we compared the antiplatelet and antithrombotic effects of clopidogrel, prasugrel, and ticagrelor in experimental sepsis in mice and rats. RESULTS Compared to healthy subjects, platelets from septic patients exhibit P2Y12 hyperactivity and higher P2Y12 expression. pAkt is enhanced and pVASP is impaired in resting platelets from the patients, indicating the constitutive activation of platelet P2Y12 receptor. Mouse sepsis model recapitulates the findings in septic patients. NOD2 deficiency attenuates sepsis-induced platelet P2Y12 high expression, hyperactivity, and thrombosis. Prasugrel and ticagrelor are potent P2Y12 inverse agonists, and exhibit superior antiplatelet and antithrombotic efficacy over clopidogrel in mice and rats with sepsis. CONCLUSIONS NOD2 activation upregulates platelet P2Y12 expression, which is constitutively activated and contributes to platelet hyperactivity in septic status. Compared to clopidogrel, prasugrel and ticagrelor are potent P2Y12 inverse agonists with superior antiplatelet and antithrombotic efficacy in experimental sepsis.
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Affiliation(s)
- Haoxuan Zhong
- Department of Cardiology, Huashan Hospital, Fudan University. Shanghai, China
| | - Maieryemu Waresi
- Department of Cardiology, Huashan Hospital, Fudan University. Shanghai, China
| | - Wei Zhang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Liping Han
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yikai Zhao
- Department of Cardiology, Huashan Hospital, Fudan University. Shanghai, China
| | - Yufei Chen
- Department of Cardiology, Huashan Hospital, Fudan University. Shanghai, China
| | - Peng Zhou
- Department of Cardiology, Huashan Hospital, Fudan University. Shanghai, China
| | - Lin Chang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Guanxing Pan
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Bangwei Wu
- Department of Cardiology, Huashan Hospital, Fudan University. Shanghai, China
| | - Jian Li
- Department of Cardiology, Huashan Hospital, Fudan University. Shanghai, China
| | - Si Zhang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Haiming Shi
- Department of Cardiology, Huashan Hospital, Fudan University. Shanghai, China
| | - Xinping Luo
- Department of Cardiology, Huashan Hospital, Fudan University. Shanghai, China
| | - Wen Gao
- Department of Cardiology, Huashan Hospital, Fudan University. Shanghai, China.
| | - Zhiyong Qi
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
| | - Zhongren Ding
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China; School of Pharmacy, Tianjin Medical University, Tianjin, China.
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Novel serotonin 5-HT 2A receptor antagonists derived from 4-phenylcyclohexane-5-spiro-and 5-methyl-5-phenyl-hydantoin, for use as potential antiplatelet agents. Pharmacol Rep 2021; 73:1361-1372. [PMID: 34115343 PMCID: PMC8460535 DOI: 10.1007/s43440-021-00284-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Antiplatelet drugs have been used in the treatment of acute coronary syndromes and for the prevention of recurrent events. Unfortunately, many patients remain resistant to the available antiplatelet treatment. Therefore, there is a clinical need to synthesize novel antiplatelet agents, which would be associated with different pathways of platelet aggregation, to develop an alternative or additional treatment for resistant patients. Recent studies have revealed that 5-HT2A receptor antagonists could constitute alternative antiplatelet therapy. METHODS Based on the structures of the conventional 5-HT2A receptor ligands, two series of compounds with 4-phenylcyclohexane-5-spiro- or 5-methyl-5-phenyl-hydantoin core linked to various arylpiperazine moieties were synthesized and their affinity for 5-HT2A receptor was assessed. Further, we evaluated their antagonistic potency at 5-HT2A receptors using isolated rat aorta and cells expressing human 5-HT2A receptors. Finally, we studied their anti-aggregation effect and compared it with ketanserin and sarpogrelate, the reference 5-HT2A receptor antagonists. Moreover, the structure-activity relationships were studied following molecular docking to the 5-HT2A receptor model. RESULTS Functional bioassays revealed some of the synthesized compounds to be moderate antagonists of 5-HT2A receptors. Among them, 13, 8-phenyl-3-(3-(4-phenylpiperazin-1-yl)propyl)-1,3-diazaspiro[4.5]decane-2,4-dione, inhibited collagen stimulated aggregation (IC50 = 27.3 μM) being more active than sarpogrelate (IC50 = 66.8 μM) and comparable with ketanserin (IC50 = 32.1 μM). Moreover, compounds 2-5, 9-11, 13, 14 inhibited 5-HT amplified, ADP- or collagen-induced aggregation. CONCLUSIONS Our study confirmed that the 5-HT2A antagonists effectively suppress platelet aggregation and remain an interesting option for the development of novel antiplatelet agents with an alternative mechanism of action.
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Kim S, Han D, Choi JH, Park EJ, Shin DG, Kang MK, Choi S, Lee N, Cho JR. Clinical significance of high on-treatment platelet reactivity in patients with prolonged clopidogrel therapy. Korean J Intern Med 2021; 36:S80-S89. [PMID: 32872739 PMCID: PMC8009166 DOI: 10.3904/kjim.2020.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Prolonged dual antiplatelet therapy (DAPT) with aspirin and clopidogrel beyond 1 year has been shown to reduce ischemic events at the expense of increased bleeding. However, limited data are available on the clinical significance of platelet reactivity (PR) at 1 year. METHODS We retrospectively identified 331 patients who underwent percutaneous coronary intervention (PCI) and assessed the on-clopidogrel PR using VerifyNow P2Y12 assay at 1 year in a single center. Two hundred eleven patients were on DAPT for > 1 year. The relationship between high on-treatment platelet reactivity (HPR) at 1 year and clinical outcomes beyond 1 year, as well as the longitudinal change in PR was analyzed. RESULTS At 1 year, 135 (64%) patients showed HPR and 76 (36%) did not. There was a significant increase in ischemic endpoint events, including cardiovascular death, non-fatal myocardial infarction, and stroke/transient ischemic attack in patients with compared to without HPR at 1 year (hazard ratio [HR], 2.68; 95% confidence interval [CI], 1.06 to 6.77; p = 0.036). However, the incidence of any Bleeding Academic Research Consortium bleeding was significantly lower in the HPR group (HR, 0.11; 95% CI, 0.02 to 0.65; p = 0.015). In the longitudinal analysis, PR significantly decreased from post-load to 1 year after index PCI in the non-HPR group. Conversely, the HPR group showed high PR from baseline through 1 year. CONCLUSION HPR at 1 year may be a useful surrogate for predicting ischemic and bleeding events in patients on prolonged DAPT. Patients with and without HPR at 1 year showed different patterns of longitudinal change in PR.
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Affiliation(s)
- Sehun Kim
- Division of Cardiology, Department of Internal Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
| | - Donghoon Han
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jae Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Eun-Joo Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Dong Geum Shin
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Min-Kyung Kang
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Namho Lee
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jung Rae Cho
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Correspondence to Jung Rae Cho, M.D. Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea Tel: +82-2-829-5393 Fax: +82-2-849-4469 E-mail:
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9
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Yang J, Yu Q, Xu Z, Zheng N, Zhong J, Li J, Liu Y, Xu H, Su J, Ji L, Chen X. Clopidogrel Resistance Is Associated With DNA Methylation of Genes From Whole Blood of Humans. Front Genet 2021; 11:583215. [PMID: 33519892 PMCID: PMC7844369 DOI: 10.3389/fgene.2020.583215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/26/2020] [Indexed: 12/31/2022] Open
Abstract
Antiplatelet therapy has become a cornerstone in the treatment of coronary heart disease (CHD). However, due to high-residual-platelet-reactivity, clopidogrel resistance (CR) is a common phenomenon, and it is rarely known about the relationship between CR and epigenetic changes. This study compared the whole genomic methylation patterns of blood samples from patients with CR (n = 6) and non-CR (n = 6) with the Human Methylation 850K BeadChip assay. We explored differentially methylated CpG sites, genes, and pathways using bioinformatics profiling. The CR and control groups showed significantly different DNA methylation at 7,098 sites, with 979 sites showing hypermethylation and 6,119 sites showing hypomethylation. The pyrosequencing method was used to validate four differentially methylated CpG loci (cg23371584, cg15971518, cg04481923, cg22507406), confirming that DNA methylation was associated with the risk of CR (30 CR vs. 30 non-CR). The relative mRNA expression of the four genes (BTG2, PRG2, VTRNA2-1, PER3) corresponding to the loci above was also associated with CR, suggesting that alterations in DNA methylation may affect the expression of these four genes, eventually resulting in CR. Additionally, differentially methylated sites are partially related to genes and pathways that play key roles in process of circadian entrainment, insulin secretion, and so on. Hence, the mechanism and biological regulation of CR might be reflected through these epigenetic alterations, but future research will need to address the causal relationships.
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Affiliation(s)
- Jin Yang
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, China
| | - Qinglin Yu
- Department of Traditional Chinese Internal Medicine, Ningbo No. 1 Hospital, Ningbo, China
| | - Zhifeng Xu
- Department of Cardiology, Zhenhai People's Hospital, Ningbo, China
| | - Nan Zheng
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, China.,Department of Cardiology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinyan Zhong
- Department of Cardiology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiyi Li
- Department of Cardiology, Yuyao People's Hospital of Zhejiang Province, Yuyao, China
| | - Yahui Liu
- Key Laboratory, Ningbo No. 1 Hospital, Ningbo, China
| | - Hongyu Xu
- Department of Gerontology, Ningbo No. 1 Hospital, Ningbo, China
| | - Jia Su
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, China
| | - Lindan Ji
- Department of Biochemistry, School of Medicine, Ningbo University, Ningbo, China
| | - Xiaomin Chen
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, China
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10
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Vranckx P, Valgimigli M, Eckardt L, Tijssen J, Lewalter T, Gargiulo G, Batushkin V, Campo G, Lysak Z, Vakaliuk I, Milewski K, Laeis P, Reimitz PE, Smolnik R, Zierhut W, Goette A. Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial. Lancet 2019; 394:1335-1343. [PMID: 31492505 DOI: 10.1016/s0140-6736(19)31872-0] [Citation(s) in RCA: 409] [Impact Index Per Article: 81.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND We aimed to assess the safety of edoxaban in combination with P2Y12 inhibition in patients with atrial fibrillation who had percutaneous coronary intervention (PCI). METHODS ENTRUST-AF PCI was a randomised, multicentre, open-label, non-inferiority phase 3b trial with masked outcome evaluation, done at 186 sites in 18 countries. Patients had atrial fibrillation requiring oral anticoagulation, were aged at least 18 years, and had a successful PCI for stable coronary artery disease or acute coronary syndrome. Participants were randomly assigned (1:1) from 4 h to 5 days after PCI using concealed, stratified, and blocked web-based central randomisation to either edoxaban (60 mg once daily) plus a P2Y12 inhibitor for 12 months or a vitamin K antagonist (VKA) in combination with a P2Y12 inhibitor and aspirin (100 mg once daily, for 1-12 months). The edoxaban dose was reduced to 30 mg per day if one or more factors (creatinine clearance 15-50 mL/min, bodyweight ≤60 kg, or concomitant use of specified potent P-glycoprotein inhibitors) were present. The primary endpoint was a composite of major or clinically relevant non-major (CRNM) bleeding within 12 months. The primary analysis was done in the intention-to-treat population and safety was assessed in all patients who received at least one dose of their assigned study drug. This trial is registered with ClinicalTrials.gov, NCT02866175, is closed to new participants, and follow-up is completed. FINDINGS From Feb 24, 2017, through May 7, 2018, 1506 patients were enrolled and randomly assigned to the edoxaban regimen (n=751) or VKA regimen (n=755). Median time from PCI to randomisation was 45·1 h (IQR 22·2-76·2). Major or CRNM bleeding events occurred in 128 (17%) of 751 patients (annualised event rate 20·7%) with the edoxaban regimen and 152 (20%) of 755 patients (annualised event rate 25·6%) patients with the VKA regimen; hazard ratio 0·83 (95% CI 0·65-1·05; p=0·0010 for non-inferiority, margin hazard ratio 1·20; p=0·1154 for superiority). INTERPRETATION In patients with atrial fibrillation who had PCI, the edoxaban-based regimen was non-inferior for bleeding compared with the VKA-based regimen, without significant differences in ischaemic events. FUNDING Daiichi Sankyo.
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Affiliation(s)
- Pascal Vranckx
- Department of Cardiology and Intensive Care, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences at the Hasselt University, Hasselt, Belgium.
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lars Eckardt
- Atrial Fibrillation Network, Munster, Germany; Department of Cardiology and Angiology, Division of Electrophysiology, University of Munster, Munster, Germany
| | - Jan Tijssen
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands; Cardialysis, Rotterdam, Netherlands
| | - Thorsten Lewalter
- Atrial Fibrillation Network, Munster, Germany; Department of Cardiology, Hospital Munich South, Munich, Germany; University of Bonn, Bonn, Germany
| | - Giuseppe Gargiulo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Valerii Batushkin
- Department of Cardiology, Kyiv City Clinical Hospital #5, Kiev, Ukraine
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Venice, Italy; Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Zoreslava Lysak
- Department of Cardiac Rehabilitation, Oleksandrivska Kyiv City Clinical Hospital, Kiev, Ukraine
| | - Igor Vakaliuk
- Department Internal Medicine No2 and Nursing, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine; Department of Anesthesiology with Wards of Intensive Care, Ivano-Frankivsk Regional Clinical Cardiological Clinic, Ivano-Frankivsk, Ukraine
| | - Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland Katowice, Poland; The Jerzy Kukuczka Academy of Physical Education, Faculty of Physiotherapy, Katowice, Katowice, Poland
| | | | | | | | | | - Andreas Goette
- Atrial Fibrillation Network, Munster, Germany; Cardiology and Intensive Care Medicine, St Vincenz-Hospital, Paderborn, Germany; Working Group of Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany.
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11
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Su J, Zheng N, Li Z, Huangfu N, Mei L, Xu X, Zhang L, Chen X. Association of GCK gene DNA methylation with the risk of clopidogrel resistance in acute coronary syndrome patients. J Clin Lab Anal 2019; 34:e23040. [PMID: 31605429 PMCID: PMC7031555 DOI: 10.1002/jcla.23040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/18/2019] [Accepted: 08/21/2019] [Indexed: 12/23/2022] Open
Abstract
Backgrounds Clopidogrel resistance (CR), which was manifested as the failure of platelet inhibition in clopidogrel treatment, was likely to lead to cardiovascular events. Our study was aimed to explore the contribution of DNA methylation in glucokinase (GCK) to the CR risk. Methods Among 36 CR and 36 non‐CR acute coronary syndrome (ACS) patients, the platelet functions were evaluated by VerifyNow P2Y12 assay (turbidimetric‐based optical detection) and DNA methylation levels on two fragments of the CGI from the GCK were investigated through bisulfite pyrosequencing methods. In addition, the GCK mRNA expression was analyzed via quantitative real‐time PCR. Lastly, the logistic regression was employed to test the interaction between GCK methylation and nongenetic variables in CR patients. Results Subunit analysis showed that in male patients without DM but suffering from dyslipidemia, the increased methylation of cg18492943 indicated a risk of poor clopidogrel response (male, NCR vs CR(%): 84.86 ± 6.29 vs 88.16 ± 4.32, P = .032; without DM, NCR vs CR (%): 84.66 ± 6.18 vs 88.16 ± 4.17, P = .029; and dyslipidemia, NCR vs CR (%): 83.81 ± 6.96 vs 88.39 ± 4.74, P = .042).In addition, GCK mRNA expression was reduced in CR patients without DM. Moreover, regression analysis indicated that the values of platelet distribution width (PDW), total cholesterol (TC), and uric acid (UA) were correlated with the incidence of CR, and hypertension lowered the CR risk. Conclusions A higher methylation of cg18492943 in GCK gene would lower the expression of GCK mRNA, which might contribute to CR in patients without DM. Meanwhile, PDW and TC might be risk factors in CR.
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Affiliation(s)
- Jia Su
- Department of Cardiology, the first Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Cardiology, Ningbo Hospital of Zhejiang University, Ningbo, China
| | - Nan Zheng
- Department of Cardiology, Ningbo Hospital of Zhejiang University, Ningbo, China.,Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenwei Li
- Department of Cardiology, the first Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Cardiology, Ningbo Hospital of Zhejiang University, Ningbo, China
| | - Ning Huangfu
- Department of Cardiology, the first Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Cardiology, Ningbo Hospital of Zhejiang University, Ningbo, China
| | - Li Mei
- Department of Cardiology, the first Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaolei Xu
- Department of Cardiology, the first Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Zhang
- Department of Cardiology, the first Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaomin Chen
- Department of Cardiology, Ningbo Hospital of Zhejiang University, Ningbo, China.,Zhejiang University School of Medicine, Hangzhou, China
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12
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The blood compatibility challenge. Part 1: Blood-contacting medical devices: The scope of the problem. Acta Biomater 2019; 94:2-10. [PMID: 31226480 DOI: 10.1016/j.actbio.2019.06.021] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023]
Abstract
Blood-contacting medical devices are an integral part of modern medicine. Such devices may be used for only a few hours or may be implanted for life. Despite advances in biomaterial science, clotting on medical devices remains a common problem. Systemic administration of antiplatelet drugs or anticoagulants is often needed to reduce the risk of clotting. Although effective, such therapy increases the risk of bleeding, which can be fatal. This chapter (a) describes some of the commonly used blood-contacting devices and their potential complications, (b) provides an overview of the mechanisms that drive device-associated clotting, and (c) reviews the strategies employed to attenuate clotting on blood-contacting medical devices. STATEMENT OF SIGNIFICANCE: This paper is part 1 of a series of 4 reviews discussing the problem of biomaterial associated thrombogenicity. The objective was to highlight features of broad agreement and provide commentary on those aspects of the problem that were subject to dispute. We hope that future investigators will update these reviews as new scholarship resolves the uncertainties of today.
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13
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Gupta S, Belley-Côté EP, Rochwerg B, Bozzo A, Panchal P, Pandey A, Mbuagbaw L, Mehta S, Schwalm JD, Whitlock RP. Antiplatelet therapy and coronary artery bypass grafting: Protocol for a systematic review and network meta-analysis. Medicine (Baltimore) 2019; 98:e16880. [PMID: 31441862 PMCID: PMC6716708 DOI: 10.1097/md.0000000000016880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Saphenous vein graft (SVG) is the most common conduit used for coronary artery bypass grafting (CABG) surgery. Unfortunately, SVG are associated with poor long-term patency rates; a significant predictor of re-operation rates and survival. As such, medical therapy to prevent SVG narrowing or occlusion is of paramount importance. Aspirin (ASA) monotherapy is the standard of care after CABG, to improve long-term major adverse cardiovascular events (MACE) and graft patency. Benefits of dual antiplatelet therapy (DAPT) have not been well established in all CABG patients. We present a protocol for a network meta-analysis (NMA) comparing the effects of various antiplatelet therapy regimens on SVG patency, mortality, and bleeding among adult patients following CABG. METHODS We will search CENTRAL, MEDLINE, EMBASE, CINAHL ACPJC, and grey literature sources (AHA, ACC, ESC, and CCC conference proceedings, ISRCTN Register, and WHO ICTRP) for randomized controlled trials (RCTs) which fit our criteria. RCTs that evaluate different antiplatelet regimens at least 3-months after CABG and have any of SVG patency, mortality, MACE, and major bleeding as outcomes will be selected. We will perform title and abstract screening, full-text screening, and data extraction independently and in duplicate. Two independent reviewers will also assess risk of bias (ROB) for each study, as well as evaluate quality of evidence using the GRADE framework. We will use R to perform the NMA and use low-dose ASA as reference within our network. We will report results as odds ratios with confidence intervals for direct comparisons, and credible intervals for indirect or mixed comparisons. We will use the surface under the cumulative ranking curve (SUCRA) to estimate the ranking of interventions. DISCUSSION Given the limited direct comparison of various antiplatelet regimens, a network approach is ideal to clarify the optimum antiplatelet therapy after CABG. We hope that our NMA will be the largest quantitative synthesis evaluating antiplatelet regimens among patients requiring CABG. It should inform clinicians and guideline developers in selecting the most effective and safest antiplatelet regimen.Systematic Review registration: International Prospective Register for Systematic Reviews (PROSPERO)-CRD42019127695.
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Affiliation(s)
- Saurabh Gupta
- Department of Surgery
- Department of Health Research Methods, Evidence and Impact
| | - Emilie P. Belley-Côté
- Department of Medicine
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact
- Department of Medicine
| | - Anthony Bozzo
- Department of Surgery
- Department of Health Research Methods, Evidence and Impact
| | | | | | | | - Shamir Mehta
- Department of Medicine
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - J-D. Schwalm
- Department of Medicine
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Richard P. Whitlock
- Department of Surgery
- Department of Health Research Methods, Evidence and Impact
- Population Health Research Institute, Hamilton, Ontario, Canada
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14
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Galvis V, Tello A, Carreño NI, Sánchez WA, Frederick GA, Blanco NA. Massive Hyphaema Following Laser Iridotomy in a Patient on Dual Antiplatelet Therapy (Aspirin plus Ticagrelor): Case report and literature review. Sultan Qaboos Univ Med J 2019; 19:e63-e67. [PMID: 31198598 PMCID: PMC6544073 DOI: 10.18295/squmj.2019.19.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/04/2018] [Accepted: 11/22/2018] [Indexed: 01/21/2023] Open
Abstract
Massive hyphaema presentation after a laser iridotomy is very rare. We report a 63-year-old man with ischaemic heart disease on dual antiplatelet therapy (aspirin plus ticagrelor) who was diagnosed as a primary angle-closure suspect and was to undergo a neodymium-doped yttrium aluminium garnet laser iridotomy at Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia in 2016. While performing the iridotomy in the left eye, active bleeding occurred that finally filled approximately 75% of the anterior chamber. Intraocular pressure (IOP) increased to 62 mmHg. Mannitol and a topical dorzolamide/timolol were used to control the increase in IOP. The hyphaema slowly resolved over the following week without sequelae. This case revealed that massive hyphaema can complicate laser iridotomy in patients on dual antiplatelet therapy, although this is rare. Therefore, if patients are taking aspirin and ticagrelor, it would be advisable to stop the second medication if possible. In addition, sequential application of photocoagulation and photodisruption lasers might diminish the risk of significant bleeding.
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Affiliation(s)
- Virgilio Galvis
- Department of Ophthalmology, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia.,Department of Ophthalmology, Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - Alejandro Tello
- Department of Ophthalmology, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia.,Department of Ophthalmology, Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - Néstor I Carreño
- Department of Ophthalmology, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia.,Department of Ophthalmology, Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - Walter A Sánchez
- Department of Ophthalmology, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia
| | - Gabriel A Frederick
- Department of Ophthalmology, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia
| | - Nicolás A Blanco
- Department of Ophthalmology, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
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15
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Abstract
ST-segment elevation myocardial infarction (STEMI) is the most acute manifestation of coronary artery disease and is associated with great morbidity and mortality. A complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI in the majority of cases. Early diagnosis and immediate reperfusion are the most effective ways to limit myocardial ischaemia and infarct size and thereby reduce the risk of post-STEMI complications and heart failure. Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion strategy in patients with STEMI; if PCI cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus. The initiation of networks to provide around-the-clock cardiac catheterization availability and the generation of standard operating procedures within hospital systems have helped to reduce the time to reperfusion therapy. Together with new advances in antithrombotic therapy and preventive measures, these developments have resulted in a decrease in mortality from STEMI. However, a substantial amount of patients still experience recurrent cardiovascular events after STEMI. New insights have been gained regarding the pathophysiology of STEMI and feed into the development of new treatment strategies.
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16
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Zhu Q, Zhong W, Wang X, Mai L, He G, Chen J, Tang L, Liu S, Lai W, Zhong S. Pharmacokinetic and Pharmacogenetic Factors Contributing to Platelet Function Recovery After Single Dose of Ticagrelor in Healthy Subjects. Front Pharmacol 2019; 10:209. [PMID: 30936830 PMCID: PMC6431676 DOI: 10.3389/fphar.2019.00209] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/19/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives: This study aimed to elucidate the contribution of candidate single nucleotide polymorphisms (SNPs) related to pharmacokinetics on the recovery of platelet function after single dose of ticagrelor was orally administered to healthy Chinese subjects. Methods: The pharmacokinetic profiles of ticagrelor and its metabolite AR-C124910XX (M8), and the platelet aggregation (PA), were assessed after 180 mg of single-dose ticagrelor was orally administered to 51 healthy Chinese subjects. Effects of CYP2C19*2, CYP2C19*3, CYP3A5*3, UGT1A1*6, UGT1A1*28, UGT2B7*2, UGT2B7*3, SLCO1B1 388A>G, and SLCO1B1 521T>C, on the pharmacokinetics of ticagrelor and M8, and platelet function recovery were investigated. Results: The time to recover 50% of the maximum drug effect (RT50) ranging from 36 to 126 h with 46.9% CV had a remarkable individual difference and was positively associated with the half-life (t1/2) of M8 (r = 0.3901, P = 0.0067). The time of peak concentration (Tmax) of ticagrelor for CYP2C19*3 GG homozygotes was significantly higher than that of GA heterozygotes (P = 0.0027, FDR = 0.0243). Decreased peak concentration (Cmax) of M8 was significantly associated with SLCO1B1 388A>G A allele (P = 0.0152, FDR = 0.1368). CYP2C19*2 A was significantly related to decreased Cmax of M8 (P = 0.0455, FDR = 0.2048). While, the influence of these nine SNPs on the recovery of platelet function was not significant. Conclusion: Our study suggests that the elimination of M8 is an important factor in determining the recovery of platelet function. Although CYP2C19 and SLCO1B1 genetic variants were related to the pharmacokinetics of ticagrelor or M8, they did not show a significant effect on the platelet function recovery in this study. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03092076, identifier: NCT03092076
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Affiliation(s)
- Qian Zhu
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Pharmacy of Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Wanping Zhong
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Pharmacy of Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xipei Wang
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liping Mai
- Department of Pharmacy of Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guodong He
- Department of Pharmacy of Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lan Tang
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Shuwen Liu
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Weihua Lai
- Department of Pharmacy of Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shilong Zhong
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Pharmacy of Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
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17
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Su J, Li J, Yu Q, Xu X, Wang J, Yang J, Li X, Chen X. Association of PON1 gene promoter DNA methylation with the risk of Clopidogrel resistance in patients with coronary artery disease. J Clin Lab Anal 2019; 33:e22867. [PMID: 30891852 PMCID: PMC6595294 DOI: 10.1002/jcla.22867] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS The failure of therapeutic response to clopidogrel in platelet inhibition, which is called clopidogrel resistance (CR), is more likely to cause cardiovascular events. We aimed to study the contribution of promoter DNA methylation of paraoxonase 1 (PON1) to the risk of clopidogrel poor response. METHODS Through VerifyNow P2Y12 assay, patient' platelet functions were measured. Among 57 non-CR and 49 CR patients, the levels of DNA methylation in four CpG dinucleotides on the PON1 promoter were tested using bisulfite pyrosequencing technology. Besides, the relative expression of PON1 mRNA was analyzed by quantitative real-time PCR. Logistic regression was applied to investigate the interaction of PON1 methylation and clinical factors in CR. RESULTS In the subgroup with dyslipidemia, we discovered that higher CpG4 levels of the PON1 promoter indicated a poorer clopidogrel response (cases versus controls (%): 51.500 ± 14.742 vs 43.308 ± 10.891, P = 0.036), and the PON1 mRNA expression was reduced in CR patients. Additionally, the logistic regression indicated that higher level of albumin and the index of ALT were related to a lower risk of CR, and the index of AST as well as the quantity of stent may be positively associated with CR. CONCLUSIONS The DNA methylation of CpG4 in the PON1 promoter would lead to a low expression of PON1 mRNA, which might induce clopidogrel resistance in the patients with dyslipidemia, and the number of stents might be a risk for CR.
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Affiliation(s)
- Jia Su
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Jiyi Li
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Qinglin Yu
- Department of Traditional Chinese Internal Medicine, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Xiaofeng Xu
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Jingqiao Wang
- Department of Cardiology, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, China
| | - Jin Yang
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Xiaojing Li
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Xiaomin Chen
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
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18
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Neilson LM, Swart ECS, Good CB, Shrank WH, Henderson R, Manolis C, Parekh N. Identifying Outcome Measures for Coronary Artery Disease Value-Based Contracting Using the Delphi Method. Cardiol Ther 2019; 8:135-143. [PMID: 30825093 PMCID: PMC6525225 DOI: 10.1007/s40119-019-0132-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Value-based contracts (VBCs) that link drug payments to disease-related performance metrics aim to increase the value and lower the cost of medications by aligning incentives and sharing risk between payers and pharmaceutical manufacturers. This study sought to identify outcome measures that are meaningful to key stakeholders to inform VBCs for coronary artery disease (CAD) medications. Methods We administered a modified Delphi survey to gather expert opinion from a diverse panel of patients (n = 9), cardiologists (n = 4), primary care physicians (n = 5), payers (n = 2), pharmacy benefits managers (n = 3), and pharmaceutical company representatives (n = 2). A list of 16 CAD-associated clinical indicators was generated from the literature and expert consultation. Delphi participants rated the importance of each outcome on a five-point Likert scale, and selected the three most meaningful outcomes. We defined consensus as ≥ 75% agreement on the importance of an outcome (Likert scores 4 or 5 or selection of an outcome as most meaningful). Results Eleven of 13 outcomes reached consensus for importance on the Likert scale. “Preventing heart attacks” was selected as the most meaningful outcome (80%) while “preventing death” ranked second (76%). Conclusions Our study results verify the utility of a widely used clinical CAD outcome measure, myocardial infarction events, for the purpose of pharmaceutical value-based contracting. Electronic supplementary material The online version of this article (10.1007/s40119-019-0132-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lynn M Neilson
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA.
| | - Elizabeth C S Swart
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
| | - Chester B Good
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - William H Shrank
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
| | | | - Chronis Manolis
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
- Pharmacy Division, UPMC Health Plan, Pittsburgh, PA, USA
| | - Natasha Parekh
- Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Juif P, Boehler M, Dobrow M, Ufer M, Dingemanse J. Clinical Pharmacology of the Reversible and Potent P2Y
12
Receptor Antagonist ACT‐246475 After Single Subcutaneous Administration in Healthy Male Subjects. J Clin Pharmacol 2018; 59:123-130. [DOI: 10.1002/jcph.1296] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/10/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Pierre‐Eric Juif
- Department of Clinical PharmacologyIdorsia Pharmaceuticals Ltd Allschwil Switzerland
| | - Margaux Boehler
- Department of Clinical PharmacologyIdorsia Pharmaceuticals Ltd Allschwil Switzerland
| | | | - Mike Ufer
- Department of Clinical PharmacologyIdorsia Pharmaceuticals Ltd Allschwil Switzerland
| | - Jasper Dingemanse
- Department of Clinical PharmacologyIdorsia Pharmaceuticals Ltd Allschwil Switzerland
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Association between baseline platelet count and severe adverse outcomes following percutaneous coronary intervention. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:346-355. [PMID: 30083187 PMCID: PMC6064779 DOI: 10.11909/j.issn.1671-5411.2018.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The aim is to evaluate the association between baseline platelet count (PC) and severe adverse outcomes following percutaneous coronary intervention (PCI) in current real-world practice. Methods A total of 18,788 patients underwent PCI with drug-eluting stents constituted the study population. Patients were categorized as having low (< 150 × 1000/µL), normal (150–300 × 1000/µL), and high (≥ 300 × 1000/µL) baseline PC. The primary endpoints included in-hospital and follow-up all-cause mortality. The secondary endpoint was major bleeding requiring a blood transfusion. Results In-hospital mortality rates for patients with low, normal, and high baseline PC were 0.6%, 0.4%, and 0.4%, respectively (P = 0.259). Similarly, mortality rates during long-term follow-up (median 23.8 months) for patients with low, normal, and high baseline PC were 0.9%, 0.6%, and 0.7%, respectively (P = 0.079). After multivariate adjustment, patients with low or high baseline PC tended to have similar risks for both in-hospital and follow-up mortality compared with the normal group. Subgroup analyses failed to demonstrate an independent prognostic value of baseline PC in specific population groups except patients who undwent transfemoral PCI. There was also no significant difference in the incidence of major bleeding requiring a blood transfusion in the low, normal, and high groups (0.5%, 0.3%, and 0.3%, respectively; P = 0.320). After multivariate adjustment, low or high baseline PC did not significantly increase the risk of major bleeding. Conclusion There is no significant association between baseline PC and severe adverse outcomes following PCI in current real-world practice.
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Walker MM, Chen S, Mercado BQ, Houk KN, Ellman JA. Formation of Aminocyclopentadienes from Silyldihydropyridines: Ring Contractions Driven by Anion Stabilization. Angew Chem Int Ed Engl 2018; 57:6605-6609. [PMID: 29570926 DOI: 10.1002/anie.201800596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/20/2018] [Indexed: 11/09/2022]
Abstract
Highly functionalized aminocyclopentadienes can be formed through the rearrangement of anions generated from readily prepared 6-silyl-1,2-dihydropyridines by desilylation with fluoride. The scope and generality of the reaction was defined, and diverse transformations were performed on the highly functionalized products. A mechanism and driving force for the rearrangement were identified from experiments and DFT calculations.
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Affiliation(s)
- Morgan M Walker
- Department of Chemistry, Yale University, 225 Prospect St., New Haven, CT, 06520, USA
| | - Shuming Chen
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, CA, 90095-1569, USA
| | - Brandon Q Mercado
- Department of Chemistry, Yale University, 225 Prospect St., New Haven, CT, 06520, USA
| | - K N Houk
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, CA, 90095-1569, USA
| | - Jonathan A Ellman
- Department of Chemistry, Yale University, 225 Prospect St., New Haven, CT, 06520, USA
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Walker MM, Chen S, Mercado BQ, Houk KN, Ellman JA. Formation of Aminocyclopentadienes from Silyldihydropyridines: Ring Contractions Driven by Anion Stabilization. Angew Chem Int Ed Engl 2018. [DOI: 10.1002/ange.201800596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Morgan M. Walker
- Department of Chemistry Yale University 225 Prospect St. New Haven CT 06520 USA
| | - Shuming Chen
- Department of Chemistry and Biochemistry University of California, Los Angeles Los Angeles CA 90095-1569 USA
| | - Brandon Q. Mercado
- Department of Chemistry Yale University 225 Prospect St. New Haven CT 06520 USA
| | - K. N. Houk
- Department of Chemistry and Biochemistry University of California, Los Angeles Los Angeles CA 90095-1569 USA
| | - Jonathan A. Ellman
- Department of Chemistry Yale University 225 Prospect St. New Haven CT 06520 USA
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Gulizia MM, Colivicchi F, Abrignani MG, Ambrosetti M, Aspromonte N, Barile G, Caporale R, Casolo G, Chiuini E, Di Lenarda A, Faggiano P, Gabrielli D, Geraci G, La Manna AG, Maggioni AP, Marchese A, Massari FM, Mureddu GF, Musumeci G, Nardi F, Panno AV, Pedretti RFE, Piredda M, Pusineri E, Riccio C, Rossini R, di Uccio FS, Urbinati S, Varbella F, Zito GB, De Luca L. Consensus Document ANMCO/ANCE/ARCA/GICR-IACPR/GISE/SICOA: Long-term Antiplatelet Therapy in Patients with Coronary Artery Disease. Eur Heart J Suppl 2018; 20:F1-F74. [PMID: 29867293 PMCID: PMC5978022 DOI: 10.1093/eurheartj/suy019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of pharmacologic management of patients with acute coronary syndrome (ACS) and/or those receiving coronary stents. Long-term (>1 year) DAPT may further reduce the risk of stent thrombosis after a percutaneous coronary intervention (PCI) and may decrease the occurrence of non-stent-related ischaemic events in patients with ACS. Nevertheless, compared with aspirin alone, extended use of aspirin plus a P2Y12 receptor inhibitor may increase the risk of bleeding events that have been strongly linked to adverse outcomes including recurrent ischaemia, repeat hospitalisation and death. In the past years, multiple randomised trials have been published comparing the duration of DAPT after PCI and in ACS patients, investigating either a shorter or prolonged DAPT regimen. Although the current European Society of Cardiology guidelines provide a backup to individualised treatment, it appears to be difficult to identify the ideal patient profile which could safely reduce or prolong the DAPT duration in daily clinical practice. The aim of this consensus document is to review contemporary literature on optimal DAPT duration, and to guide clinicians in tailoring antiplatelet strategies in patients undergoing PCI or presenting with ACS.
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Affiliation(s)
- Michele Massimo Gulizia
- U.O.C. di Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia e UTIC, Ospedale San Filippo Neri, Roma, Italy
| | | | - Marco Ambrosetti
- Servizio di Cardiologia Riabilitativa, Clinica Le Terrazze Cunardo, Varese, Italy
| | - Nadia Aspromonte
- U.O. Scompenso e Riabilitazione Cardiologica, Polo Scienze Cardiovascolari, Toraciche, Policlinico Agostino Gemelli, Roma, Italy
| | | | - Roberto Caporale
- U.O.C. Cardiologia Interventistica, Ospedale Annunziata, Cosenza, Italy
| | - Giancarlo Casolo
- S.C. Cardiologia, Nuovo Ospedale Versilia, Lido di Camaiore (LU), Italy
| | - Emilia Chiuini
- Specialista Ambulatoriale Cardiologo, ASL Umbria 1, Perugia, Italy
| | - Andrea Di Lenarda
- S.C. Cardiovascolare e Medicina dello Sport, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | | | - Domenico Gabrielli
- ASUR Marche - Area Vasta 4 Fermo, Ospedale Civile Augusto Murri, Fermo, Italy
| | - Giovanna Geraci
- U.O.C. Cardiologia Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | | | | | - Ferdinando Maria Massari
- U.O.C. Malattie Cardiovascolari "Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Federico Nardi
- S.C. Cardiologia, Ospedale Santo Spirito, Casale Monferrato (AL), Italy
| | | | | | - Massimo Piredda
- Centro Cardiotoracico, Divisione di Cardiologia, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | - Enrico Pusineri
- U.O.C. di Cardiologia, Ospedale Civile di Vigevano, A.S.S.T., Pavia, Italy
| | - Carmine Riccio
- Prevenzione e Riabilitazione Cardiopatico, AZ. Ospedaliera S. Anna e S. Sebastiano, Caserta, Italy
| | | | | | - Stefano Urbinati
- U.O.C. Cardiologia, Ospedale Bellaria, AUSL di Bologna, Bologna, Italy
| | | | | | - Leonardo De Luca
- U.O.C. Cardiologia, Ospedale San Giovanni Evangelista, Tivoli, Roma, Italy
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Wong PC, Seiffert D, Bird JE, Watson CA, Bostwick JS, Giancarli M, Allegretto N, Hua J, Harden D, Guay J, Callejo M, Miller MM, Lawrence RM, Banville J, Guy J, Maxwell BD, Priestley ES, Marinier A, Wexler RR, Bouvier M, Gordon DA, Schumacher WA, Yang J. Blockade of protease-activated receptor-4 (PAR4) provides robust antithrombotic activity with low bleeding. Sci Transl Med 2018; 9:9/371/eaaf5294. [PMID: 28053157 DOI: 10.1126/scitranslmed.aaf5294] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/23/2016] [Indexed: 12/21/2022]
Abstract
Antiplatelet agents are proven efficacious treatments for cardiovascular and cerebrovascular diseases. However, the existing drugs are compromised by unwanted and sometimes life-threatening bleeding that limits drug usage or dosage. There is a substantial unmet medical need for an antiplatelet drug with strong efficacy and low bleeding risk. Thrombin is a potent platelet agonist that directly induces platelet activation via the G protein (heterotrimeric guanine nucleotide-binding protein)-coupled protease-activated receptors PAR1 and PAR4. A PAR1 antagonist is approved for clinical use, but its use is limited by a substantial bleeding risk. Conversely, the potential of PAR4 as an antiplatelet target has not been well characterized. Using anti-PAR4 antibodies, we demonstrated a low bleeding risk and an effective antithrombotic profile with PAR4 inhibition in guinea pigs. Subsequently, high-throughput screening and an extensive medicinal chemistry effort resulted in the discovery of BMS-986120, an orally active, selective, and reversible PAR4 antagonist. In a cynomolgus monkey arterial thrombosis model, BMS-986120 demonstrated potent and highly efficacious antithrombotic activity. BMS-986120 also exhibited a low bleeding liability and a markedly wider therapeutic window compared to the standard antiplatelet agent clopidogrel tested in the same nonhuman primate model. These preclinical findings define the biological role of PAR4 in mediating platelet aggregation. In addition, they indicate that targeting PAR4 is an attractive antiplatelet strategy with the potential to treat patients at a high risk of atherothrombosis with superior safety compared with the current standard of care.
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Affiliation(s)
- Pancras C Wong
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA.
| | - Dietmar Seiffert
- Bristol-Myers Squibb Company, Route 206 and Province Line Road, Princeton, NJ 08543, USA
| | - J Eileen Bird
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA
| | - Carol A Watson
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA
| | - Jeffrey S Bostwick
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA
| | - Mary Giancarli
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA
| | - Nick Allegretto
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA
| | - Ji Hua
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA
| | - David Harden
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA
| | - Jocelyne Guay
- Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Quebec H3C 3J7, Canada
| | - Mario Callejo
- Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Quebec H3C 3J7, Canada
| | - Michael M Miller
- Bristol-Myers Squibb Company, Route 206 and Province Line Road, Princeton, NJ 08543, USA
| | | | - Jacques Banville
- Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Quebec H3C 3J7, Canada
| | - Julia Guy
- Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Quebec H3C 3J7, Canada
| | - Brad D Maxwell
- Bristol-Myers Squibb Company, Route 206 and Province Line Road, Princeton, NJ 08543, USA
| | - E Scott Priestley
- Bristol-Myers Squibb Company, 350 Carter Road, Hopewell, NJ 08540, USA
| | - Anne Marinier
- Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Quebec H3C 3J7, Canada
| | - Ruth R Wexler
- Bristol-Myers Squibb Company, 350 Carter Road, Hopewell, NJ 08540, USA
| | - Michel Bouvier
- Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Quebec H3C 3J7, Canada.,Department of Biochemistry and Molecular Medicine, Université de Montréal, Montréal, Quebec H3C 3J7, Canada
| | - David A Gordon
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA
| | - William A Schumacher
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA
| | - Jing Yang
- Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ 08534, USA
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Wilson SJ, Ismat FA, Wang Z, Cerra M, Narayan H, Raftis J, Gray TJ, Connell S, Garonzik S, Ma X, Yang J, Newby DE. PAR4 (Protease-Activated Receptor 4) Antagonism With BMS-986120 Inhibits Human Ex Vivo Thrombus Formation. Arterioscler Thromb Vasc Biol 2017; 38:448-456. [PMID: 29269513 PMCID: PMC5779320 DOI: 10.1161/atvbaha.117.310104] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/13/2017] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Objective— BMS-986120 is a novel first-in-class oral PAR4 (protease-activated receptor 4) antagonist with potent and selective antiplatelet effects. We sought to determine for the first time, the effect of BMS-986120 on human ex vivo thrombus formation. Approach and Results— Forty healthy volunteers completed a phase 1 parallel-group PROBE trial (Prospective Randomized Open-Label Blinded End Point). Ex vivo platelet activation, platelet aggregation, and thrombus formation were measured at 0, 2, and 24 hours after (1) oral BMS-986120 (60 mg) or (2) oral aspirin (600 mg) followed at 18 hours with oral aspirin (600 mg) and oral clopidogrel (600 mg). BMS-986120 demonstrated highly selective and reversible inhibition of PAR4 agonist peptide (100 μM)-stimulated P-selectin expression, platelet-monocyte aggregates, and platelet aggregation (P<0.001 for all). Compared with pretreatment, total thrombus area (μm2/mm) at high shear was reduced by 29.2% (95% confidence interval, 18.3%–38.7%; P<0.001) at 2 hours and by 21.4% (9.3%–32.0%; P=0.002) at 24 hours. Reductions in thrombus formation were driven by a decrease in platelet-rich thrombus deposition: 34.8% (19.3%–47.3%; P<0.001) at 2 hours and 23.3% (5.1%–38.0%; P=0.016) at 24 hours. In contrast to aspirin alone, or in combination with clopidogrel, BMS-986120 had no effect on thrombus formation at low shear (P=nonsignificant). BMS-986120 administration was not associated with an increase in coagulation times or serious adverse events. Conclusions— BMS-986120 is a highly selective and reversible oral PAR4 antagonist that substantially reduces platelet-rich thrombus formation under conditions of high shear stress. Our results suggest PAR4 antagonism has major potential as a therapeutic antiplatelet strategy. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02439190.
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Affiliation(s)
- Simon J Wilson
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.).
| | - Fraz A Ismat
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
| | - Zhaoqing Wang
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
| | - Michael Cerra
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
| | - Hafid Narayan
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
| | - Jennifer Raftis
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
| | - Timothy J Gray
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
| | - Shea Connell
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
| | - Samira Garonzik
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
| | - Xuewen Ma
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
| | - Jing Yang
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
| | - David E Newby
- From the British Heart Foundation Centre for Cardiovascular Science (S.J.W., D.E.N.), Medical Research Council Centre for Inflammation Research (J.R., S.C.), and Edinburgh College of Medicine (T.J.G.), University of Edinburgh, United Kingdom; Bristol Myers Squibb, Princeton, NJ (F.A.I., Z.W., M.C., S.G., X.M., J.Y.); and Royal Infirmary of Edinburgh, United Kingdom (H.N.)
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Xi Z, Fang F, Wang J, AlHelal J, Zhou Y, Liu W. CYP2C19 genotype and adverse cardiovascular outcomes after stent implantation in clopidogrel-treated Asian populations: A systematic review and meta-analysis. Platelets 2017; 30:229-240. [PMID: 29257922 DOI: 10.1080/09537104.2017.1413178] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The effect of CYP2C19 gene polymorphism on clinical outcomes of patients with coronary artery disease (CAD) treated with clopidogrel remains controversial. Ethnicity has been proposed to influence clopidogrel response following stent implantation in CAD patients with different CYP2C19 genotypes. Furthermore, Asian populations are reported to have a relatively greater prevalence of CYP2C19 loss-of-function (LOF) alleles. We aimed to evaluate the impact of CYP2C19 gene polymorphism on clinical outcomes in Asian populations who underwent percutaneous coronary interventions (PCI) and received clopidogrel therapy. We conducted a comprehensive search in PubMed, EMBASE, and Cochrane Library from their inceptions to January 20, 2017. Studies that reported clopidogrel therapy information, clinically relevant outcomes (adverse cardiovascular events, stent thrombosis and bleeding), and CYP2C19 genotypes among Asian populations were included. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death and myocardial infarction. The safety endpoint was any kind of bleeding. We retrieved 20 studies of 15056 patients reporting 1301 cardiovascular events. The primary analysis showed at least one CYP2C19 LOF allele (*2 and/or *3) carriers were at an increased risk of MACE compared with non-carriers (10.58% vs. 6.07%, OR: 1.99, 95% CI: 1.64 to 2.42, p < .001). Stent thrombosis (ST) was also more frequent in LOF allele carriers (2.22% vs. 0.44%, OR: 4.77, 95% CI: 2.84 to 8.01, p < .001). Inversely, the risk of bleeding was lower in LOF allele carriers (OR: 0.66, 95% CI: 0.46 to 0.96, p < .001). Subgroup analysis was performed to assess differences by high (600 mg) or routine (300 mg) loading dose of clopidogrel and by different nationalities. The risk of MACE in LOF allele carriers remained significantly higher even in high loading dose group (high loading dose: OR 1.72, 95% CI: 1.37 to 2.16, and routine loading dose: OR 2.22, 95% CI: 1.68 to 2.94, p for subgroup heterogeneity = 0.16). Subgroup analysis between three nationalities of China, Korea, and Japan demonstrated that the risk of MACE among Chinese LOF allele carriers was the greatest (OR: 2.28; 95% CI:1.91 to 2.73). In conclusion, among Asian populations with CAD undergoing stent implantation, CYP2C19 LOF allele carriers are at greater risk of adverse cardiovascular events and lower risk of bleeding compared with non-carriers. Genetic testing may be helpful for clinicians to personalize antiplatelet therapy especially in Asian population.
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Affiliation(s)
- Ziwei Xi
- a Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease , Beijing , China
| | - Fang Fang
- b Sleep Center , Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease , Beijing , China
| | - Jiayang Wang
- a Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease , Beijing , China
| | - Jumana AlHelal
- c International School of Capital Medical University , Beijing , China
| | - Yujie Zhou
- a Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease , Beijing , China
| | - Wei Liu
- a Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease , Beijing , China
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Collet C, Serruys PW. Early invasive strategy should be performed within 72 hours in high-risk patients with non-ST-elevation myocardial infarction. EVIDENCE-BASED MEDICINE 2017; 22:227. [PMID: 29170158 DOI: 10.1136/ebmed-2017-110848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, North Holland, The Netherlands
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Al-Salama ZT, Keating GM, Keam SJ. Ticagrelor: A Review in Long Term Secondary Prevention of Cardiovascular Events. Drugs 2017; 77:2025-2036. [DOI: 10.1007/s40265-017-0844-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Role of P2Y 12 Receptor in Thrombosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 906:307-324. [PMID: 27628007 DOI: 10.1007/5584_2016_123] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
P2Y12 receptor is a 342 amino acid Gi-coupled receptor predominantly expressed on platelets. P2Y12 receptor is physiologically activated by ADP and inhibits adenyl cyclase (AC) to decrease cyclic AMP (cAMP) level, resulting in platelet aggregation. It also activates PI3 kinase (PI3K) pathway leading to fibrinogen receptor activation, and may protect platelets from apoptosis. Abnormalities of P2Y12 receptor include congenital deficiencies or high activity in diseases like diabetes mellitus (DM) and chronic kidney disease (CKD), exposing such patients to a prothrombotic condition. A series of clinical antiplatelet drugs, such as clopidogrel and ticagrelor, are designed as indirect or direct antagonists of P2Y12 receptor to reduce incidence of thrombosis mainly for patients of acute coronary syndrome (ACS) who are at high risk of thrombotic events. Studies on novel dual-/multi-target antiplatelet agents consider P2Y12 receptor as a promising part in combined targets. However, the clinical practical phenomena, such as "clopidogrel resistance" due to gene variations of cytochrome P450 or P2Y12 receptor constitutive activation, call for better antiplatelet agents. Researches also showed inverse agonist of P2Y12 receptor could play a better role over neutral antagonists. Personalized antiplatelet therapy is the most ideal destination for antiplatelet therapy in ACS patients with or without other underlying diseases like DM or CKD, however, there is still a long way to go.
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Comparison of platelet aggregation response in switching regimen from prasugrel to clopidogrel between CYP2C19 extensive versus non-extensive metabolizers. Cardiovasc Interv Ther 2017; 33:277-284. [PMID: 28681220 DOI: 10.1007/s12928-017-0482-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
Little is known about the response of platelet aggregation in patients with acute coronary syndrome (ACS) when prasugrel is changed to clopidogrel. In this study, we evaluated the pharmacodynamic effects of this medication switch. Twenty-one consecutive ACS patients received prasugrel 20 mg as a loading dose before emergent percutaneous coronary intervention and 3.75 mg as a maintenance dose on days 2-7 (prasugrel phase). From day 8, prasugrel was switched to clopidogrel 75 mg/day (clopidogrel phase). P2Y12 reaction units (PRU) were measured 2-4 h after prasugrel loading, and on days 7, 11, 13, 15, and 42. Eight patients had the CYP2C19 extensive metabolizer (EM) genotype variant, while 13 were non-EM. In the EM group, no changes were observed in PRU level between days 7 and 15 (136.8 ± 51.2 vs. 166.2 ± 41.9, P = 0.07). However, in the non-EM group, a significant increase in PRU levels was observed between days 7 and 15 (165.8 ± 57.2 vs. 223.6 ± 60.9, P = 0.002). However, 2 patients in the non-EM group (15%) showed high on-clopidogrel treatment platelet reactivity (HTPR) 2-4 h after prasugrel loading, and during the clopidogrel phase there were significant differences in the incidence of HTPR between the EM and non-EM groups. Ischemic and bleeding events were not observed during this period. In the acute phase of ACS, changing from prasugrel to clopidogrel therapy decreased the effects of suppressing platelet aggregation. However, this change was not associated with increased ischemic or bleeding events.
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Domingues R, Bruniera G, Brunale F, Mangueira C, Senne C. Lumbar puncture in patients using anticoagulants and antiplatelet agents. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 74:679-86. [PMID: 27556380 DOI: 10.1590/0004-282x20160098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/25/2016] [Indexed: 12/26/2022]
Abstract
The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks.
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Affiliation(s)
| | - Gustavo Bruniera
- Senne Líquor Diagnóstico, São Paulo SP, Brasil;,Hospital Israelita Albert Einstein, Laboratório de Patologia Clínica, São Paulo SP, Brasil
| | - Fernando Brunale
- Senne Líquor Diagnóstico, São Paulo SP, Brasil;,Hospital Israelita Albert Einstein, Laboratório de Patologia Clínica, São Paulo SP, Brasil
| | - Cristóvão Mangueira
- Hospital Israelita Albert Einstein, Laboratório de Patologia Clínica, São Paulo SP, Brasil
| | - Carlos Senne
- Senne Líquor Diagnóstico, São Paulo SP, Brasil;,Hospital Israelita Albert Einstein, Laboratório de Patologia Clínica, São Paulo SP, Brasil
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Naber CK, Urban P, Ong PJ, Valdes-Chavarri M, Abizaid AA, Pocock SJ, Fabbiocchi F, Dubois C, Copt S, Greene S, Morice MC. Biolimus-A9 polymer-free coated stent in high bleeding risk patients with acute coronary syndrome: a Leaders Free ACS sub-study. Eur Heart J 2017; 38:961-969. [PMID: 27190095 PMCID: PMC5837685 DOI: 10.1093/eurheartj/ehw203] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 04/27/2016] [Accepted: 05/03/2016] [Indexed: 01/11/2023] Open
Abstract
Aims Although a true clinical challenge, high bleeding risk patients with an acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) have never been specifically studied. Leaders Free ACS, a pre-specified Leaders Free sub-study, determined efficacy, and safety of a combination of 1-month dual anti-platelet therapy (DAPT) with implantation of either a polymer-free Biolimus-A9-coated stent (BA9-DCS) or a bare-metal stent (BMS) in these patients. Methods and results Leaders Free included 2466 patients undergoing PCI who had at least 1 of 13 pre-defined factors for an increased bleeding risk. Of these, 659 ACS patients were included in this analysis (BA9-DCS 330, BMS 329). At 12-month follow-up, treatment with the BA9-DCS was more effective (clinically driven target-lesion revascularization 3.9 vs. 9.0%, P = 0.009) and safer (cumulative incidence of cardiac death, myocardial infarction, or definite or probable stent thrombosis 9.3 vs. 18.5%, P = 0.001), driven by significantly lower rates of cardiac mortality (3.4 vs. 6.9%, P = 0.049) and myocardial infarction (6.9 vs. 13.8%, P = 0.005). Conclusion We believe that the results of this sub-analysis from the Leaders Free trial are likely to significantly impact clinical practice for high bleeding risk patients presenting with an ACS: the use of a BMS can, in our view, no longer be recommended, and, given the paucity of available data for second-generation DES with shortened DAPT in these patients, the BA9-DCS should currently be considered as the device with the strongest evidence to support its use for this indication.
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Affiliation(s)
- Christoph K. Naber
- Contilia Heart and Vascular Centre, Elisabeth Krankenhaus Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | | | | | | | | | | | | | - Christophe Dubois
- Department of Cardiovascular Medicine, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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Su J, Yu Q, Zhu H, Li X, Cui H, Du W, Ji L, Tong M, Zheng Y, Xu H, Zhang J, Zhu Y, Xia Y, Liu T, Yao Q, Yang J, Chen X, Yu J. The risk of clopidogrel resistance is associated with ABCB1 polymorphisms but not promoter methylation in a Chinese Han population. PLoS One 2017; 12:e0174511. [PMID: 28358842 PMCID: PMC5373545 DOI: 10.1371/journal.pone.0174511] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
The goal of our study was to investigate the contribution of ABCB1 expression to the risk of clopidogrel resistance (CR). Platelets functions were measured using the Verify-Now P2Y12 assay. Applying Polymerase Chain Reaction–Restriction Fragment Length Polymorphism (PCR-RFLP), the single-nucleotide polymorphisms (SNPs) was tested. Using bisulphite pyrosequencing assay, we investigated the association of the ABCB1 DNA methylation levels and CR. It was shown that female, hypertension, and lower albumin levels increased the risk of CR (P<0.05). If patients did not have hypoproteinaemia or had hypertension, the SNP in rs1045642 was associated with CR (CC vs. TT: albumin ≥35, P = 0.042; hypertension, P = 0.045; C vs. T: albumin ≥35, P = 0.033; hypertension, P = 0.040). Additionally, the platelet inhibition of the CT+TT genotype in rs1128503 was larger than that of the CC genotype (P = 0.021). Multivariate logistic regression analysis showed that male, higher albumin and hsCRP decreased the risk of CR, and the stent size maybe positively correlated with CR. The SNP in rs1045642 was related to all-cause mortality (P = 0.024). We did not find any relationship between the methylation levels of the ABCB1 promoter and CR. In conclusions, our study indicated that ABCB1 polymorphisms might be useful in further evaluating the pathogenesis of CR.
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Affiliation(s)
- Jia Su
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Qinglin Yu
- Department of Traditional Chinese Internal Medicine, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Hao Zhu
- Department of Anaesthesia, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Xiaojing Li
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Hanbin Cui
- Department of Cardiology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Weiping Du
- Department of Cardiology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Lindan Ji
- Department of Biochemistry, School of Medicine, Ningbo University, Ningbo, Zhejiang Province, People's Republic of China
| | - Maoqing Tong
- The Key Laboratory of Molecular Medicine, Ningbo No. 1 Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yibo Zheng
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Hongyu Xu
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Jianjiang Zhang
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Yunyun Zhu
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Yezi Xia
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Ting Liu
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
| | - Qi Yao
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
- * E-mail: (QY); (JY); (XC); (JY)
| | - Jun Yang
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
- * E-mail: (QY); (JY); (XC); (JY)
| | - Xiaomin Chen
- Department of Cardiology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
- * E-mail: (QY); (JY); (XC); (JY)
| | - Jingbo Yu
- Department of Gerontology, Ningbo No.1 Hospital, Ningbo, Zhejiang Province, People's Republic of China
- * E-mail: (QY); (JY); (XC); (JY)
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Jiang M, You JHS. CYP2C19 LOF and GOF-Guided Antiplatelet Therapy in Patients with Acute Coronary Syndrome: A Cost-Effectiveness Analysis. Cardiovasc Drugs Ther 2017; 31:39-49. [PMID: 27924429 DOI: 10.1007/s10557-016-6705-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to examine the cost-effectiveness of CYP2C19 loss-of-function and gain-of-function allele guided (LOF/GOF-guided) antiplatelet therapy in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS A life-long decision-analytic model was designed to simulate outcomes of three strategies: universal clopidogrel (75 mg daily), universal alternative P2Y12 inhibitor (prasugrel 10 mg daily or ticagrelor 90 mg twice daily), and LOF/GOF-guided therapy (LOF/GOF allele carriers receiving alternative P2Y12 inhibitor, wild-type patients receiving clopidogrel). Model outcomes included clinical event rates, quality-adjusted life-years (QALYs) gained and direct medical costs from perspective of US healthcare provider. RESULTS Base-case analysis found nonfatal myocardial infarction (5.62%) and stent thrombosis (1.2%) to be the lowest in universal alternative P2Y12 inhibitor arm, whereas nonfatal stroke (0.72%), cardiovascular death (2.42%), and major bleeding (2.73%) were lowest in LOF/GOF-guided group. LOF/GOF-guided arm gained the highest QALYs (7.5301 QALYs) at lowest life-long cost (USD 76,450). One-way sensitivity analysis showed base-case results were subject to the hazard ratio of cardiovascular death in carriers versus non-carriers of LOF allele and hazard ratio of cardiovascular death in non-carriers of LOF allele versus general patients. In probabilistic sensitivity analysis of 10,000 Monte Carlo simulations, LOF/GOF-guided therapy, universal alternative P2Y12 inhibitor, and universal clopidogrel were the preferred strategy (willingness-to-pay threshold = 50,000 USD/QALY) in 99.07%, 0.04%, and 0.89% of time, respectively. CONCLUSIONS Using both CYP2C19 GOF and LOF alleles to select antiplatelet therapy appears to be the preferred antiplatelet strategy over universal clopidogrel and universal alternative P2Y12 inhibitor therapy for ACS patients with PCI.
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Affiliation(s)
- Minghuan Jiang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N. T, Hong Kong, China
| | - Joyce H S You
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N. T, Hong Kong, China.
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Kwong W, Parker JD. The Effect of Clopidogrel on the Response to Ischemia Reperfusion. J Cardiovasc Pharmacol Ther 2016; 22:368-373. [DOI: 10.1177/1074248416683047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Reperfusion in the setting of acute ischemia is essential in limiting tissue necrosis. However, reperfusion itself is associated with significant adverse effects. There is animal evidence that platelets play a role in the adverse effects of ischemia and reperfusion (IR) injury. We examined whether clopidogrel would have favorable effects on endothelial dysfunction induced by an episode of IR. Using a parallel design, we administered clopidogrel 600 mg or matching placebo to normal volunteers (n = 20) 24 hours before an episode of IR. Flow-mediated dilatation (FMD, radial artery) was assessed before and after 20 minutes of upper arm ischemia. Following IR, there was a highly significant decrease in FMD in the placebo group (7.6% ± 1.3% vs 3.4% ± 0.1%; P < .001). In the clopidogrel group, there was no change in FMD post-IR (8.3% ± 0.8% vs 7.1% ± 1.2%; P = not significant). Following IR, FMD in the placebo group was significantly smaller than that observed in the clopidogrel group ( P < .01). Ischemia and reperfusion caused no change in plasma levels of biomarkers of inflammation (intercellular adhesion molecule 1, chemokine ligand 5, and interleukin 6) in either group. Therefore, a single dose of clopidogrel given 24 hours prior to an episode of IR had protective effects, limiting the adverse effects of ischemia on endothelial function.
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Affiliation(s)
- Wilson Kwong
- Division of Cardiology, Mount Sinai and University Health Network Hospitals, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - John D. Parker
- Division of Cardiology, Mount Sinai and University Health Network Hospitals, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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Wong PC, Watson C, Crain EJ. The P2Y1 receptor antagonist MRS2500 prevents carotid artery thrombosis in cynomolgus monkeys. J Thromb Thrombolysis 2016; 41:514-21. [PMID: 26660522 DOI: 10.1007/s11239-015-1302-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Adenosine diphosphate directly induces platelet aggregation via the G-protein coupled P2Y1 and P2Y12 receptors. P2Y12, but not P2Y1, receptor antagonists are available in the clinic. The relevance of the P2Y1 receptor as an antiplatelet target has been studied in rodents, but not in higher species. We therefore examined effects of the pharmacological blockade of the P2Y1 receptor with its selective antagonist MRS2500 in monkey models of electrolytic-mediated arterial thrombosis (ECAT) and kidney bleeding time (KBT). Abciximab, a GPIIb-IIIa antagonist, and cangrelor, a P2Y12 antagonist, were utilized to validate these monkey models. Compounds were given IV at 15-60 min before thrombosis initiation in anesthetized monkeys. Scanning electron microscopy showed the luminal surface of thrombotic artery covered with platelet aggregates and fibrin network. Administration of abciximab at 0.25 and 0.7 mg/kg IV significantly reduced thrombus weight by 71 ± 1 and 100 ± 0 %, and increased KBT by 10.0 ± 0.1- and 10.1 ± 0-fold, respectively (n = 3/dose). Likewise, cangrelor at 0.6 and 2 mg/kg/h IV significantly reduced thrombus weight significantly by 72 ± 9 % and 100 ± 0 % and increased KBT by 2.1 ± 0.1- and 9.8 ± 0.2-fold, respectively (n = 3/dose). MRS2500 [mg/kg + mg/kg/h IV] at 0.09 + 0.14 and 0.45 + 0.68 significantly reduced thrombus weight by 57 ± 1 % and 88 ± 1 % and increased KBT by 2.1 ± 0.3- and 4.9 ± 0.6-fold, respectively (n = 4/dose). In summary, MRS2500 prevented occlusive arterial thrombosis at a dose that moderately prolonged KBT, indicating a role of P2Y1 receptors in arterial thrombosis and hemostasis in monkeys. Thus P2Y1 receptor antagonism provides a suitable target for drug discovery.
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Affiliation(s)
- Pancras C Wong
- Cardiovascular Drug Discovery Biology, Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ, 08534, USA.
| | - Carol Watson
- Cardiovascular Drug Discovery Biology, Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ, 08534, USA
| | - Earl J Crain
- Cardiovascular Drug Discovery Biology, Bristol-Myers Squibb Company, 311 Pennington-Rocky Hill Road, Pennington, NJ, 08534, USA
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Singh M, Bhatt DL, Stone GW, Rihal CS, Gersh BJ, Lennon RJ, Narula J, Fuster V. Antithrombotic Approaches in Acute Coronary Syndromes: Optimizing Benefit vs Bleeding Risks. Mayo Clin Proc 2016; 91:1413-1447. [PMID: 27712639 DOI: 10.1016/j.mayocp.2016.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 01/06/2023]
Abstract
It is estimated that in the United States, each year, approximately 620,000 persons will experience an acute coronary syndrome and approximately 70% of these will have non-ST-elevation acute coronary syndrome. Cardiovascular disease still accounts for 1 of every 3 deaths in the United States, and there is an urgent need to improve the prognosis of patients presenting with acute coronary syndrome. Cardiovascular mortality and ischemic complications are common after acute coronary syndrome, and the advent of newer antithrombotic therapies has reduced ischemic complications, but at the expense of greater bleeding. The new antithrombotic agents also raise the challenge of choosing between multiple potential therapeutic combinations to minimize recurrent ischemia without a concomitant increase in bleeding, a decision that often varies according to an individual patient's relative propensity for ischemia versus hemorrhage. In this review, we will synthesize the available information to arm health care providers with the contemporary knowledge on antithrombotic therapy and individualize treatment decisions.
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Affiliation(s)
- Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA
| | - Gregg W Stone
- Columbia University Medical Center, New York Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, NY
| | | | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY
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Steg PG, Bhatt DL. Viewpoint: a proposal for a simple algorithm for managing oral anticoagulation and antiplatelet therapy in patients with non-valvular atrial fibrillation and coronary stents. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:93-97. [DOI: 10.1177/2048872615610868] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ph Gabriel Steg
- FACT (French Alliance for Cardiovascular clinical Trials), Hôpital Bichat, France
- Université Paris-Diderot, Sorbonne Paris Cité, France
- INSERM U-1148, France
- NHLI, Imperial College London, UK
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center and Harvard Medical School, USA
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Gareri C, De Rosa S, Indolfi C. MicroRNAs for Restenosis and Thrombosis After Vascular Injury. Circ Res 2016; 118:1170-84. [PMID: 27034278 DOI: 10.1161/circresaha.115.308237] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
Percutaneous revascularization revolutionized the therapy of patients with coronary artery disease. Despite continuous technical advances that substantially improved patients' outcome after percutaneous revascularization, some issues are still open. In particular, restenosis still represents a challenge, even though it was dramatically reduced with the advent of drug-eluting stents. At the same time, drug-eluting stent thrombosis emerged as a major concern because of incomplete or delayed re-endothelialization after vascular injury. The discovery of microRNAs revealed a previously unknown layer of regulation for several biological processes, increasing our knowledge on the biological mechanisms underlying restenosis and stent thrombosis, revealing novel promising targets for more efficient and selective therapies. The present review summarizes recent experimental and clinical evidence on the role of microRNAs after arterial injury, focusing on practical aspects of their potential therapeutic application for selective inhibition of smooth muscle cell proliferation, enhancement of endothelial regeneration, and inhibition of platelet activation after coronary interventions. Application of circulating microRNAs as potential biomarkers is also discussed.
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Affiliation(s)
- Clarice Gareri
- From the Department of Medicine, Duke University, Durham, NC (C.G.); Division of Cardiology, Department of Medical and Surgical Science, "Magna Graecia" University, Catanzaro, Italy (S.D.R., C.I.); and URT-CNR, Department of Medicine, URT of Consiglio Nazionale delle Ricerche, Catanzaro, Italy (C.I.)
| | - Salvatore De Rosa
- From the Department of Medicine, Duke University, Durham, NC (C.G.); Division of Cardiology, Department of Medical and Surgical Science, "Magna Graecia" University, Catanzaro, Italy (S.D.R., C.I.); and URT-CNR, Department of Medicine, URT of Consiglio Nazionale delle Ricerche, Catanzaro, Italy (C.I.)
| | - Ciro Indolfi
- From the Department of Medicine, Duke University, Durham, NC (C.G.); Division of Cardiology, Department of Medical and Surgical Science, "Magna Graecia" University, Catanzaro, Italy (S.D.R., C.I.); and URT-CNR, Department of Medicine, URT of Consiglio Nazionale delle Ricerche, Catanzaro, Italy (C.I.).
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Bliden KP, Tantry US, Chaudhary R, Byun S, Gurbel PA. Extended-release acetylsalicylic acid for secondary prevention of stroke and cardiovascular events. Expert Rev Cardiovasc Ther 2016; 14:779-91. [DOI: 10.1080/14779072.2016.1188005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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De Caterina R, Goto S. Targeting thrombin long-term after an acute coronary syndrome: Opportunities and challenges. Vascul Pharmacol 2016; 81:1-14. [DOI: 10.1016/j.vph.2016.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/06/2016] [Accepted: 03/13/2016] [Indexed: 01/21/2023]
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Abstract
Platelets play a very important role in physiological haemostasis and thrombus formation. Platelet aggregation is the key pathophysiological factor in the development of arterial ischaemic events, including coronary artery disease, cerebrovascular accidents and peripheral arterial disease. As such, antiplatelet therapy plays a very important role in preventing recurrent events in the individuals who are affected by one of these conditions. Until recently, the repertoire of antiplatelet therapy was limited to aspirin and clopidogrel. However, this landscape has changed dramatically with the advent of newer and more potent agents, prasugrel and ticagrelor and also the glycoprotein IIb/IIIa antagonists. This armamentarium is likely to expand further with the advent of protease-activated receptor-1 antagonists and the intravenous cangrelor. This review summarises the different agents available and some practical considerations for their use from a general physician's perspective.
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Affiliation(s)
- Jecko Thachil
- Department of Haematology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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44
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Affiliation(s)
- Philippe Gabriel Steg
- French Alliance for Cardiovascular clinical Trials (FACT), and Université Paris-Diderot, INSERM U-1148, Bichat Hospital, Fibrosis, Inflammation and Remodeling (FIRE) Department, Assistance Publique-Hôpitaux de Paris
- National Heart and Lung Institute, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial College
| | - Grégory Ducrocq
- French Alliance for Cardiovascular clinical Trials (FACT), and Université Paris-Diderot, INSERM U-1148, Bichat Hospital, Fibrosis, Inflammation and Remodeling (FIRE) Department, Assistance Publique-Hôpitaux de Paris
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Spiliopoulos S, Pastromas G. Current status of high on-treatment platelet reactivity in patients with coronary or peripheral arterial disease: Mechanisms, evaluation and clinical implications. World J Cardiol 2015; 7:912-921. [PMID: 26730297 PMCID: PMC4691818 DOI: 10.4330/wjc.v7.i12.912] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/16/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Antiplatelet therapy with aspirin or clopidogrel or both is the standard care for patients with proven coronary or peripheral arterial disease, especially those undergoing endovascular revascularization procedures. However, despite the administration of the antiplatelet regiments, some patients still experience recurrent cardiovascular ischemic events. So far, it is well documented by several studies that in vitro response of platelets may be extremely variable. Poor antiplatelet effect of clopidogrel or high on-treatment platelet reactivity (HTPR) is under investigation by numerous recent studies. This review article focuses on methods used for the ex vivo evaluation of HTPR, as well as on the possible underlying mechanisms and the clinical consequences of this entity. Alternative therapeutic options and future directions are also addressed.
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Dual antiplatelet therapy and newer agents: More efficacy but lets keep the brain safe!! Indian Heart J 2015; 67 Suppl 3:S7-S10. [PMID: 26995438 PMCID: PMC4799025 DOI: 10.1016/j.ihj.2016.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ducrocq G, Steg PG. Treating coronary artery disease in patients with a history of cerebrovascular disease. Arch Cardiovasc Dis 2015; 108:606-11. [PMID: 26371986 DOI: 10.1016/j.acvd.2015.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 11/25/2022]
Abstract
Patients with coronary artery disease and a history of stroke account for as many as one in eight of all patients with coronary artery disease, and they are at higher risk of ischaemic events than patients with 'lone' coronary artery disease. It is therefore tempting to increase the potency of antithrombotic treatment in this patient subset. However, these patients are also at greater risk of intracranial haemorrhage. In recent trials of new antithrombotic agents in acute coronary syndromes, patients with a history of cerebrovascular disease derived no clinical benefit from (and were even harmed by) the potent novel antithrombotic agents, with an increased risk of intracranial haemorrhage. However, this risk did not appear to be uniform: it was higher in patients with a history of stroke than in those with a history of transient ischaemic attack, and appeared to be largely confined to the first year after stroke/transient ischaemic attack. Specific strategies to optimize the benefit/risk ratio of antithrombotic agents in this relatively common patient group should be developed and evaluated.
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Affiliation(s)
- Gregory Ducrocq
- French Alliance for Cardiovascular Clinical Trials (FACT), département hospitalo-universitaire FIRE, AP-HP, hôpital Bichat, Paris, France; LVTS, Inserm U-1148, Paris, France.
| | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Clinical Trials (FACT), département hospitalo-universitaire FIRE, AP-HP, hôpital Bichat, Paris, France; LVTS, Inserm U-1148, Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, Paris, France; National Heart and Lung Institute, ICMS, Royal Brompton hospital, London, UK
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Hohmann JD, Peter K. Activated-platelet targeting of CD39 as a potential way forward. The quest for efficient antithrombotic therapy without associated bleeding complications. Hamostaseologie 2015; 36:17-25. [PMID: 26328528 DOI: 10.5482/hamo-14-12-0085] [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] [Received: 12/29/2014] [Accepted: 08/27/2015] [Indexed: 01/20/2023] Open
Abstract
UNLABELLED Antiplatelet therapy is given to millions of patients and has saved numerous lives. However, it is also associated with complications including fatal bleedings. Clinically used antiplatelet drugs seem to follow the rule of an inherent link of improved anti-thrombotic potency with increased risk of bleeding complications. Therefore, there is an ongoing quest to develop drugs that are able to break this link that has prevented many patients from receiving antiplatelet protection and has resulted in substantial mortality and morbidity. We describe a new antiplatelet approach that is based on an recombinant antibody protein, a drug format that has recently attracted major interest. Two unique components are genetically combined in this molecule: 1) The ecto-nucleoside triphosphate diphosphohydrolase NTPDase CD39, which enzymatically degrades ATP and ADP to AMP, which is then further degraded to adenosine by the endothelially expressed CD73. Thereby, the platelet activating ADP is reduced and replaced by the platelet inhibiting adenosine resulting in a strong antiplatelet effect. 2) A single-chain antibody (scFv) that specifically binds to the activated GPIIb/IIIa receptor and thus allows targeting to activated platelets. The described fusion protein results in strong enrichment of CD39's antiplatelet effect, resulting in potent inhibition of platelet adhesion and aggregation and thrombosis in mice. The activated platelet targeting allows using a low systemic concentration that does not interfere with normal haemostasis and thus does not cause bleeding time prolongation in mice. CONCLUSION We describe a new antiplatelet approach that promises to deliver strong localized antithrombotic effects without associated bleeding problems.
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Affiliation(s)
| | - K Peter
- Prof. Karlheinz Peter, Baker IDI Heart and Diabetes Institute, PO Box 6492, St Kilda Road Central, Melbourne, Victoria 8008, Australia,
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