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Callichurn K, Simard P, De Marco C, Jamali P, Saada Y, Matteau A, Schampaert É, Mansour S, Hatem R, Potter BJ. A dual-center analysis of conservative versus liberal glycoprotein IIb-IIIa antagonist strategies in the treatment of ST-elevation myocardial infarction. Sci Rep 2024; 14:15003. [PMID: 38951544 PMCID: PMC11217494 DOI: 10.1038/s41598-024-64652-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 06/11/2024] [Indexed: 07/03/2024] Open
Abstract
While the efficacy of GpIIb-IIIa-inhibitors during primary PCI (pPCI) for ST-elevated myocardial infarction (STEMI) has previously been demonstrated, its ongoing role and safety in combination with newer P2Y12-inhibitors is unclear. We therefore sought to compare outcomes between two centers with divergent approaches to the use of GpIIbIIIa antagonists in pPCI. We performed a retrospective chart review of all-comer STEMI patients treated with pPCI at two high-volume Montreal academic tertiary care centers. One center tended to use GpIIb-IIIa-inhibitors up-front in a large proportion of patients (liberal strategy) and the other preferring a bail-out approach (conservative strategy). Baseline patient characteristics and procedural data were compared between the two groups. The main efficacy outcome was rate of no-reflow/slow-reflow and the main safety outcome was BARC ≥ 2 bleeding events. A total of 459 patients were included, of whom 167 (36.5%) were exposed to a GpIIb-IIIa-antagonist. There was a significant overall difference in use of GpIIb-IIIa-antagonist between the two centers (60.5% vs. 16.1%, p < 0.01). Rate of no-reflow/slow-reflow was similar between groups (2.6% vs. 1.4%, p = 0.22). In-hospital rates of unplanned revascularization, stroke and death were also not different between groups. Use of a liberal GpIIb--IIIa-antagonist strategy was however associated with a higher risk of bleeding (OR 3.16, 95% CI 1.57-6.37, p < 0.01), which persisted after adjustment for covariables (adjusted OR 2.85, 95% CI 1.40-5.81, p < 0.01). In this contemporary retrospective cohort, a conservative, bail-out only GpIIb--IIIa-antagonist strategy was associated with a lower incidence of clinically relevant bleeding without any signal for an increase in no-reflow/slow-reflow or ischemic clinical events.
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Affiliation(s)
| | - Philippe Simard
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Corrado De Marco
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Payman Jamali
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Yacine Saada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alexis Matteau
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- Department of Medicine, Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
- CHUM Research Center (CRCHUM), Montreal, QC, Canada
| | - Érick Schampaert
- Department of Medicine, Division of Cardiology, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Samer Mansour
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- Department of Medicine, Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
- CHUM Research Center (CRCHUM), Montreal, QC, Canada
| | - Raja Hatem
- Department of Medicine, Division of Cardiology, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Brian J Potter
- Faculty of Medicine, McGill University, Montreal, QC, Canada.
- Department of Medicine, Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
- CHUM Research Center (CRCHUM), Montreal, QC, Canada.
- Carrefour de l'innovation et Évaluation en Santé (CIÉS), Centre de Recherche du CHUM (CRCHUM), Cardiology and Interventional Cardiology, CHUM, Pavillon S, S03-334, 850, Rue St-Denis, Montréal, QC, H2X 0A9, Canada.
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Coadă CA, Lupu M, Florea I, Di Constanzo S, Coluccelli S, Şimon I. Association of Glycoprotein IIIa PlA1/A2 Polymorphism with Risk of Stroke: Updated Meta-Analysis. Curr Issues Mol Biol 2024; 46:5364-5378. [PMID: 38920993 PMCID: PMC11201703 DOI: 10.3390/cimb46060321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/27/2024] Open
Abstract
Cardiovascular diseases are the main cause of death in the world, with ischemic heart disease (i.e., myocardial infarction) and cerebrovascular disease (i.e., stroke) taking the highest toll. Advances in diagnosis and treatment have led to a significant alleviation of ischemic complications, specifically in the realm of pharmacotherapy and interventional devices, while pharmacogenomics has yet to be fully leveraged to improve the burden of disease. Atherothrombotic events might occur earlier or respond worse to treatment in patients with genetic variants of GP IIb/IIIa. Therefore, we aimed to quantitate the involvement of the PlA2 variant in the risk of cerebral stroke events. A systematic search and meta-analysis were performed by pooling the risks of individual studies. A total of 31 studies comprising 5985 stroke patients and 7886 controls were analyzed. A meta-analysis of four studies on hemorrhagic stroke patients showed no association with the PIA2 rs5918(C) polymorphism in both fixed-effect (OR = 0.90 95%CI [0.71; 1.14]; p = 0.398) and random-effect models (OR = 0.86 95%CI [0.62; 1.20]; p-value = 0.386). The power of this analysis was below <30%, indicating a limited ability to detect a true effect. An analysis of the 28 studies on ischemic stroke revealed a significant association with the PIA2 rs5918(C) allele in both fixed-effect (OR = 1.16 95%CI [1.06; 1.27]; p = 0.001) and random-effect models (OR = 1.20 95%CI [1.04; 1.38]; p-value = 0.012), with a power of >80%. The PIA2 allele was associated with an increased risk of ischemic stroke. No association was found with hemorrhagic stroke, most likely due to the small number of available studies, which resulted in a lack of power.
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Affiliation(s)
- Camelia Alexandra Coadă
- Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania; (C.A.C.); (I.F.)
| | - Mihai Lupu
- Morpho-Functional Sciences Department, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Iulia Florea
- Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania; (C.A.C.); (I.F.)
| | - Stella Di Constanzo
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Sara Coluccelli
- Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Ioan Şimon
- Department of Surgery, Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania;
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Hou X. Epoxidase inhibitor-aspirin resistance and the relationship with genetic polymorphisms: a review. J Int Med Res 2024; 52:3000605241230429. [PMID: 38420770 PMCID: PMC10903214 DOI: 10.1177/03000605241230429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024] Open
Abstract
Strokes are the leading cause of death in most regions of the world. Epoxidase inhibitors include the drug aspirin (acetylsalicylic acid). Aspirin is widely used as first-line treatment for the prevention of cardiovascular and cerebrovascular diseases in at-risk patients. However, patients using conventional doses of aspirin can still develop ischaemic cardiovascular and cerebrovascular diseases, a phenomenon known as aspirin resistance. The occurrence of aspirin resistance hinders the prevention and treatment of ischaemic cardiovascular and cerebrovascular diseases. There are many factors affecting aspirin resistance, such as sex, drug dose, metabolic disease, genetic polymorphisms, drug interactions and pharmacokinetics. Genetic polymorphism refers to the simultaneous and frequent presence of two or more discontinuous variants or genotypes or alleles in a population of organisms. Platelets contain a large number of highly polymorphic transmembrane glycoprotein receptors encoded by two or more isomeric alleles. Changes in gene polymorphisms in various pathways during platelet aggregation can lead to aspirin resistance. This narrative review describes the gene polymorphisms that have been demonstrated to be significantly associated with aspirin resistance. Research on the mechanisms of aspirin resistance and increased knowledge should provide accurate drug guidance in individuals that require first-line antiplatelet therapy.
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Affiliation(s)
- Xiaolin Hou
- Department of Emergency Medicine, Zigong First People’s Hospital, Zigong City, China
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Li CY, Yang P, Zheng J, Zhang J, Liu YQ, Liu XQ, Hu Y, Lan WJ. Establishment of a forward primers-superposed amplification analysis for accurate aspirin pharmacogenomic measurement. Sci Rep 2024; 14:880. [PMID: 38195704 PMCID: PMC10776573 DOI: 10.1038/s41598-024-51458-0] [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: 10/16/2023] [Accepted: 01/05/2024] [Indexed: 01/11/2024] Open
Abstract
Genotyping of gDNA rs12041331 (PEAR1), rs6065 (GP1BA), and rs730012 (LTC4S) can provide systematic guidance on the use of aspirin. However, an accurate, reliable and economical approach to simultaneous detection of the above single nucleotide polymorphisms (SNPs) is not reported. Herein, we designed and substantiated an allele-specific (AS) forward primer-superposed amplification analysis for measurement of the SNPs in PEAR1, GP1BA and LTC4S genes, in which the values of ∆Cq (differences in threshold cycles between the wild-type forward primer-based assay and the mutated-type forward primer-based assay) were employed to decide genotype. Mismatch AS forward primers were screened with the singleplex amplification analysis. Moreover, Cq extension optimized by AS forward primer superposition was observed in the selected forward primer-based triplex analysis. Further, robustness assessment of the triplex analysis showed the amplification efficiency ranging from 0.9 to 1.1. Precision test demonstrated the coefficient of variation of less than 2%. And the detective results of 189 DNA samples was completely concordant with that of commercial Sanger sequencing. In summary, we developed a simple, accurate and economical approach to genotyping of rs12041331 (PEAR1), rs6065 (GP1BA) and rs730012 (LTC4S) to provide a valuable pharmacogenomics tool for guidance of aspirin delivery.
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Affiliation(s)
- Chun-Yan Li
- Institute of Biomedical Engineering, Qilu University of Technology (Shandong Academy of Sciences), No.3501, Daxue Road, Jinan, 250353, China
| | - Ping Yang
- Institute of Biomedical Engineering, Qilu University of Technology (Shandong Academy of Sciences), No.3501, Daxue Road, Jinan, 250353, China
| | - Jie Zheng
- Institute of Biomedical Engineering, Qilu University of Technology (Shandong Academy of Sciences), No.3501, Daxue Road, Jinan, 250353, China
| | - Jing Zhang
- Institute of Biomedical Engineering, Qilu University of Technology (Shandong Academy of Sciences), No.3501, Daxue Road, Jinan, 250353, China
| | - Yi-Qing Liu
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250000, China
| | - Xiao-Quan Liu
- Institute of Biomedical Engineering, Qilu University of Technology (Shandong Academy of Sciences), No.3501, Daxue Road, Jinan, 250353, China
| | - Yue Hu
- Institute of Biomedical Engineering, Qilu University of Technology (Shandong Academy of Sciences), No.3501, Daxue Road, Jinan, 250353, China.
| | - Wen-Jun Lan
- Institute of Biomedical Engineering, Qilu University of Technology (Shandong Academy of Sciences), No.3501, Daxue Road, Jinan, 250353, China.
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Wu J, Chang R, Liu Y. Key Mutant Genes and Biological Pathways Involved in Aspirin Resistance in the Residents of the Chinese Plateau Area. Comb Chem High Throughput Screen 2024; 27:632-640. [PMID: 37076463 DOI: 10.2174/1386207326666230418113637] [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: 08/25/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Aspirin is used to prevent and treat cardiovascular diseases; however, some patients develop aspirin resistance. AIM We aimed to explore the potential molecular mechanisms underlying aspirin resistance in people living in the Chinese plateau area. METHODS In total, 91 participants receiving aspirin treatment from the Qinghai plateau area were divided into the aspirin resistance and aspirin sensitivity groups. Genotyping was performed using the Sequence MASSarray. Differentially mutated genes between the two groups were analyzed using MAfTools. The annotation of differentially mutated genes was conducted based on the Metascape database. RESULTS AND DISCUSSION In total, 48 differential SNP and 22 differential InDel mutant genes between the aspirin resistance and aspirin sensitivity groups were screened using Fisher's exact test (P < 0.05). After the χ2 test, a total of 21 SNP mutant genes, including ZFPL1 and TLR3, and 19 InDel mutant genes were found to be differentially expressed between the two groups (P < 0.05). Functional analysis revealed that these differential SNP mutations were mainly enriched in aspirin resistance pathways, such as the Wnt signaling pathway. Furthermore, these genes were related to many diseases, including various aspirin indications. CONCLUSION This study identified several genes and pathways that could be involved in arachidonic acid metabolic processes and aspirin resistance progression, which will provide a theoretical understanding of the molecular mechanism of aspirin resistance.
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Affiliation(s)
- Jinchun Wu
- Department of Cardiology, Qinghai Provincial People's Hospital, Xining, Qinghai, 810007, China
| | - Rong Chang
- Department of Cardiology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong, 518109, China
| | - Yanmin Liu
- Department of Cardiology, Qinghai Provincial People's Hospital, Xining, Qinghai, 810007, China
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Qiuyue L, Gulin D, Hong X, Jiazhen Y, Rukui Y, Xinwu H, Guochun L. Zhilong Huoxue Tongyu Capsule Ameliorates Platelet Aggregation and Thrombus Induced by Aspirin in Rats by Regulating Lipid Metabolism and MicroRNA Pathway. Comb Chem High Throughput Screen 2024; 27:854-862. [PMID: 37438906 DOI: 10.2174/1386207326666230712110103] [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: 12/04/2022] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Zhilong Huoxue Tongyu capsule (ZLHX) is a traditional Chinese medicinal compound preparation, which exhibits obvious therapeutic effects on aspirin resistance (AR). However, the mechanism of ZLHX on AR is rarely reported. OBJECTIVES This study aimed to explore the therapeutic effects of AR and the underlying mechanisms of ZLHX on AR rats. METHODS An AR model was established through treatment with a high-fat, high-sugar, and highsalt diet for 12 weeks and oral administration of aspirin (27 mg/kg/day) and ibuprofen (36 mg/kg/day) in weeks 9-12. The rats were administrated with ZLHX (225, 450, and 900 mg/kg) from week 12 to week 16. Blood samples were collected after the experiment. Thromboelastography analysis was performed, and the levels of triglyceride (TG), total cholesterol (TC), lowdensity lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were determined. Furthermore, the levels of thromboxane B2 (TXB2) and 6-keto-prostaglandin F1α (6- keto-PGF1α) were determined with commercial ELISA kits. Finally, the gene expressions of microRNA- 126-3p (miRNA-126-3p) and miRNA-34b-3p were detected through a real-time quantitative polymerase chain reaction. RESULTS Results demonstrated that ZLHX significantly inhibited platelet aggregation in the AR rats. Moreover, ZLHX markedly decreased the levels of TC, TG, and LDL-C and increased the level of HDL-C. Meanwhile, ELISA results confirmed that ZLHX can elevate the expression levels of TXB2 and 6-keto-PGF1α. Further studies suggested that ZLHX significantly downregulated the expression levels of miRNA-126-3p and miRNA-34b-3p. CONCLUSION This study revealed that the therapeutic effect of ZLHX might be related to the regulation of lipid metabolism and the miRNA pathway.
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Affiliation(s)
- Li Qiuyue
- National Traditional Chinese Medicine Clinical Research Base and Pharmacy Intravenous Admixture Service of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Deng Gulin
- National Traditional Chinese Medicine Clinical Research Base and Pharmacy Intravenous Admixture Service of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Xu Hong
- National Traditional Chinese Medicine Clinical Research Base and Pharmacy Intravenous Admixture Service of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Yin Jiazhen
- National Traditional Chinese Medicine Clinical Research Base and Pharmacy Intravenous Admixture Service of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Yuan Rukui
- National Traditional Chinese Medicine Clinical Research Base and Pharmacy Intravenous Admixture Service of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Huang Xinwu
- School of Pharmacy, Southwest Medical University, Luzhou, 646000, China
| | - Li Guochun
- National Traditional Chinese Medicine Clinical Research Base and Pharmacy Intravenous Admixture Service of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China
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Qureshi K, Farooq MU, Gorelick PB. Genotype-guided dual antiplatelet therapy in cerebrovascular disease: assessing the risk and benefits for ethnic populations. Expert Rev Cardiovasc Ther 2023; 21:621-630. [PMID: 37551687 DOI: 10.1080/14779072.2023.2245754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Cerebrovascular disease is a leading cause of morbidity and mortality in the world and antiplatelet therapy is a main pharmacologic means of secondary prevention. Clinical information has accumulated about benefit of dual antiplatelet therapy in certain clinical scenarios, genetic causes of antiplatelet resistance and its effect on clinical outcomes, and ethnic and geographic distributions of genetic polymorphisms. AREAS COVERED This review covers literature related to the pharmacogenomics of antiplatelet agents with a focus on ethnic variability, antiplatelet resistance, and dual antiplatelet therapy in cerebrovascular disease. EXPERT OPINION Selecting patients for dual antiplatelet therapy and specific agents require consideration of multiple factors. Ethnic factors should be considered in certain circumstances, but additional research is needed to determine the generalizability of the findings.
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Affiliation(s)
- Kasim Qureshi
- Department of Neurology, Trinity Health, Saint Mary's, Grand Rapids, MI, United States
- Department of Neurology, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
| | - Muhammad U Farooq
- Department of Neurology, Trinity Health, Saint Mary's, Grand Rapids, MI, United States
- Department of Neurology, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
| | - Philip B Gorelick
- Department of Neurology, Trinity Health, Saint Mary's, Grand Rapids, MI, United States
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Abstract
Antiplatelet therapy is used in the treatment of patients with acute coronary syndromes, stroke, and those undergoing percutaneous coronary intervention. Clopidogrel is the most widely used antiplatelet P2Y12 inhibitor in clinical practice. Genetic variation in CYP2C19 may influence its enzymatic activity, resulting in individuals who are carriers of loss-of-function CYP2C19 alleles and thus have reduced active clopidogrel metabolites, high on-treatment platelet reactivity, and increased ischemic risk. Prospective studies have examined the utility of CYP2C19 genetic testing to guide antiplatelet therapy, and more recently published meta-analyses suggest that pharmacogenetics represents a key treatment strategy to individualize antiplatelet therapy. Rapid genetic tests, including bedside genotyping platforms that are validated and have high reproducibility, are available to guide selection of P2Y12 inhibitors in clinical practice. The aim of this review is to provide an overview of the background and rationale for the role of a guided antiplatelet approach to enhance patient care.
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Affiliation(s)
- Matteo Castrichini
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA;
| | - Jasmine A Luzum
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Naveen Pereira
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA;
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Ross S, Krebs K, Paré G, Milani L. Pharmacogenomics in Stroke and Cardiovascular Disease: State of the Art. Stroke 2023; 54:270-278. [PMID: 36325912 DOI: 10.1161/strokeaha.122.037717] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is considerable interindividual variability in the response to antiplatelet and anticoagulant therapies, and this variation may be attributable to genetic variants. There has been an increased understanding of the genetic architecture of stroke and cardiovascular disease, which has been driven by advancements in genomic technologies and this has raised the possibility of more targeted pharmaceutical treatments. Pharmacogenetics promises to use a patient's genetic profile to treat those who are more likely to benefit from a particular intervention by selecting the best possible therapy. Although there are numerous studies indicating strong evidence for the effect of specific genotypes on the outcomes of vascular drugs, the adoption of pharmacogenetic testing in clinical practice has been slow. This resistance may stem from sometimes conflicting findings among pharmacogenetic studies, a lack of stroke-specific randomized controlled trials to test the effectiveness of genetically-guided therapies, and the practical and cost-effective implementation of genetic testing within the clinic. Thus, this review provides an overview of the genetic variants that influence the individual responses to aspirin, clopidogrel, warfarin and statins and the different methods for pharmacogenetic testing and guidelines for clinical implementation for stroke patients.
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Affiliation(s)
- Stephanie Ross
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.R., G.P.)
| | - Kristi Krebs
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia (K.K., L.M.)
| | - Guillaume Paré
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.R., G.P.).,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (G.P.).,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (G.P.).,Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada (G.P.)
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia (K.K., L.M.)
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10
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Zhao Y, Yang S, Wu M. Mechanism of Improving Aspirin Resistance: Blood-Activating Herbs Combined With Aspirin in Treating Atherosclerotic Cardiovascular Diseases. Front Pharmacol 2022; 12:794417. [PMID: 34975490 PMCID: PMC8718695 DOI: 10.3389/fphar.2021.794417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/29/2021] [Indexed: 01/03/2023] Open
Abstract
Atherosclerotic thrombotic disease continues to maintain a high morbidity and mortality rate worldwide at present. Aspirin, which is reckoned as the cornerstone of primary and secondary prevention of atherosclerotic cardiovascular diseases (ASCVDs), has been applied in clinics extensively. However, cardiovascular events continue to occur even though people utilize aspirin appropriately. Therefore, the concept of aspirin resistance (AR) was put forward by scholars, which is of great significance for the prediction of the clinical outcome of diseases. The pathogenesis of AR may be incorporated with low patient compliance, insufficient dose, genetic polymorphism, increased platelet transformation, inflammation, and the degenerative changes and calcification of platelets. The improvement of AR in the treatment of ASCVDs has gradually become a research hot spot in recent years. Traditional Chinese medicine (TCM) regards individuals as a whole and treats them from a holistic view, which has been found to have advantages in clinical studies on the treatment of AR. Many kinds of blood-activating TCM have the effect of improving AR. The potential mechanism for the improvement of AR by blood-activating herbs combined with aspirin was explored. The combination of blood-activating herbs and aspirin to improve AR is likely to turn into a hot topic of research in the future.
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Affiliation(s)
- Yixi Zhao
- Comprehensive Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Shengjie Yang
- Comprehensive Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Min Wu
- Comprehensive Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Melnichnikova OS, Nazarova IA, Sirotkina OV, Panov AV, Abesadze IT, Alugishvili MZ, Lokhovinina NL, Vavilova TV. [Integral tests of the hemostasis system in assessing the efficiency of acetylsalicylic acid in patients with ischemic heart disease]. BIOMEDIT︠S︡INSKAI︠A︡ KHIMII︠A︡ 2021; 67:427-433. [PMID: 34730556 DOI: 10.18097/pbmc20216705427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite the fact that acetylsalicylic acid (ASA) is the "gold" standard for the prevention of cardiovascular complications in patients with coronary heart disease (CAD), a number of patients still have risks of atherothrombosis. In the present study, the antithrombotic effect of ASA in patients with CAD was assessed in platelet-rich plasma (PRP) using integral tests of the hemostasis study: the T-TAS system (Total Thrombus-formation Analysis System) and the thrombin generation test (TGT). The study involved 34 patients with stable CAD (11 women, 23 men) and people (15 women, 18 men) in the control group. As a result of assessing the activity of thrombus formation using the T-TAS system, a significant decrease in the area under the curve (AUC10) was found in the group with CAD patients compared with the control (135.6 [88.0-222.3] and 260.5 [217.3-301.9], respectively, p.
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Affiliation(s)
- O S Melnichnikova
- V.A. Almazov National Medical Research Center, St.Petersburg, Russia
| | - I A Nazarova
- V.A. Almazov National Medical Research Center, St.Petersburg, Russia
| | - O V Sirotkina
- V.A. Almazov National Medical Research Center, St.Petersburg, Russia; Petersburg Nuclear Physics Institute named by B.P. Konstantinov of National Research Centre "Kurchatov Institute", St.Petersburg, Russia
| | - A V Panov
- V.A. Almazov National Medical Research Center, St.Petersburg, Russia
| | - I T Abesadze
- V.A. Almazov National Medical Research Center, St.Petersburg, Russia
| | - M Z Alugishvili
- V.A. Almazov National Medical Research Center, St.Petersburg, Russia
| | - N L Lokhovinina
- V.A. Almazov National Medical Research Center, St.Petersburg, Russia
| | - T V Vavilova
- V.A. Almazov National Medical Research Center, St.Petersburg, Russia
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Chang R, Wu J, Han C, Liu Y, Liu X, Ye Y, Zhou W. Correlation of aspirin resistance with serological indicators in patients with coronary heart disease in the plateau. Am J Transl Res 2021; 13:9024-9031. [PMID: 34540014 PMCID: PMC8430094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the incidence rate of aspirin resistance (AR) in patients with coronary heart disease (CHD) in the plateau, and analyze its correlation with clinical influencing factors and serological indicators. METHODS In this retrospective study, 90 patients with CHD who had lived in the plateau for a long time (>10 years) and received treatment were selected as the subjects. Patients were divided into the AR group (11-dehydrothromboxane B2 (11-DH-TXB2) >1500 pg/mg) and aspirin sensitivity group (AS group, 11-DH-TXB2 ≤1500 pg/mg) according to the content of 11-DH-TXB2 in the urine. The differences in gender, body weight, blood pressure and heart rate between the two groups were compared, and the correlation of these indexes with the incidence rate of AR was analyzed. Moreover, serum indicators were detected. Multiple variable binary logistic regression was used to detect the independent risk factors for AR. RESULTS The incidence rate of AR in the enrolled patients with CHD was 27.78% (25/90). The body mass index (BMI) in the AR group was significantly higher than that in the AS group (P<0.05). Patients in the AR group had significantly higher C-reactive protein (CRP) and total bilirubin levels and lower mean corpuscular volume and mean corpuscular hemoglobin compared with the AS group (all P<0.05). Binary logistic regression showed that BMI and CRP were independent factors for AR. CONCLUSION AR occurs in patients with CHD who take aspirin in the plateau. Patients with high BMI or CRP level have an increased risk of AR. In addition, BMI and CRP are independent factors for AR, and bilirubin can be a predictive factor for AR.
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Affiliation(s)
- Rong Chang
- Department of Cardiology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical UniversityShenzhen, Guangdong Province, China
| | - Jinchun Wu
- Department of Cardiology, Qinghai Provincial People’s HospitalXining, Qinghai Province, China
| | - Cheng Han
- Department of Cardiology, Qinghai Provincial People’s HospitalXining, Qinghai Province, China
| | - Yanmin Liu
- Department of Cardiology, Qinghai Provincial People’s HospitalXining, Qinghai Province, China
| | - Xiangbo Liu
- Department of Cardiology, Qinghai Provincial People’s HospitalXining, Qinghai Province, China
| | - Yi Ye
- Department of Cardiology, Qinghai Provincial People’s HospitalXining, Qinghai Province, China
| | - Wenqin Zhou
- Department of Cardiology, Qinghai Provincial People’s HospitalXining, Qinghai Province, China
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Fontana P, Roffi M, Reny JL. Platelet Function Test Use for Patients with Coronary Artery Disease in the Early 2020s. J Clin Med 2020; 9:jcm9010194. [PMID: 31936845 PMCID: PMC7019825 DOI: 10.3390/jcm9010194] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 12/14/2022] Open
Abstract
In the field of antithrombotics, precision medicine is of particular interest, as it may lower the incidence of potentially life-threatening side effects. Indeed, antiplatelet drugs such as P2Y12 inhibitors are one of the most common causes of emergency admissions for drug-related adverse events. The last ten years have seen a continuous debate on whether platelet function tests (PFTs) should be used to tailor antiplatelet drugs to cardiovascular patients. Large-scale randomized studies investigating the escalation of antiplatelet therapies according to the results of PFTs were mostly negative. Potent P2Y12 inhibitors are recommended as a first-line treatment in acute coronary syndrome patients, bringing the bleeding risk at the forefront. De-escalation from prasugrel or ticagrelor to clopidogrel is now considered, with or without the use of a PFT. This review covers recent advances in escalation and de-escalation strategies based on PFTs in various clinical settings. It also describes the main features of the most popular platelet function tests as well as the potential added value of genetic testing. Finally, we detail practical suggestions on how PFTs could be used in clinical practice.
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Affiliation(s)
- Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
- Division of Angiology and Haemostasis, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-372-97-51; Fax: +41-22-372-98-91
| | - Marco Roffi
- Division of Cardiology, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Jean-Luc Reny
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
- Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
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