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Chan MV, Chen MH, Thibord F, Nkambule BB, Lachapelle AR, Grech J, Schneider ZE, Wallace de Melendez C, Huffman JE, Hayman MA, Allan HE, Armstrong PC, Warner TD, Johnson AD. Factors that modulate platelet reactivity as measured by 5 assay platforms in 3429 individuals. Res Pract Thromb Haemost 2024; 8:102406. [PMID: 38813256 PMCID: PMC11135030 DOI: 10.1016/j.rpth.2024.102406] [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: 03/20/2024] [Accepted: 04/05/2024] [Indexed: 05/31/2024] Open
Abstract
Background Assessment of platelet function is key in diagnosing bleeding disorders and evaluating antiplatelet drug efficacy. However, there is a prevailing "one-size-fits-all" approach in the interpretation of measures of platelet reactivity, with arbitrary cutoffs often derived from healthy volunteer responses. Objectives Our aim was to compare well-used platelet reactivity assays. Methods Blood and platelet-rich plasma obtained from the Framingham Heart Study (N = 3429) were assayed using a range of agonists in 5 platelet assays: light transmission aggregometry, Optimul aggregometry, Multiplate impedance aggregometry (Roche Diagnostics), Total Thrombus-Formation Analysis System, and flow cytometry. Using linear mixed-effect models, we determined the contribution of preanalytical and technical factors that modulated platelet reactivity traits. Results A strong intra-assay correlation of platelet traits was seen in all assays, particularly Multiplate velocity (r = 0.740; ristocetin vs arachidonic acid). In contrast, only moderate interassay correlations were observed (r = 0.375; adenosine diphosphate Optimul Emax vs light transmission aggregometry large area under the curve). As expected, antiplatelet drugs strongly reduced platelet responses, with aspirin use primarily targeting arachidonic acid-induced aggregation, and explained substantial variance (β = -1.735; P = 4.59 × 10-780; variance proportion = 46.2%) and P2Y12 antagonists blocking adenosine diphosphate responses (β = -1.612; P = 6.75 × 10-27; variance proportion = 2.1%). Notably, female sex and older age were associated with enhanced platelet reactivity. Fasting status and deviations from standard venipuncture practices did not alter platelet reactivity significantly. Finally, the agonist batch, phlebotomist, and assay technician (more so for assays that require additional sample manipulation) had a moderate to large effect on measured platelet reactivity. Conclusion Caution must be exercised when extrapolating findings between assays, and the use of standard ranges must be medication-specific and sex-specific at a minimum. Researchers should also consider preanalytical and technical variables when designing experiments and interpreting platelet reactivity measures.
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Affiliation(s)
- Melissa V. Chan
- Population Sciences Branch, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA
| | - Ming-Huei Chen
- Population Sciences Branch, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA
| | - Florian Thibord
- Population Sciences Branch, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA
| | - Bongani B. Nkambule
- Population Sciences Branch, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA
| | - Amber R. Lachapelle
- Population Sciences Branch, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA
| | - Joseph Grech
- Population Sciences Branch, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA
| | - Zoe E. Schneider
- Population Sciences Branch, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA
| | | | - Jennifer E. Huffman
- Population Sciences Branch, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA
| | - Melissa A. Hayman
- Centre for Immunobiology, the Blizard Institute, Faculty of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Harriet E. Allan
- Centre for Immunobiology, the Blizard Institute, Faculty of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Paul C. Armstrong
- Centre for Immunobiology, the Blizard Institute, Faculty of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Timothy D. Warner
- Centre for Immunobiology, the Blizard Institute, Faculty of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Andrew D. Johnson
- Population Sciences Branch, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA
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Franz C, Bender L, Dorn C, Sichtermann T, Minkenberg J, Franko M, Wiesmann M, Stockero A, Nikoubashman O, May R, Ridwan H. Platelet function testing using the Multiplate analyzer after administration of aspirin in Aachen minipigs. PLoS One 2022; 17:e0275756. [PMID: 36256639 PMCID: PMC9578582 DOI: 10.1371/journal.pone.0275756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Abstract
Knowledge of platelet function in pigs and the effectiveness of antiplatelet therapy is important to ensure proper transferability from animal studies to humans. Our aim was to (1) characterize baseline platelet function of Aachen minipigs using the bedside Multiplate analyzer, (2) compare baseline platelet function with Göttingen minipigs, and (3) characterize platelet inhibition within the first 5 minutes after intravenous administration of acetylsalicylic acid (ASA). We characterized the baseline platelet function and hematological parameters in 9 Aachen minipigs. Historical data of 8 unmedicated Göttingen minipigs were used for comparison of baseline values. Platelet inhibition in Aachen minipigs was tested 1-5 minutes after intravenous administration of 500 mg ASA. Multiplate examinations included the following tests: ASPI test (to assess the effect of ASA), adenosine-diphosphate-test (ADP test) and thrombin receptor activating peptide test (TRAP test). Median values and interquartile range (IQR) of the Multiplate baseline tests in Aachen minipigs were as follows: ASPI: 39 U (IQR = 21-71), ADP: 70 U (IQR = 48-73), and TRAP: 8 U (IQR = 6-9), whereas the values in Göttingen minipigs were as follows: ASPI: 70.5 U (IQR = 60-78), ADP: 51 U (IQR = 45-66), and TRAP: 6.5 U (IQR = 4-8). ASPI values of Göttingen minipigs were significantly higher than those of Aachen minipigs (p = 0.046). Intravenous administration of ASA in Aachen minipigs resulted in significant platelet inhibition after 1 minute, which remained stable over a period of 5 minutes (p≤0.038). Aachen minipigs appeared to have a high variance in arachidonic acid-mediated platelet aggregation. In Aachen minipigs, intravenous ASA administration resulted in immediate platelet inhibition.
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Affiliation(s)
- Christiane Franz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Lara Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Christoph Dorn
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Thorsten Sichtermann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Minkenberg
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Maximilian Franko
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Andrea Stockero
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Rebecca May
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Hani Ridwan
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
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Heidari Z, Daei M, Khalili H, Sahebkar A. Bleeding Complication in a Patient with Concomitant Use of Rivaroxaban and Saffron Supplement: a Case Report. Cardiovasc Hematol Disord Drug Targets 2022; 22:CHDDT-EPUB-122643. [PMID: 35440328 DOI: 10.2174/1871529x22666220418102545] [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: 09/24/2021] [Revised: 12/15/2022] [Accepted: 02/10/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) carry a lower potential risk of food/herb and drug interactions compared with oral vitamin K antagonists. However, as a new class of medications, drug interactions of DOACs have not been fully known. CASE PRESENTATION We herein present the case of a 64-year old male with the complaint of acute onset epistaxis and bleeding gums following the concomitant use of rivaroxaban and saffron supplement. It seems that coadministration of DOACs and saffron supplements should be avoided due to the potential drug-herbal interactions and possible risk of subsequent bleeding complications. CONCLUSION However, further larger scale surveillance studies are needed to confirm the findings and assess the clinical significance.
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Affiliation(s)
- Zinat Heidari
- Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad
| | - Maryam Daei
- Alborz University of Medical Sciences, Alborz
| | - Hossein Khalili
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad
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4
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Romlin B, Dahlin A, Hallhagen S, Björk K, Wåhlander H, Söderlund F. Clinical course and outcome after treatment with ventricular assist devices in paediatric patients: A single-centre experience. Acta Anaesthesiol Scand 2021; 65:785-791. [PMID: 33616235 DOI: 10.1111/aas.13804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heart failure is a rare condition in the paediatric population, associated with high morbidity and mortality. When medical therapy is no longer sufficient, mechanical circulatory support such as a ventricular assist device can be used to bridge these children to transplant or recovery. Coagulation-related complications such as thrombi, embolism and bleeding events represent the greatest challenge in paediatric patients on mechanical support. We aimed to describe the outcomes and coagulation-related complications in this patient population at our institution. METHODS A total of 20 patients with either Berlin Heart EXCOR® or HeartWare® implantation were reviewed in this retrospective study. Study endpoints were survival to heart transplant, weaning due to recovery or death. Thrombotic events were defined as thrombus formation in the device or in the patient, or cardioembolic strokes. Bleeding events were defined as events requiring interventional surgery or transfusion of red blood cells. RESULTS The aetiology of heart failure included cardiomyopathy (n = 12), end-stage congenital heart disease (n = 6) and myocarditis (n = 2). Of the 20 patients, 12 were bridged to transplant, 7 recovered and could be weaned and 1 died. The median duration of mechanical support was 84 days (range: 20-524 days). At least one major or minor bleeding event occurred in 45% of the patients. Thrombotic events occurred 21 times in 10 patients. Four of the patients (20%) had no bleeding or thromboembolic event. CONCLUSION In all, 95% of the patients were successfully bridged to transplant or recovery. Bleeding events and thrombotic events were common.
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Affiliation(s)
- Birgitta Romlin
- Department of Paediatric Anaesthesiology and Intensive Care Queen Silvia Children's Hospital Gothenburg Sweden
- Department of Anaesthesiology and Intensive Care Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Anna Dahlin
- Department of Paediatric Anaesthesiology and Intensive Care Queen Silvia Children's Hospital Gothenburg Sweden
| | - Stefan Hallhagen
- Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Kerstin Björk
- Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Håkan Wåhlander
- Paediatric Heart Centre Queen Silvia Children's Hospital Gothenburg Sweden
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Fredrik Söderlund
- Department of Paediatric Anaesthesiology and Intensive Care Queen Silvia Children's Hospital Gothenburg Sweden
- Department of Anaesthesiology and Intensive Care Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
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5
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Blomqvist LRF, Strandell AM, Jeppsson A, Hellgren MSE. Arachidonic acid-induced platelet aggregation and acetylsalicylic acid treatment during pregnancy in women with recurrent miscarriage, a post hoc study. Platelets 2021; 33:278-284. [PMID: 33646930 DOI: 10.1080/09537104.2021.1883573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this post hoc study, arachidonic acid (AA)-induced platelet aggregation during pregnancy with and without acetylsalicylic acid (ASA) treatment was studied in 323 women with unexplained recurrent first-trimester miscarriage and in 59 healthy women with normal pregnancies. All women had normal AA-induced platelet aggregation in the non-pregnant state. Women with recurrent miscarriage were treated with 75 mg ASA or placebo daily. AA-induced platelet aggregation was measured with multiple electrode impedance aggregometry and presented in units (U), where 1 U = 10 aggregation units x minutes. There were no significant differences in platelet aggregation between placebo-treated women with recurrent miscarriage and healthy women. The mean differences were-0.7 (95%CI; -7.0; 5.6) U in the non-pregnant state, 3.8 (95%CI; -4.6; 12.2) U during the late first trimester and 1.7 (95%CI; -6.7; 10.3) U and 4.1 (95%CI; -3.9; 12.0) U during the early and late third trimester, respectively. ASA reduced platelet aggregation by median -84.0% (Q1; Q3; -89.8; -76.3), -79.9% (-84.7; -69.2) and -75.7% (-83.5; -49.5), respectively, during pregnancy. The degree of inhibition by ASA decreased during the third trimester (p < .0001). There were two (1.9%) complete non-responders to ASA and 32.1% with a partial response. The rate of subsequent miscarriage was not affected by ASA, which did not seem to influence the rate of early miscarriage if treatment was initiated when a viable pregnancy was detectable by ultrasound.
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Affiliation(s)
- Lennart R F Blomqvist
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Södra Älvsborg Hospital, Borås, Sweden
| | - Annika M Strandell
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margareta S E Hellgren
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
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6
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Bagger H, Hansson M, Kander T, Schött U. Synergistic platelet inhibition between Omega-3 and acetylsalicylic acid dose titration; an observational study. BMC Complement Med Ther 2020; 20:204. [PMID: 32615977 PMCID: PMC7331184 DOI: 10.1186/s12906-020-02990-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Omega-3 and acetylsalicylic acid (ASA) are two widely used "over-the-counter" drugs. Previous research has shown multiple electrode aggregometry (MEA) can detect ASA and varying Omega-3 platelet inhibiting effects. Synergistic platelet inhibiting effects of ASA and Omega-3 have been found using other methods than MEA. The aim of this study was to investigate the antiplatelet effects of Omega-3, and ASA synergism with MEA. METHODS Ten healthy male volunteers ingested Omega-3 (1260 mg/day) for 5 days. MEA was used to analyse platelet function before and after Omega-3 intake. Aggregation was initiated using three different agonists and measured as area under the curve (AUC): adenosine diphosphate (ADP), thrombin receptor activating peptide (TRAP) and arachidonic acid (ASPI). Two concentrations of ASA were dose titrated ex vivo to 2 out of 3 ASPI test cells in order to measure synergism between Omega-3 and ASA. RESULTS Following 5 days Omega-3 intake, ADP, TRAP and ASPI AUC did not change significantly. In vitro ASA before Omega-3 intake, reduced ASPI AUC < 30 U, indicating a strong platelet inhibiting effect. Below this AUC level, the 5 days Omega-3 intake increased ASPI-AUC with the ex vivo added low dose ASA (P = 0.02) and high dose ASA (P = 0.04). CONCLUSIONS No synergism between ASA and Omega-3 was found using the MEA ASPI test. The surprising increase in ASPI-AUC following Omega-3 intake and ex vivo ASA suggest that there are methodological issuses with the MEA ASPI test. TRIAL REGISTRATION Trial registration ISRCTN78027929 . Registered 19 May 2015.
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Affiliation(s)
- Harald Bagger
- Institution of Clinical Science, Medical Faculty, Lund University, S-22185, Lund, Sweden
| | - Mattias Hansson
- Institution of Clinical Science, Medical Faculty, Lund University, S-22185, Lund, Sweden
| | - Thomas Kander
- Institution of Clinical Science, Medical Faculty, Lund University, S-22185, Lund, Sweden
- Department of Anaesthesiology and Intensive Care, Skane University Hospital, S-22185, Lund, Sweden
| | - Ulf Schött
- Institution of Clinical Science, Medical Faculty, Lund University, S-22185, Lund, Sweden.
- Department of Anaesthesiology and Intensive Care, Skane University Hospital, S-22185, Lund, Sweden.
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Tofler GH, Morel-Kopp MC, Spinaze M, Dent J, Ward C, McKinley S, Mihailidou AS, Havyatt J, Whitfield V, Bartrop R, Fethney J, Prigerson HG, Buckley T. The effect of metoprolol and aspirin on cardiovascular risk in bereavement: A randomized controlled trial. Am Heart J 2020; 220:264-272. [PMID: 31923768 DOI: 10.1016/j.ahj.2019.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 11/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bereavement is associated with an increased risk of cardiovascular disease; however, no reports exist of interventions to reduce risk. In a randomized, double-blind, placebo-controlled trial of 85 recently bereaved participants, we determined whether β-blocker (metoprolol 25 mg) and aspirin (100 mg) reduce cardiovascular risk markers and anxiety, without adversely affecting bereavement intensity. METHODS Participants were spouses (n = 73) or parents (n = 12) of deceased from 5 hospitals in Sydney, Australia, 55 females, 30 males, aged 66.1 ± 9.4 years. After assessment within 2 weeks of bereavement, subjects were randomized to 6 weeks of daily treatment or placebo, and the effect evaluated using ANCOVA, adjusted for baseline values (primary analysis). RESULTS Participants on metoprolol and aspirin had lower levels of home systolic pressure (P = .03), 24-hour average heart rate (P < .001) and anxiety (P = .01) platelet response to arachidonic acid (P < .001) and depression symptoms (P = .046) than placebo with no difference in standard deviation of NN intervals index (SDNNi), von Willebrand Factor antigen, platelet-granulocyte aggregates or bereavement intensity. No significant adverse safety impact was observed. CONCLUSIONS In early bereavement, low dose metoprolol and aspirin for 6 weeks reduces physiological and psychological surrogate measures of cardiovascular risk. Although further research is needed, results suggest a potential preventive benefit of this approach during heightened cardiovascular risk associated with early bereavement.
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Affiliation(s)
- Geoffrey H Tofler
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia.
| | - Marie-Christine Morel-Kopp
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia; Kolling Institute, St Leonards, NSW, Autralia
| | - Monica Spinaze
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Jill Dent
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Christopher Ward
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | | | - Anastasia S Mihailidou
- Royal North Shore Hospital, St Leonards, NSW, Autralia; Kolling Institute, St Leonards, NSW, Autralia; Macquarie University, Sydney, NSW, Autralia
| | - Jennifer Havyatt
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Victoria Whitfield
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Roger Bartrop
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | | | | | - Thomas Buckley
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia; Weill Cornell Medicine, New York, NY, U.S.A
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8
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Katzman BM, Wockenfus AM, Scott RJ, Bryant SC, Jaffe AS, Karon BS. Estimating short- and long-term reference change values and index of individuality for tests of platelet function. Clin Biochem 2019; 74:54-59. [PMID: 31669512 DOI: 10.1016/j.clinbiochem.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND In order to manage risks of bleeding and thrombosis after some surgical procedures, platelet function is often measured repeatedly over days or weeks using laboratory tests of platelet function. To interpret test results in the perioperative period, it is necessary to understand analytical, biological and between-person variation. METHODS We collected three separate blood specimens from 16 healthy volunteers on the first study day, and one additional specimen from each volunteer 1, 2, and 3 months later. Arachidonic acid-induced and adenosine diphosphate (ADP)-induced platelet function were measured in duplicate by whole blood impedance aggregometry using Multiplate (ASPI/ADP tests) and VerifyNow (Aspirin Reaction Units [ARU] and P2Y12 Reaction Units [PRU]). The analytical variation (CVA), within-subject variation (CVI), between-subject variation (CVG), index of individuality (II), and reference change values (RCV) were calculated. RESULTS VerifyNow ARU demonstrated the smallest short-term and long-term variability (CVA, CVI, and CVG ~1%), resulting in short- and long-term RCV values <5%. II was also higher (1.92) for VerifyNow ARU than other platelet function tests. Multiplate ASPI and ADP tests had the highest RCV both short-(19.0% and 25.2%, respectively) and long-term (32.1% and 39.6%, respectively) due to increased CVA (>5%) and CVI (3.9-13.1%). VerifyNow PRU had a lower RCV than Multiplate ADP; but was the only test with II <0.6. CONCLUSIONS VerifyNow ARU results can be interpreted relative to a fixed cut-off or population-based reference interval; or relative to small changes in an individual's previous values. VerifyNow PRU and Multiplate ASPI and ADP tests should only be interpreted based upon relative change; and can only distinguish relatively large (>23%) changes over several weeks.
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Affiliation(s)
- Brooke M Katzman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Amy M Wockenfus
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Renee J Scott
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Sandra C Bryant
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Department of Cardiology, Mayo Clinic, Rochester, MN, United States
| | - Brad S Karon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
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9
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Gäckler A, Rohn H, Lisman T, Benkö T, Witzke O, Kribben A, Saner FH. Evaluation of hemostasis in patients with end-stage renal disease. PLoS One 2019; 14:e0212237. [PMID: 30785941 PMCID: PMC6382154 DOI: 10.1371/journal.pone.0212237] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/29/2019] [Indexed: 02/06/2023] Open
Abstract
An increased bleeding risk is reported for patients with end-stage renal disease. This study aims to analyze, whether bleeding risk can be assessed by global tests of hemostasis. Standard laboratory tests and an extended evaluation of hemostasis by rotational thromboelastometry, platelet function analyzer (PFA) and multiple electrode aggregometry as well as thrombin generation assays and measurement of fibrinolytic potential were performed in 20 patients on hemodialysis, 10 patients on peritoneal dialysis, 10 patients with chronic kidney disease stage G5 (CKD5) and in 10 healthy controls (HC). Hemoglobin was significantly lower in patients with end-stage renal disease versus HC (each p<0.01). Patients on peritoneal dialysis showed increased fibrinogen levels compared to HC (p<0.01), which were also reflected by FIBTEM results (each p<0.05). 41% of hemodialysis patients and 44% of CKD5 patients presented with prolonged PFA-ADP-test (p<0.05), while no patient on peritoneal dialysis and no HC offered this modification. Thrombin generating potential was significantly lower in patients on hemodialysis, while clot lysis time revealed a hypofibrinolytic state in patients on hemo- and peritoneal dialysis compared to HC (p<0.001). In conclusion, patients with end-stage renal disease have complex hemostatic changes with both hyper- and hypocoagulable features, which are dependent on use and type of dialysis. Hypercoagulable features include elevated fibrinogen levels and a hypofibrinolytic state, whereas hypocoagulable features include decreased thrombin generating capacity and platelet dysfunction. Our results may contribute to a more rational approach to hemostatic management in these patients.
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Affiliation(s)
- Anja Gäckler
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- * E-mail:
| | - Hana Rohn
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ton Lisman
- Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen University Medical Center Groningen, Groningen, The Netherlands
| | - Tamas Benkö
- Department of General, Visceral and Transplant Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Fuat H. Saner
- Department of General, Visceral and Transplant Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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10
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Dallaku K, Shakur-Still H, Beaumont D, Roberts I, Huque S, Delius M, Holdenrieder S, Gliozheni O, Mansmann U. No effect of tranexamic acid on platelet function and thrombin generation (ETAPlaT) in postpartum haemorrhage: a randomised placebo-controlled trial. Wellcome Open Res 2019; 4:21. [PMID: 31223662 PMCID: PMC6556984 DOI: 10.12688/wellcomeopenres.14977.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. To determine whether TXA has pro-thrombotic effects in women with PPH, we measured endogenous thrombin potential (ETP), coagulation factors V, VIII, von Willebrand (vW), fibrinogen, D-Dimers and platelet function. Methods: We conducted a sub-study within the WOMAN trial, an international randomized, parallel-group, double blind, placebo-controlled trial. Women with primary PPH were randomly allocated to receive 1 gram of tranexamic acid or matching placebo. Baseline blood samples were collected just prior to the first dose and a follow up sample was collected 30±15 minutes afterwards. We compared before and after changes in coagulation parameters between treatment groups using repeated measurement ANOVA. Change in ETP was the primary outcome. We did an intention-to-treat analysis using ANCOVA with adjustment for baseline and the time interval between the blood samples. Findings: A total of 187 patients were randomized to receive TXA (n=93) or matching placebo (n=94). Six patients were excluded due to incomplete data. The reduction in ETP from baseline to follow up was 43.2 nM*min (95%CI, -16.6 to 103.1) in the TXA group and 4.6 nM*min (95%CI, -51.4 to 60.6) in the placebo group. The difference was not statistically significant (95%CI, -42.9 to 120). There were no significant effects of TXA treatment on any other parameters (ADPtest, TRAPtest, coagulation factors activity, fibrinogen levels, D-Dimer level). Conclusion: We found no evidence that tranexamic acid treatment for PPH has substantial pro-coagulant effects. However, larger studies are needed to confirm or refute more modest effects. Trial registration: ISRCTN76912190 (initially registered 10/12/2008, WOMAN-ETAPlat included on 28/10/2013) and NCT00872469 (initially registered 31/03/2009, WOMAN-ETAPlat included on 28/10/2013).
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Affiliation(s)
- Kastriot Dallaku
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital LMU, Munich, Germany.,University Hospital of Obstetrics Gynaecology "Koço Gliozheni", Tirana, Albania
| | | | - Danielle Beaumont
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Sumaya Huque
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Delius
- Department of Obstetrics and Gynaecology, University Hospital LMU, Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Center of the Technical University Munich, Munich, Germany
| | - Orion Gliozheni
- University Hospital of Obstetrics Gynaecology "Koço Gliozheni", Tirana, Albania
| | - Ulrich Mansmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital LMU, Munich, Germany
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Blomqvist LRF, Strandell AM, Baghaei F, Hellgren MSE. Platelet aggregation in healthy women during normal pregnancy - a longitudinal study. Platelets 2018; 30:438-444. [DOI: 10.1080/09537104.2018.1492106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lennart Rune Fredrik Blomqvist
- Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Södra Älvsborg Hospital, Borås, Sweden
| | - Annika Margareta Strandell
- Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fariba Baghaei
- Department of Medicine/Haematology and Coagulation Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margareta Sofia Elisabet Hellgren
- Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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Roullet S, Labrouche S, Carrie C, Auque H, Berard X, Freyburger G. Multiplate ® evaluation of acetylsalicylic acid efficacy in carotid surgery: routine and genetic influencing factors. J Thromb Haemost 2018; 16:583-591. [PMID: 29314596 DOI: 10.1111/jth.13943] [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: 10/03/2017] [Indexed: 11/30/2022]
Abstract
Essentials Acetylsalicylic acid (ASA) is prescribed to patients scheduled for carotid endarterectomy (CEA). We measured ASA efficacy during CEA by Multiplate® and searched for influencing factors. Most patients scheduled for CEA and treated by ASA are sensitive to this therapy. Influencing genomic factors are involved in ASA metabolism and in platelet function modulations. SUMMARY Background Acetylsalicylic acid (ASA) is recommended before, during and after carotid endarterectomy (CEA). The efficacy of ASA is influenced by numerous biological and genotypic factors. Objectives To determine the biological efficacy of ASA by using the Multiplate® method, and to explore the biological parameters and genomic factors influencing this efficacy. Methods This descriptive cross-sectional study included all patients scheduled for CEA between January 2012 and April 2013. Multiplate® tests were performed at day 0 and day 30. A set of 66 single-nucleotide polymorphisms (SNPs) from 38 genes or DNA regions were selected and studied along with phenotypic parameters by the use of hierarchical clustering (HC) for multidimensional data management. Results Fifty-five patients receiving ASA were analyzed. Of the patients, 95% were found to be sensitive to ASA, with values under the threshold of normality (400 AU min-1 ). However, there were notable differences in residual aggregation among subjects over a wide range. HC revealed four subclusters comprising three categories of parameters: (i) routine and functional parameters - in ASA-treated patients, the ASPItest was highly linked to the ADPtest, to platelet count, and, to a lesser extent, to fibrinogen and hematocrit; (ii) polymorphisms in genes involved in ASA absorption and in the arachidonic acid pathway (ABCB1 and COX-1); and (iii) polymorphisms in genes modulating basal platelet function, i.e. TBXA2R, ADRA2A, PEAR1, ITGA2 and ITGB1. Conclusion Most patients treated with ASA before CEA were sensitive to it, according to Multiplate® ASPItest results. Genomic factors influencing this efficacy are SNPs involved in ASA absorption and metabolic pathway, and in modulations in basal platelet function.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B/genetics
- Aged
- Aged, 80 and over
- Aspirin/therapeutic use
- Carotid Arteries/surgery
- Cluster Analysis
- Cyclooxygenase 1/genetics
- Endarterectomy, Carotid/methods
- Female
- Fibrinogen/analysis
- Genomics
- Hematocrit
- Humans
- Integrin alpha2/genetics
- Integrin beta1/genetics
- Male
- Middle Aged
- Platelet Aggregation/drug effects
- Platelet Aggregation Inhibitors/therapeutic use
- Platelet Count
- Platelet Function Tests
- Polymorphism, Genetic
- Polymorphism, Single Nucleotide
- Receptors, Adrenergic, alpha-2/genetics
- Receptors, Cell Surface/genetics
- Receptors, Thromboxane A2, Prostaglandin H2/genetics
- Sequence Analysis, DNA
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Affiliation(s)
- S Roullet
- CHU Bordeaux, Service Anesthésie Réanimation I, Bordeaux, France
- Université Bordeaux, Inserm U 12-11, Bordeaux, France
| | - S Labrouche
- CHU Bordeaux, Laboratoire Hématologie-PTRR, Bordeaux, France
- Université Bordeaux, Inserm U 10-34, Bordeaux, France
| | - C Carrie
- CHU Bordeaux, Service Anesthésie Réanimation I, Bordeaux, France
| | - H Auque
- CHU Bordeaux, Service de chirurgie vasculaire, Bordeaux, France
| | - X Berard
- CHU Bordeaux, Service de chirurgie vasculaire, Bordeaux, France
- Université Bordeaux, Inserm U 10-26, Bordeaux, France
| | - G Freyburger
- CHU Bordeaux, Laboratoire Hématologie-PTRR, Bordeaux, France
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13
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Kadam P, Lim J, Paver I, Connor DE, Parsi K. Telangiectatic Matting is Associated with Hypersensitivity and a Bleeding Tendency. Eur J Vasc Endovasc Surg 2018; 55:554-559. [PMID: 29409702 DOI: 10.1016/j.ejvs.2017.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/14/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim was to investigate the pathogenesis of telangiectatic matting (TM) and identify possible risk factors. METHODS This study had two parts. The clinical records of consecutive patients were retrospectively analysed to identify risk factors for TM. In the second part, the haemostatic and coagulation profile of the subset of patients with TM were analysed and compared with controls using standard coagulation tests, platelet function and a global assay of coagulation (rotational thromboelastometry, ROTEM). RESULTS In 352 consecutive patients presenting to a phlebology practice, 25 patients had TM (7.1%). All 25 patients were female with the median age of 45 (27-57) years. A comprehensive medical history was taken. Among 27 possible risk factors assessed, statistically significant associations included recurrent epistaxis, easy bruising, hypersensitivity (eczema, hives, hay fever, and rhinitis), previous treatment with sclerotherapy or endovenous laser for lower limb veins, and a family history of telangiectasias. Variables not associated with TM included oral contraceptive intake, hormone replacement therapy, and age. The haemostatic and coagulation profile of 12 patients (6 male and 6 female) with TM did not differ significantly from those without TM. CONCLUSION TM is associated with both hypersensitivity and a bleeding tendency. This study revealed no significant increase in the incidence of haemostatic abnormalities in patients with TM compared with the control group. Given the significant association with hypersensitivity disorders, the underlying mast cell hyper-reactivity may contribute to both hypersensitivity and a bleeding tendency and predispose patients to TM.
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Affiliation(s)
- Pooja Kadam
- Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, Australia; Department of Dermatology, St Vincent's Hospital, Darlinghurst, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jerrick Lim
- Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ian Paver
- Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - David E Connor
- Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kurosh Parsi
- Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, Australia; Department of Dermatology, St Vincent's Hospital, Darlinghurst, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
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14
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Eichenlaub M, Pfeufer A, Behrens L, Klauss V, Roettinger M, Brodherr T, Lewalter T. REduction of THRomboembolic EVents during Ablation using the laserballoon: The RETHREVA registry. J Cardiovasc Electrophysiol 2018; 29:365-374. [PMID: 29315961 DOI: 10.1111/jce.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/25/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Cerebral events (CEs), including silent (SCEs), are a known complication of left atrial catheter ablation (LACA) in patients with atrial fibrillation. The aim of this prospective registry was to gain more information about CEs during laserballoon LACA and to reduce the risk of their occurrence. METHODS AND RESULTS We enrolled 74 patients (age 61 ± 11 years; 74% male; CHA2 DS2 -VASc 1.9 ± 1.4). Cerebral MRI (1.5 Tesla) was performed to detect CEs. ASPItest identified aspirin-resistant patients (ARPs). All bleeding complications were recorded. Due to an initial high CE rate, we evolved our clinical procedure step-by-step arriving at an optimized protocol: -Group 1: heparin after single transseptal puncture (TP), activated clotting time (ACT) > 300 seconds (CE: 64.3%). -Group 2: heparin after double TP, ACT > 300 seconds; 2a without (CE: 45.5%, RRR: -29.2%) and 2b with additional intravenous aspirin (CE: 36.4%, RRR: -43.4%; excluding ARP: 30%, RRR: -53.3%). -Group 3: heparin before double TP, ACT > 350 seconds; 3a without (CE: 54.5%, RRR: -15.2%) and 3b with aspirin (CE: 18.5%, RRR: -71.2%; excluding ARP: 8.7%, RRR: -86.5%). Larger LA diameter > 44 mm (OR: 1.149, P = 0.005) and no aspirin use (OR: 4.308, P = 0.008) were CE risk factors in multivariate logistic regression. In those patients receiving aspirin, aspirin resistance (OR: 22.4, P = 0.011) was an exceptionally strong risk factor. CONCLUSION These data support the use of intravenous aspirin including monitoring of aspirin resistance in addition to ACT-guided heparin. An optimized protocol of heparin before TP, double TP, and intravenous aspirin in non-ARP resulted in a significantly lowered CE incidence and severity.
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Affiliation(s)
- Martin Eichenlaub
- Isar Heart Center, Munich, Germany.,Peter Osypka Heart Center, Munich, Germany.,Department of Cardiology, University Hospital Bonn, Germany
| | - Arne Pfeufer
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum Munich, Germany
| | | | | | | | | | - Thorsten Lewalter
- Isar Heart Center, Munich, Germany.,Peter Osypka Heart Center, Munich, Germany.,Department of Cardiology, University Hospital Bonn, Germany
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15
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The incidence of aspirin resistance in heart transplantation recipients. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:115-119. [PMID: 28747943 PMCID: PMC5519837 DOI: 10.5114/kitp.2017.68742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/15/2017] [Indexed: 11/17/2022]
Abstract
Introduction Coronary allograft vasculopathy can cause as many deaths as infections or rejection episodes within 3 years following heart transplantation. Aim To compare the aspirin resistance rate in an allograft heart transplantation population and in a control group by laboratory tests including the Aspirin-Resistant Patients Identification Test (ASPItest). Material and methods A total of 24 heart recipients (20 men and 4 women) at a mean age of 48 ±13 years who underwent routine clinical follow-up were consecutively enrolled in group 1. The control group consisted of 24 patients (19 men and 5 women) at a mean age of 64 ±7 years waiting for coronary artery bypass grafting in our department. All patients were treated with a standard dose of 75 mg aspirin (ASA) daily. Results Aspirin resistance was evaluated by the Multiplate platelet function test. The ASPItest revealed a mean value of 27 ±22 U in the transplant group. Results above 30 U were obtained in 8 (34%) patients, with a mean value of 50.3 ±20.6 U, indicating aspirin resistance. In the control group ASPItest results above 30 U were obtained in 5 (20%) patients, with a mean value of 43.3 ±6.4 U. Conclusions There is a high incidence (34% vs. 20%, NS) of ASA resistance in heart transplantation recipients and in the general population, respectively.
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Wand S, Adam EH, Wetz AJ, Meybohm P, Kunze-Szikszay N, Zacharowski K, Popov AF, Moritz A, Moldenhauer L, Kaiser J, Bauer M, Weber CF. The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac Surgery: A Prospective Bicentric Study. Clin Appl Thromb Hemost 2017; 24:179-185. [PMID: 28301911 DOI: 10.1177/1076029617693939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We aimed to identify the prevalence of acetylsalicylic acid (ASA) nonresponse in patients after coronary artery bypass graft (CABG) surgery and the possible consequences for the rate of major cardiovascular events. This prospective, observational, bicentric cohort study was conducted in two German University hospitals. A total of 400 patients (200 in each study center) undergoing elective CABG surgery were enrolled after written informed consent. Platelet function was analyzed on day 3 (d3) and day 5 (d5) postoperatively following stimulation with arachidonic acid (ASPItest) and with thrombin receptor-activating peptide 6 (TRAPtest) using multiple electrode aggregometry (Multiplate). Individuals with an ASPItest ≥40 AU·min were categorized as ASA nonresponders. A 1-year follow-up recorded the combined end point of cardiovascular events, hospital admissions, or deaths related to cardiovascular disease. The prevalence of ASA nonresponse was 51.5% on d3, and it significantly increased to 71.3% on d5 ( P = .0049). The area under the aggregation curve in the TRAPtest ( P < .0001), the platelet count on d5 ( P = .009), and the cardiopulmonary bypass time ( P = .01) were identified as independent predictors of an ASA nonresponse. A 1-year follow-up recorded 54 events fulfilling criteria for the combined end point with no difference between ASA responders and nonresponders. This study indicates a high incidence of perioperative ASA nonresponse in patients following CABG. No effect on the incidence of cardiovascular events was recorded in the 1-year follow-up. Therefore, a randomized dosage adjustment trial should elucidate whether a tailored ASA treatment after CABG surgery represents a useful concept.
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Affiliation(s)
- Saskia Wand
- 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Elisabeth Hannah Adam
- 2 Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anna Julienne Wetz
- 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Patrick Meybohm
- 2 Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Nils Kunze-Szikszay
- 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Kai Zacharowski
- 2 Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Aron Frederick Popov
- 3 Department of Thoracic and Cardiovascular Surgery, University Medical Center Göttingen, Göttingen, Germany.,4 Department for Cardiothoracic and Vascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anton Moritz
- 4 Department for Cardiothoracic and Vascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lisa Moldenhauer
- 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Kaiser
- 2 Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Martin Bauer
- 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
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17
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Durán J, Peloquin C, Zhang Y, Felson DT. Primary Prevention of Myocardial Infarction in Rheumatoid Arthritis Using Aspirin: A Case-crossover Study and a Propensity Score–matched Cohort Study. J Rheumatol 2017; 44:418-424. [DOI: 10.3899/jrheum.160930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/22/2022]
Abstract
Objective.Subjects with rheumatoid arthritis (RA) are at higher risk of developing cardiovascular disease, which is their leading cause of death. Conflicting evidence exists regarding the efficacy of aspirin (ASA) as primary prevention. We evaluated whether a protective association exists between ASA and myocardial infarction (MI) in RA subjects.Methods.In the United Kingdom, persons age ≥ 60 years receive free ASA by prescription and 75% of use is by prescription. Subjects ≥ 60 years with RA in the population-based The Health Improvement Network database constituted our study population. We excluded patients with history of MI, angina, stroke, peripheral vascular disease, or coronary artery procedures. Our main outcome was the occurrence of fatal and nonfatal MI. We performed a case-crossover study with each subject contributing a hazard period and a control period 90 days prior to the MI. In addition, to minimize confounding by indication, a propensity score (PS)–matched cohort study was performed, considering all patients with RA with an incident prescription of low-dose ASA as our exposed group.Results.We did not find a protective effect in the case-crossover study (OR 1.83, 95% CI 0.71–4.71), with 55 subjects exposed in the hazard period and 44 in the control period. Similarly, among 1836 subjects included in the PS-matched cohort study (918 ASA users and 918 ASA non-users), we did not find a protective effect of low ASA on MI (HR 1.39, 95% CI 0.87–2.23).Conclusion.We did not find a protective effect of ASA on MI in patients with RA when used as primary prophylaxis.
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Vlot EA, Meents N, van de Garde EM, Hackeng CM, Noordzij PG. Early Point-of-Care Platelet Function Testing Using Multiple Electrode Aggregometry in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 30:e56-e58. [DOI: 10.1053/j.jvca.2016.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Indexed: 11/11/2022]
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19
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Assessment of the Hemostatic Parameters and Platelet Function on Thromboelastometry and Impedance Aggregometry in Hemodialysis Patients Qualified for Kidney Transplantation: Preliminary Report. Transplant Proc 2016; 48:1431-4. [DOI: 10.1016/j.transproceed.2016.02.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/04/2016] [Accepted: 02/24/2016] [Indexed: 11/23/2022]
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20
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Tauber H, Streif W, Fritz J, Ott H, Weigel G, Loacker L, Heinz A, Velik-Salchner C. Predicting Transfusion Requirements During Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2016; 30:692-701. [PMID: 27321792 DOI: 10.1053/j.jvca.2016.01.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Patients requiring extracorporeal membrane oxygenation (ECMO) have a well-known bleeding risk and the potential for experiencing possibly fatal thromboembolic complications. Risk factors and predictors of transfusion requirements during ECMO support remain uncertain. The authors hypothesized that compromised organ function immediately before ECMO support will influence transfusion requirements. DESIGN A prospective observational study. SETTING A tertiary, single-institutional university hospital. PARTICIPANTS The study included 40 adult patients requiring ECMO for intractable cardiac and respiratory failure between July 2010 and December 2012. Blood samples were taken before initiation of ECMO (baseline), after 24 and 48 hours on ECMO, and 24 hours after termination of ECMO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Independent of veno-arterial or veno-venous support, 26% of patients required≥2 packed red blood cells per day (PRBC/d) and 74% of patients required<2 PRBC/d during ECMO. Requirements of≥2 PRBC/d during ECMO support were associated with higher creatinine levels and lower prothrombin times (PT, %) at baseline and with impaired platelet function after 24 hours on ECMO. Platelet function, activated by thrombin receptor-activating peptide stimulation, decreased by 30% to 40% over time on ECMO. Receiver operating characteristic curve analysis showed cut-off values for creatinine of 1.49 mg/dL (sensitivity 70%, specificity 70%; area under the curve [AUC] 0.76, 95% confidence interval [CI] 0.58-0.94), for PT of 48% (sensitivity 80%, specificity 59%; AUC 0.69, 95% CI 0.50-0.87), and for thrombin receptor-activating peptide (TRAP) 32 U (sensitivity 90%, specificity 68%; AUC 0.76, 95% CI 0.59-0.93). CONCLUSIONS The results of this study demonstrated that increased creatinine levels and lower PT before ECMO and secondary impaired platelet function significantly increased transfusion requirement.
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Affiliation(s)
- Helmuth Tauber
- Departments of Anaesthesiology and Critical Care Medicine
| | | | - Josef Fritz
- Medical Statistics, Informatics and Health Economics
| | - Helmut Ott
- Central Institute for Medical and Chemical Laboratory Diagnostics
| | - Guenter Weigel
- Central Institute for Medical and Chemical Laboratory Diagnostics
| | - Lorin Loacker
- Central Institute for Medical and Chemical Laboratory Diagnostics
| | - Anneliese Heinz
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Corinna Velik-Salchner
- Departments of Anaesthesiology and Critical Care Medicine; Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
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Muñoz M, Gómez-Ramírez S, Kozek-Langeneker S. Pre-operative haematological assessment in patients scheduled for major surgery. Anaesthesia 2015; 71 Suppl 1:19-28. [DOI: 10.1111/anae.13304] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 12/29/2022]
Affiliation(s)
- M. Muñoz
- Peri-operative Transfusion Medicine; School of Medicine; University of Málaga; Málaga Spain
| | - S. Gómez-Ramírez
- Department of Internal Medicine; Xanit International Hospital; Benalmádena Spain
| | - S. Kozek-Langeneker
- Department of Anaesthesia and Intensive Care; Evangelical Hospital; Vienna Austria
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Krüger JC, Meves SH, Kara K, Mügge A, Neubauer H. Monitoring ASA and P2Y12-specific platelet inhibition--comparison of conventional (single) and multiple electrode aggregometry. Scandinavian Journal of Clinical and Laboratory Investigation 2015; 74:568-74. [PMID: 25296945 DOI: 10.3109/00365513.2014.913305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Several platelet function test systems exist for the evaluation of the platelet inhibitory effect in patients on P2Y12 inhibitors and/or acetylsalicylic acid (ASA, aspirin) therapy. Studies comparing different available assays found only a poor correlation. The objective of the present study was to evaluate the correlation and agreement between single electrode (SEA) and multiple electrode (MEA) aggregometry. METHODS AND RESULTS In whole blood arachidonic acid (AA) and adenosine diphosphate (ADP)-induced platelet aggregation was measured simultaneously using SEA (Chrono-Log) and MEA (Multiplate). We analyzed a total of 226 measurements taken from 58 patients on single ASA therapy or dual antiplatelet therapy with ASA and a thienopyridine. A cut-off value for clopidogrel/prasugrel high on-treatment platelet reactivity (HPR) of > 47 units (U) was chosen for MEA testing using hirudin and > 5 Ohm for SEA with citrate anticoagulated blood samples. The respective cut-off values for ASA HPR were > 30 U for the MEA assay and > 1 Ohm for SEA testing. There was a good correlation of the prevalence of thienopyridine-HPR in both whole blood assays (Spearman rank correlation coefficient r = 0.698) and a good inter-rate accordance (Cohen's Kappa statistic κ = 0.648). For AA-induced aggregation, the correlation of the results obtained was significant (r = 0.536; p < 0.001) and detecting ASA-HPR revealed a moderate (κ = 0.482) correlation between both impedance aggregometry assays. CONCLUSION Platelet function testing using SEA and MEA provided both good accordance and correlation and therefore study results obtained by these two assays similarly enabled the detection of HPR of thienopyridine (and ASA) therapy.
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Intraoperative changes in platelet function in relation to moderate haemorrhage. Thromb Res 2015; 135:1198-202. [PMID: 25887634 DOI: 10.1016/j.thromres.2015.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 03/06/2015] [Accepted: 03/30/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Haemorrhage is associated with haemostatic dysfunction. Previous studies have focused on coagulation factors, but platelet function plays an equally important role. The time course of alterations in platelet function in relation to injurious stimuli is not known. AIM To evaluate short-term, intra-operative changes in platelet function, by whole blood impedance aggregometry in patients undergoing hip arthroplasty. The primary outcome was platelet aggregation in response to adenosine diphosphate (ADP) stimulation. We also evaluated other agonists, and the feasibility of conducting platelet aggregometry measurement in the operating theatre. METHODS Patients undergoing primary cemented hip arthroplasty had six peri-operative arterial blood samples analysed at pre-set stages of the operation, using the Multiplate Impedance Aggregometer. Four agonists were used: ADP, TRAP, Collagen and Arachidonic Acid. RESULTS There was a statistically significant change (p<0.05, ANOVA) in platelet response to ADP over the course of the operations. The trend demonstrated an initial decrease in responsiveness, followed by increased platelet responsiveness in the later stages. Other agonists (TRAP, COL, ASPItest) demonstrated a similar pattern of changes. Of 360 tests conducted, 12 (3.3%) had to be re-run due to poor intra-assay variability. Satisfactory values were obtained on the second attempt in all 12 samples. CONCLUSION Platelet function, as measured by impedance aggregometry, changes in response to a surgical stimulus involving blood loss. The clinical significance of these changes, and the potential of manipulating them for therapeutic purposes, remains to be elucidated.
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Karon BS, Tolan NV, Koch CD, Wockenfus AM, Miller RS, Lingineni RK, Pruthi RK, Chen D, Jaffe AS. Precision and Reliability of 5 Platelet Function Tests in Healthy Volunteers and Donors on Daily Antiplatelet Agent Therapy. Clin Chem 2014; 60:1524-31. [DOI: 10.1373/clinchem.2014.226332] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Anticoagulation protocols used during mechanical circulatory support call for titration of antiplatelet agents. We compared the precision and reliability of 5 platelet function tests in healthy volunteers and donors on daily antiplatelet therapy to distinguish their efficacy for titrating antiplatelet therapy.
METHODS
We assessed arachidonic acid–induced platelet function by light transmission aggregometry (LTA), Multiplate impedance aggregometry, VerifyNow, and platelet mapping by thromboelastography (TEG PM). We assessed ADP-induced platelet function by the same methods and flow cytometry. Forty healthy volunteers and 10–13 volunteers on daily aspirin and/or clopidogrel therapy were evaluated. We compared tests for intraassay precision, interassay precision (samples from 2 separate blood draws), and reliability coefficient.
RESULTS
For arachidonic acid–induced platelet aggregation in healthy volunteers, intra- and interassay CVs were ≤10% for all methods. Intra- and interassay precision among donors on daily aspirin was ≤30% for all methods except LTA (38% interassay CV) and TEG PM (95% intraassay and 104% interassay CV). For ADP-induced platelet function, intra- and interassay precision was ≤10% and ≤30% for all methods. Only Multiplate demonstrated moderate or greater (R > 0.40) reliability coefficients for arachidonic acid–induced platelet function among all subjects. All methods of ADP-induced platelet function, except TEG PM, demonstrated substantial or greater (R > 0.60) reliability among all subjects.
CONCLUSIONS
TEG PM is least suited to monitor effects of antiplatelet agents. Multiplate impedance aggregometry was the only method to demonstrate an acceptable reliability coefficient among healthy volunteers and donors on both aspirin and clopidogrel therapy.
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Affiliation(s)
- Brad S Karon
- Department of Laboratory Medicine and Pathology and
| | - Nicole V Tolan
- Current address: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | | | | | - Ravi K Lingineni
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Dong Chen
- Department of Laboratory Medicine and Pathology and
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Romlin B, Söderlund F, Wåhlander H, Nilsson B, Baghaei F, Jeppsson A. Platelet count and function in paediatric cardiac surgery: a prospective observational study. Br J Anaesth 2014; 113:847-54. [DOI: 10.1093/bja/aeu194] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Aspirin Treatment and Outcomes After Percutaneous Coronary Intervention. J Am Coll Cardiol 2014; 64:863-71. [DOI: 10.1016/j.jacc.2014.05.049] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/09/2014] [Accepted: 05/12/2014] [Indexed: 12/21/2022]
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Shams Hakimi C, Hesse C, Wallén H, Boulund F, Grahn A, Jeppsson A. In vitroassessment of platelet concentrates with multiple electrode aggregometry. Platelets 2014; 26:132-7. [DOI: 10.3109/09537104.2014.898141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Changes in response to antiaggregatory treatment in patients with myeloproliferative neoplasms: a sequential study using multiple electrode aggregometry. Blood Coagul Fibrinolysis 2014; 24:869-73. [PMID: 24176950 DOI: 10.1097/mbc.0b013e328364713a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the present study, we used multiple electrode aggregometry (MEA) to investigate the response to aspirin and clopidogrel treatment, and its potential changes over a long-time disease course in patients with myeloproliferative neoplasms (MPNs). arachidonic acid (ASPI), ADP, and thrombin receptor activating peptide (TRAP) tests were performed at two timepoints between 32-50 months in 21 patients with MPN and 1-46 months in 29 controls. We further checked the medical records of the participants to identify a potential correlation of changes in the treatment response with clinical events. In MPN, four out of 13 patients treated with 100 mg of aspirin, no patients receiving 50 mg of aspirin, and one out of five clopidogrel-treated patients showed a therapeutic antiplatelet effect. In the subsequent examinations, five patients changed from response to nonresponse or vice versa. Initial nonresponse and changes from an initial response to nonresponse were observed in six patients with thrombotic events. In the controls, 25 out of 26 aspirin-treated patients and two out of three clopidogrel-treated patients showed an initially adequate in-vitro response. Except from one patient changing from initial aspirin nonresponse to response, all controls showed a stable response state. One control with two ischemic strokes showed a nonresponse to clopidogrel. In conclusion, MEA detects the response to antiaggregatory treatment, as well as its changes during the disease course in patients with MPN. An initial or subsequent nonresponse was observed in patients with thrombotic events.
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Gasparovic H, Petricevic M, Kopjar T, Djuric Z, Svetina L, Biocina B. Impact of dual antiplatelet therapy on outcomes among aspirin-resistant patients following coronary artery bypass grafting. Am J Cardiol 2014; 113:1660-7. [PMID: 24666617 DOI: 10.1016/j.amjcard.2014.02.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 02/07/2014] [Accepted: 02/07/2014] [Indexed: 11/25/2022]
Abstract
Coronary artery bypass grafting is pivotal in the contemporary management of complex coronary artery disease. Interpatient variability to antiplatelet agents, however, harbors the potential to compromise the revascularization benefit by increasing the incidence of adverse events. This study was designed to define the impact of dual antiplatelet therapy (dAPT) on clinical outcomes among aspirin-resistant patients who underwent coronary artery surgery. We randomly assigned 219 aspirin-resistant patients according to multiple electrode aggregometry to receive clopidogrel (75 mg) plus aspirin (300 mg) or aspirin-monotherapy (300 mg). The primary end point was a composite outcome of all-cause death, nonfatal myocardial infarction, stroke, or cardiovascular hospitalization assessed at 6 months postoperatively. The primary end point occurred in 6% of patients assigned to dAPT and 10% of patients randomized to aspirin-monotherapy (relative risk 0.61, 95% confidence interval 0.25 to 1.51, p = 0.33). No significant treatment effect was noted in the occurrence of the safety end point. The total incidence of bleeding events was 25% and 19% in the dAPT and aspirin-monotherapy groups, respectively (relative risk 1.34, 95% confidence interval 0.80 to 2.23, p = 0.33). In the subgroup analysis, dAPT led to lower rates of adverse events in patients with a body mass index >30 kg/m(2) (0% vs 18%, p <0.01) and those <65 years (0% vs 10%, p = 0.02). In conclusion, the addition of clopidogrel in patients found to be aspirin resistant after coronary artery bypass grafting did not reduce the incidence of adverse events, nor did it increase the number of recorded bleeding events. dAPT did, however, lower the incidence of the primary end point in obese patients and those <65 years.
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Christensen KH, Grove EL, Würtz M, Kristensen SD, Hvas AM. Reduced antiplatelet effect of aspirin during 24 hours in patients with coronary artery disease and type 2 diabetes. Platelets 2014; 26:230-5. [DOI: 10.3109/09537104.2014.901497] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Lee J, Kim JK, Kim JH, Dunuu T, Park SH, Park SJ, Kang JY, Choi RK, Hyon MS. Recovery time of platelet function after aspirin withdrawal. Curr Ther Res Clin Exp 2014; 76:26-31. [PMID: 25031665 PMCID: PMC4008770 DOI: 10.1016/j.curtheres.2014.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 01/15/2023] Open
Abstract
Introduction Inappropriate antiplatelet therapy discontinuation increases the risk of thrombotic complications and bleeding after dental procedures. To determine the platelet reactivity recovery time after aspirin withdrawal in vivo, our study was conducted in patients with low-risk cardiovascular disease who can stop aspirin administration following the guidelines stipulated by the American College of Chest Physicians. The time it takes for platelet activity to normalize and the diagnostic accuracy of testing methods were assessed for a residual antiplatelet activity with multiple electrode aggregometry. Our study included patients with clinically indicated hypertension preparing for a dental extraction procedure. Materials and methods A total of 212 patients not taking aspirin (control group) and 248 patients with hypertension receiving long-time aspirin treatment at a 100-mg daily dose were prospectively included in the study, which involved stopping aspirin intake before dental extraction. The residual platelet activity and dental bleeding in patients who stopped aspirin intake were analyzed and compared with those of the control group. In addition, platelet reactivity recovery time and bleeding risk in patients who stopped taking aspirin every 24 hours for 0 to 5 days (0–143 hours) before dental extraction was also assessed. Results Platelet reactivity normalized 96 hours after aspirin withdrawal. The cut-off value of 49 arbitrary units in the arachidonic acid platelet aggregation test excluded the effect of aspirin with 91% sensitivity and 66% specificity. AUC showed 0.86 (P < 0.001) diagnostic accuracy. The immediate bleeding complications in all treatment groups were similar to those seen in the control group and were successfully managed with local hemostatic measures. Conclusions The antiplatelet effects of aspirin disappeared 96 hours after aspirin withdrawal in our study, and dental extractions may be safely performed in this period when appropriate local hemostatic measures are taken. Based on these results, a shorter aspirin intake cessation period may be allowable in complex dental procedures and surgery for which a longer aspirin intake cessation period (7–10 days) is recommended based on the American College of Chest Physicians guidelines.
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Affiliation(s)
- Jeonghun Lee
- Cardiovascular Interventional Center, Sun General Hospital, Daejeon, Korea
| | - Jeong Kyung Kim
- Cardiovascular Interventional Center, Sun General Hospital, Daejeon, Korea
| | - Jeong Hee Kim
- Cardiovascular Interventional Center, Sun General Hospital, Daejeon, Korea
| | - Tsagaan Dunuu
- Intensive Care Unit and Department of Emergency, Shastin Central Hospital, Ulaanbaatar, Mongolia
| | - Sang-Ho Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sang Joon Park
- Interventional Radiology, Department of Radiology, Sun General Hospital, Daejeon, Korea
| | - Ji Yeon Kang
- Department of Oral and Maxillofacial Surgery, Sun General Hospital, Daejeon, Korea
| | - Rak Kyeong Choi
- Cardiovascular Division of Internal Medicine, Bucheon Sejong General Hospital, Bucheon, Korea
| | - Min Su Hyon
- Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cardiovascular Institution, Seoul, Korea
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Gasparovic H, Petricevic M, Biocina B. Management of antiplatelet therapy resistance in cardiac surgery. J Thorac Cardiovasc Surg 2014; 147:855-62. [DOI: 10.1016/j.jtcvs.2013.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/24/2013] [Accepted: 10/06/2013] [Indexed: 12/01/2022]
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Ibrahim O, Maskon O, Darinah N, Raymond AA, Rahman MM. Aspirin resistance in patients with acute coronary events: risk factors and prevalence as determined by whole blood multiple electrode aggregometry. Pak J Med Sci 2014; 29:1319-22. [PMID: 24550945 PMCID: PMC3905384 DOI: 10.12669/pjms.296.3608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/26/2013] [Accepted: 08/08/2013] [Indexed: 01/28/2023] Open
Abstract
Objectives: To determine the prevalence of aspirin resistance and associated risk factors based on biochemical parameters using whole blood multiple electrode aggregometry. Methods:The study was conducted at the outpatients cardiology clinic of the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from August 2011 to February 2012. Subjects on aspirin therapy were divided into two groups; first-ever coronary event and recurrent coronary event. Aspirin resistance was measured by a Multiplate® platelet analyser. Results: A total of 74 patients (63 male, 11 female), with a mean age of 57.93 ± 74.1years were enrolled in the study. The patients were divided into two groups –first-ever coronary event group (n=52) and recurrent coronary event group (n=22). Aspirin resistance was observed in 12 out of 74 (16%) of the study patients, which consisted of 11 patients from the first-ever coronary event group and one patient from the recurrent coronary event group. There were significant correlations between aspirin resistance and age (r = -0.627; p = 0.029), total cholesterol (r = 0.608; p = 0.036) and LDL (r = 0.694; p = 0.012). LDL was the main predictor for area under the curve (AUC) for aspirin resistance. However, there was no association between aspirin resistance and cardiovascular events in both groups in this study. Conclusions: Aspirin resistance was observed in 16% of the study population. LDL was the major predictor of aspirin resistance. No association was found in the study between aspirin resistance with recurrent coronary events.
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Affiliation(s)
- O Ibrahim
- O. Ibrahim, Department of Medicine, University Kebangsaan Malaysia Medical Centre, Cheras 56000, Kuala Lumpur, Malaysia
| | - O Maskon
- O. Maskon, Department of Medicine, University Kebangsaan Malaysia Medical Centre, Cheras 56000, Kuala Lumpur, Malaysia
| | - Noor Darinah
- Noor Darinah, Department of Medicine, University Kebangsaan Malaysia Medical Centre, Cheras 56000, Kuala Lumpur, Malaysia
| | - A A Raymond
- A A Raymond, Department of Medicine, University Kebangsaan Malaysia Medical Centre, Cheras 56000, Kuala Lumpur, Malaysia
| | - M M Rahman
- M.M. Rahman, Department of Medical Microbiology & Immunology
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Robier C, Neubauer M, Quehenberger F, Stettin M, Neumeister P. Assessment of the response to acetylsalicylic acid in patients with myeloproliferative neoplasms by whole blood assays: a comparison of the PFA-100 with multiple electrode aggregometry. Platelets 2013; 25:608-11. [PMID: 24245548 DOI: 10.3109/09537104.2013.852661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Since thrombotic and haemorrhagic complications are the most important causes of morbidity and mortality in myeloproliferative neoplasms (MPN), establishing valid techniques for the monitoring of antiaggregatory treatment would be beneficial. The aim of this study was to assess the aspirin responsiveness in patients with MPN by multiple electrode aggregometry (MEA) and the PFA-100, to determine the concordance rate between the two techniques and to examine a potential clinical impact. Twenty-two consecutive outpatients with polycythaemia vera and essential thrombocythaemia receiving long-time treatment with 100 mg of aspirin were included and clinically re-evaluated within six months after study entry. All subjects were identified as aspirin responders using the PFA-100, whereas only nine (41%) study participants were detected as responders by MEA. The difference in the response rates was statistically highly significant (p < 0.0001). The median aggregation result was 55.5 U (8-123) in the ASPI test, and the median PFA-100 closure time (CT) was 300 sec (221 to 300) in the COL-EPI test. Within the clinical observation period no thrombotic or haemorrhagic events occurred in the study population. In this study we concluded that MEA and the PFA-100 are suitable devices for the detection of a response to aspirin treatment in patients with MPN, but differ significantly in the response rates and thus show a low concordance rate.
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Affiliation(s)
- Christoph Robier
- Central Laboratory, Hospital of the Brothers of St. John of God , Graz-Eggenberg , Austria
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Würtz M, Hvas AM, Christensen KH, Rubak P, Kristensen SD, Grove EL. Rapid evaluation of platelet function using the Multiplate® Analyzer. Platelets 2013; 25:628-33. [PMID: 24246241 DOI: 10.3109/09537104.2013.849804] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Rapid evaluation of platelet function may be advantageous in the setting of surgical and interventional procedures to tailor treatment of ongoing bleeding. We investigated if platelet function testing performed with the Multiplate® Analyzer (Roche Diagnostics, Mannheim, Germany) only 5 minutes after blood sampling yields reliable test results compared to analyses performed 30 minutes after sampling as currently recommended. We included 48 patients with type II diabetes and stable coronary artery disease treated with aspirin 75 mg daily and 50 healthy individuals not taking any medications. Platelet aggregometry by the Multiplate® Analyzer was performed 5 and 30 minutes after blood sampling using arachidonic acid (1.0 mM), collagen (3.2 µg/ml) and adenosine diphosphate (ADP; 6.5 µM) as agonists. Compliance with aspirin was verified by serum thromboxane B2 measurements. Aggregation levels assessed 5 minutes after blood sampling correlated strongly with those assessed after 30 minutes irrespective of the agonist used (r-values 0.75-0.89, p values <0.0001). Aggregation levels were 4-8% lower and displayed a larger standard deviation when measured 5 minutes after sampling, compared to 30 minutes after sampling. Weak, but significant correlations were observed between platelet aggregation and platelet count (r-values = 0.28-0.39; p values <0.01). The currently recommended 30-minute standing time can be omitted, when platelet aggregation is measured using the Multiplate® Analyzer. Platelet aggregation measured 5 minutes after blood sampling correlates strongly with aggregation measured 30 minutes after sampling, but yields slightly lower aggregation levels. The Multiplate® Analyzer enables rapid on-site evaluation of platelet function.
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Affiliation(s)
- Morten Würtz
- Department of Cardiology, Aarhus University Hospital , Denmark and
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Gasparovic H, Petricevic M, Biocina B. Impact and Diagnosis of Antiplatelet Therapy Resistance in Patients Undergoing Cardiac Surgery. Drug Dev Res 2013. [DOI: 10.1002/ddr.21107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Hrvoje Gasparovic
- Department of Cardiac Surgery; Clinical Hospital Center Zagreb; University of Zagreb; Zagreb; Croatia
| | - Mate Petricevic
- Department of Cardiac Surgery; Clinical Hospital Center Zagreb; University of Zagreb; Zagreb; Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery; Clinical Hospital Center Zagreb; University of Zagreb; Zagreb; Croatia
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Point of Care Testing in Cardiac Surgery: Diagnostic Modalities to Assess Coagulation and Platelet Function. Drug Dev Res 2013. [DOI: 10.1002/ddr.21099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gulpinar K, Ozdemir S, Ozis E, Sahli Z, Demirtas S, Korkmaz A. A preliminary study: aspirin discontinuation before elective operations; when is the optimal timing? JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:185-90. [PMID: 24106686 PMCID: PMC3791362 DOI: 10.4174/jkss.2013.85.4.185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/04/2013] [Accepted: 06/09/2013] [Indexed: 11/30/2022]
Abstract
Purpose To evaluate the optimum timing of aspirin cessation before noncardiac surgeries. We have conducted a pilot study to minimize the aspirin cessation time before various surgeries. Methods Eighty patients who were taking regular aspirin for secondary prevention undergoing elective surgical operations were enrolled in the study. We separated the patients into two groups. The control group had 35 patients who stopped aspirin intake 10 days before surgery. The study group had 45 patients who stopped their aspirin intake and underwent surgery one day after arachidonic acid aggregation tests were within normal limits. Bleeding, blood loss, and transfusion requirements were assessed perioperatively. Results The mean time between aspirin cessation and aspirin nonresponsiveness were found to be 4.2 days with a median value of 4 days. In addition, the mean time between aspirin cessation and operation day were found to be 5.5 days with a median value of 5 days. No perioperative bleeding, thromboembolic or cardiovascular complications were encountered. Conclusion Reducing time of aspirin cessation from 7-10 days to 4-5 days is a possibility for patients using aspirin for secondary prevention without increased perioperative complications.
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Affiliation(s)
- Kamil Gulpinar
- Department of General Surgery, Ufuk University School of Medicine, Ankara, Turkey
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Monitoring of acetyl salicylic acid-induced platelet inhibition with impedance aggregometry in children with systemic-to-pulmonary shunts. Cardiol Young 2013; 23:225-32. [PMID: 22691184 DOI: 10.1017/s1047951112000753] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Shunt thrombosis after implantation of systemic-to-pulmonary shunts in paediatric patients is common. Acetyl salicylic acid is used for anti-thrombotic treatment; however, the effect is rarely monitored, although it is known that the response varies. The aim was to determine the effects of acetyl salicylic acid medication on platelet aggregation in children with systemic-to-pulmonary shunts. METHODS A total of 14 children – median age 12 days; ranging from 3 to 100 days – were included in a prospective observational longitudinal study. All children were treated with oral acetyl salicylic acid (3–5 milligrams per kilogram once daily) after shunt implantation. Acetyl salicylic acid-dependent platelet aggregation in whole blood was analysed with impedance aggregometry (Multiplate®) after addition of arachidonic acid. Analyses were carried out before the primary operation, before and 5 and 24 hours after the first acetyl salicylic acid dose, and after 3–6 months of treatment. The therapeutic range for acetyl salicylic acid was defined as a test result less than 60 units. RESULTS Acetyl salicylic acid reduced the arachidonic acid-induced platelet aggregation in all but one patient. Of the patients, 93% were in the therapeutic range 5 hours after acetyl salicylic acid intake, 86% were in the range after 24 hours, and 64% after 3–6 months. CONCLUSIONS Acetyl salicylic acid reduces platelet aggregation after shunt implantation in paediatric patients, but a considerable percentage of the children are outside the therapeutic range. Monitoring of platelet aggregation has the potential to improve anti-platelet treatment after shunt implantation by identifying children with impaired acetyl salicylic acid response.
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Theusinger OM, Levy JH. Point of care devices for assessing bleeding and coagulation in the trauma patient. Anesthesiol Clin 2012; 31:55-65. [PMID: 23351534 DOI: 10.1016/j.anclin.2012.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Severe trauma is associated with bleeding, coagulopathy, and transfusion of blood and blood products, all contributing to higher rates of morbidity and mortality. The aim of this review is to focus on point-of-care devices to monitor coagulation in trauma. Close monitoring of bleeding and coagulation as well as platelet function in trauma patients allows goal-directed transfusion and an optimization of the patient's coagulation, reduces the exposure to blood products, reduces costs, and probably improves clinical outcome. Noninvasive hemoglobin measurements are not to be used in trauma patients due to a lack in specificity and sensitivity.
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Affiliation(s)
- Oliver M Theusinger
- Institute of Anesthesiology, University Zurich, University Hospital Zurich, Zurich, Switzerland.
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Gasparovic H, Petricevic M, Kopjar T, Djuric Z, Svetina L, Biocina B. Dual antiplatelet therapy in patients with aspirin resistance following coronary artery bypass grafting: study protocol for a randomized controlled trial [NCT01159639]. Trials 2012; 13:148. [PMID: 22920307 PMCID: PMC3502596 DOI: 10.1186/1745-6215-13-148] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 08/08/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Coronary artery disease remains the dominant cause of mortality in developed countries. While platelets have been recognized to play a pivotal role in atherothrombosis, the ideal antiplatelet regime after coronary artery surgery remains elusive. The evolution of CABG has presently moved beyond technical improvements to involve modulation of pharmacologic management designed to improve patient outcomes. The aim of this trial will be to test the hypothesis that the addition of clopidogrel to patients with documented postoperative aspirin resistance will reduce the incidence of major cardiovascular events. METHODS Patients scheduled for isolated coronary artery surgery will be eligible for the study. Patients in whom postoperative multiple electrode aggregometry documents aspirin resistance will be randomized into two groups. The control group will receive 300 mg of aspirin. The dual antiplatelet group will receive 75 mg of clopidogrel in addition to 300 mg of aspirin. Patients will be followed for 6 months. Major adverse cardiac and cerebrovascular events (death from any cause, myocardial infarction, stroke, hospitalization due to cardiovascular pathology) as well as bleeding events will be recorded. DISCUSSION This will be the first trial that will specifically address the issue of dual antiplatelet therapy in patients undergoing coronary artery surgery who have been found to be aspirin resistant. In the event that the addition of clopidogrel proves to be beneficial in this subset of surgical patients, this study could significantly impact their future antiplatelet management. This randomized controlled trial has been registered at the ClinicalTrials.gov website (Identifier NCT01159639).
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Affiliation(s)
- Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Kispaticeva 12, 10 000 Zagreb, Croatia.
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Bednar F, Tencer T, Plasil P, Paluch Z, Sadilkova L, Prucha M, Kopa M. Evaluation of Aspirin's Effect on Platelet Function Early After Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2012; 26:575-80. [DOI: 10.1053/j.jvca.2011.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Indexed: 11/11/2022]
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Codner P, Vaduganathan M, Rechavia E, Iakobishvili Z, Greenberg G, Assali A, Hasdai D, Battler A, Kornowski R, Lev EI. Clopidogrel response up to six months after acute myocardial infarction. Am J Cardiol 2012; 110:321-5. [PMID: 22534051 DOI: 10.1016/j.amjcard.2012.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 03/13/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
High on-treatment platelet reactivity (HTPR) despite clopidogrel therapy is associated with adverse cardiac events after acute myocardial infarction (AMI). Most studies to date have assessed clopidogrel response at a single time point before or after percutaneous coronary intervention (PCI). It is unclear, however, whether the HTPR phenotype is stable over time. Therefore, we aimed to examine response to clopidogrel in patients with AMI treated with PCI over a 6-month period. Patients (n = 57) with AMI treated with PCI were assessed for response to clopidogrel at 3 time points: in hospital, 30 days, and 6 months after index hospitalization. Response to clopidogrel was determined by the VerifyNow P2Y12 assay (reported as P2Y12 response units) and multiple electrode aggregometry (MEA; reported as aggregation units). HTPR was defined as ≥235 P2Y12 response units or ≥47 aggregation units. Patients' mean age was 54.5 ± 10.9 years, 91% were men, 19% had diabetes, and 74% were admitted with ST-segment elevation MI. HTPR based on MEA was observed in 22.8% of patients in hospital, 26.3% at 30 days, and 17.5% at 6 months (p = NS). HTPR based on the VerifyNow assay was observed in 38.6% of patients in hospital, 28.1% at 30 days, and 33.3% at 6 months (p = NS). Individual HTPR phenotypic assignment at baseline was stable in 73.7% (based on MEA) and 70.2% (based on VerifyNow) of patients at 6-month follow-up. In conclusion, this is the first study evaluating the stability of clopidogrel response over time after AMI. Rates of HTPR to clopidogrel therapy appear to be relatively stable up to 6 months after AMI.
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Kilickesmez KO, Kocas C, Abaci O, Okcun B, Gorcin B, Gurmen T. Follow-up of aspirin-resistant patients with end-stage kidney disease. Int Urol Nephrol 2012; 45:1097-102. [DOI: 10.1007/s11255-012-0217-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 06/04/2012] [Indexed: 11/30/2022]
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VIDALI M, ROLLA R, PARRELLA M, CASSANI C, MANZINI M, PORTALUPI MR, SERINO R, PRANDO MD, BELLOMO G, PERGOLINI P. Role of the laboratory in monitoring patients receiving dual antiplatelet therapy. Int J Lab Hematol 2012; 34:484-94. [DOI: 10.1111/j.1751-553x.2012.01428.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee KR, Verheyden VJE, Mumford AD. Evaluation of multiple electrode aggregometry in whole blood using Multiplate Mini Test cells. Thromb Res 2012; 129:e59-64. [PMID: 22281068 DOI: 10.1016/j.thromres.2011.12.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/22/2011] [Accepted: 12/22/2011] [Indexed: 11/19/2022]
Abstract
Multiple electrode aggregometry (MEA) enables rapid platelet function testing in whole blood using 600 μL disposable standard test cells (STC). However, newly available 350 μL mini test cells (MTC) could potentially be advantageous in some clinical settings where sample volume is limiting. In order to evaluate the diagnostic performance of MTC, we have estimated assay imprecision, correlation and agreement between area under curve (AUC) determined using MTC and STC in whole blood from healthy donors and from 119 cardiac surgery patients. Imprecision was similar with ADP, AA and TRAP test reagents using STC and MTC, but was markedly higher with the unvalidated ADR reagent. AUC determined using MTC and STC and the ADP, AA and TRAP reagents correlated strongly although MTC yield consistently lower AUC values reflecting fewer platelets in the smaller test cell. Agreement between AUC from STC and MTC was less strong, probably reflecting a composite effect of imprecision from both assay formats. MTC and STC are equally valid for MEA but AUC values obtained using one test format cannot be directly transformed to the other. Therefore, STC and MTC cannot be used interchangeably and AUC results must be compared to separately determined reference intervals.
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Affiliation(s)
- Kurtis R Lee
- University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, United Kingdom.
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Petricevic M, Biocina B, Konosic S, Kopjar T, Kunac N, Gasparovic H. Assessment of platelet function by whole blood impedance aggregometry in coronary artery bypass grafting patients on acetylsalicylic acid treatment may prompt a switch to dual antiplatelet therapy. Heart Vessels 2011; 28:57-65. [DOI: 10.1007/s00380-011-0216-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 11/04/2011] [Indexed: 11/24/2022]
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Hofer A, Kozek-Langenecker S, Schaden E, Panholzer M, Gombotz H. Point-of-care assessment of platelet aggregation in paediatric open heart surgery. Br J Anaesth 2011; 107:587-92. [PMID: 21697184 DOI: 10.1093/bja/aer190] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is associated with complex coagulation abnormalities. Platelet aggregability has not been investigated in detail in children with acyanotic and cyanotic malformations undergoing open heart surgery. The method of whole-blood multiple electrode aggregometry (MEA) appears suitable for rapid platelet analysis in children, for example, because of small sample volumes. We investigated perioperative evolution of platelet aggregation by means of MEA in children with CHD. METHODS Fifty children with acyanotic or cyanotic malformations were included in a prospective observational study. Laboratory testing was assessed before anaesthesia, and during and after surgery until the fifth postoperative day. MEA was performed in hirudin-anticoagulated blood using adenosine diphosphate (ADP), arachidonic acid, and thrombin receptor-activating peptide for platelet activation. Surgical variables, bleeding volumes, and transfusion requirements were documented during hospital stay. RESULTS Mean platelet count was within the normal range in all patients with no intergroup differences. Before surgery, aggregation to all agonists was within the age-adjusted normal range in cyanotic children and was statistically significantly higher compared with acyanotic children. Platelet aggregation decreased significantly during surgery in both groups followed by a slow recovery not reaching baseline levels. Bleeding and platelet transfusions were higher in the cyanotic group. Transfusion requirements correlated with ADP-induced platelet aggregation. CONCLUSIONS These results indicate higher blood loss, despite better platelet aggregation in cyanotic patients compared with acyanotic patients. MEA alone might not be suitable for predicting increased perioperative blood loss.
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Affiliation(s)
- A Hofer
- Department of Anaesthesiology and Intensive Care, General Hospital Linz, Austria
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