1
|
Amri Z, Amor IB, Zarrouk A, Chaaba R, Gargouri J, Hammami M, Hammami S. Anti-glycation, antiplatelet and antioxidant effects of different pomegranate parts. BMC Complement Med Ther 2022; 22:339. [PMID: 36575459 PMCID: PMC9793499 DOI: 10.1186/s12906-022-03824-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Platelet aggregation and advanced glycation end products (AGEs) and oxidative stress are known as key factors for the development of cardiovascular diseases and diabetic complications. In this context, fruit and vegetable consumption, good sources of antioxidant compounds have been largely reported as an effective way of preventing human against these diseases. The current study focuses on the evaluation of antioxidant, antiplatelet and anti-glycation activities of pomegranate (Punica granatum L.) flowers (PF), leaves (PL), peel (PP) juice (PJ) and seeds oil (PSO). METHODS Antioxidant activities was measured against ABTS radical and lipid peroxidation. Antiglycation activity was determined using the formation of AGE fluorescence intensity in the BSA/ribose system. Antiplatelet activity was measured in platelet rich plasma (PRP) against adenosine diphosphate (ADP), Collagen and arachidonic acid (AA). RESULTS PF extract displayed the highest antioxidant activity against ABTS and lipid peroxidation with IC50 values of 0.7 mg/mL and 0.63 mg/mL respectively. For anti-glycation activity, PP, PF and PL inhibited moderately the pentosidine-like AGEs formation compared to positive controls with AGE-IC50 value of 0.4 mg/mL. PJ and PSO haven't any anti-AGE effect. All the extracts selectively inhibited platelet aggregation caused by one, two or three inducers in dose dependent manner. PF was the most potent inhibitor caused by all three inducers, with inhibitory effects ranging from 35.6 to 66.6%. PP and PJ exhibited antiplatelet effect against both ADP and collagen and PL and PSO only against AA. CONCLUSIONS These results suggest that some pomegranate extracts exert potential in vitro anti-glycative and antiplatelet activities.
Collapse
Affiliation(s)
- Zahra Amri
- grid.411838.70000 0004 0593 5040Biochemistry Laboratory, LR12ES05 “Nutrition- Functional Foods and vascular Health”, Faculty of Medicine, University of Monastir, 5019 Monastir, Tunisia
| | - Ikram Ben Amor
- Centre Régional de Transfusion Sanguine de Sfax, Route El-Ain Km 0.5, CP 3003 Sfax, Tunisia
| | - Amira Zarrouk
- grid.411838.70000 0004 0593 5040Biochemistry Laboratory, LR12ES05 “Nutrition- Functional Foods and vascular Health”, Faculty of Medicine, University of Monastir, 5019 Monastir, Tunisia
| | - Raja Chaaba
- grid.411838.70000 0004 0593 5040Biochemistry Laboratory, LR12ES05 “Nutrition- Functional Foods and vascular Health”, Faculty of Medicine, University of Monastir, 5019 Monastir, Tunisia
| | - Jalel Gargouri
- Centre Régional de Transfusion Sanguine de Sfax, Route El-Ain Km 0.5, CP 3003 Sfax, Tunisia
| | - Mohamed Hammami
- grid.411838.70000 0004 0593 5040Biochemistry Laboratory, LR12ES05 “Nutrition- Functional Foods and vascular Health”, Faculty of Medicine, University of Monastir, 5019 Monastir, Tunisia
| | - Sonia Hammami
- grid.411838.70000 0004 0593 5040Biochemistry Laboratory, LR12ES05 “Nutrition- Functional Foods and vascular Health”, Faculty of Medicine, University of Monastir, 5019 Monastir, Tunisia
| |
Collapse
|
2
|
Astrocyte-Derived TNF-α-Activated Platelets Promote Cerebral Ischemia/Reperfusion Injury by Regulating the RIP1/RIP3/AKT Signaling Pathway. Mol Neurobiol 2022; 59:5734-5749. [PMID: 35781632 PMCID: PMC9395439 DOI: 10.1007/s12035-022-02942-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 06/23/2022] [Indexed: 12/12/2022]
Abstract
Ischemic stroke is a clinical syndrome caused by the disruption of blood flow into cerebral tissues and is associated with high disability and mortality rates. Studies have established the pathological role of platelets in cerebral ischemia/reperfusion (I/R) injury, although the underlying mechanism of action remains largely unclear. In this study, we created an I/R mouse model via middle cerebral artery occlusion and reperfusion (MCAO/R) and analyzed the transcriptomic profiles of the ipsilateral and contralateral cortices using RNA-seq. We found that cerebral I/R injury induced platelet invasion and accumulation in the cerebral cortex by stimulating TNF-α secretion from activated astrocytes in the ischemic region, while TNF-α expression enhanced platelet reactivity through the RIP1/RIP3/AKT pathway. Furthermore, the inoculation of TNF-α-stimulated platelets aggravated I/R injury in mice, whereas the administration of anti-TNF-α antibodies at the onset of reperfusion alleviated ischemic damage. The RNA-seq results further showed that AP-1 transcriptionally activated TNF-α in the I/R-injured cortex by directly binding to the promoter region. These findings provide novel insights into the pathological role of platelets activated by reactive astrocyte-derived TNF-α in cerebral I/R injury.
Collapse
|
3
|
Lim S, Murphy S, Murphy S, Coughlan T, O'Neill D, Tierney S, Egan B, Collins D, McCarthy A, Lim SY, Smith D, Cox D, McCabe D. Assessment of on-treatment platelet reactivity at high and low shear stress and platelet activation status after the addition of dipyridamole to aspirin in the early and late phases after TIA and ischaemic stroke. J Neurol Sci 2022; 441:120334. [DOI: 10.1016/j.jns.2022.120334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 05/30/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
|
4
|
Zhou K, Yu S, Li J, Tan Y, Xing S, Chen Y, Ouyang F, Zeng J, Zhang J. High on-treatment platelet reactivity is associated with poor outcomes after ischemic stroke: A meta-analysis. Acta Neurol Scand 2022; 146:205-224. [PMID: 35652290 DOI: 10.1111/ane.13655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES High on-treatment platelet reactivity (HTPR) determined by platelet function assays is present in certain patients with ischemic stroke or transient ischemic attack (TIA). However, it is unclear whether HTPR is associated with poor clinical outcomes. Our study aimed to investigate the relationship of HTPR with recurrent vascular events in ischemic stroke or TIA. METHODS Pubmed (MEDLINE), EMBASE, and Cochrane Library were searched for eligible studies from inception to January 1, 2022. Stata 17.0 software was used to calculate the risk ratio (RR). Subgroup and sensitivity analyses were conducted to assess the source of heterogeneity. A random-effects model was used when heterogeneity was present. Primary endpoint of the meta-analysis was the risk ratio of recurrent vascular events in HTPR Patients. While stroke and TIA, all-cause death, early neurological deterioration, early new ischemic lesions, and stroke severity measured by National Institute of Health Stroke Scale (NIHSS) scores at admission were also pooled. RESULTS Thirty articles (7995 patients) were eligible including 28 cohort studies and 2 prospective case-control studies. The prevalence of HTPR varied from 5.9% to 60%. HTPR was associated with an increased risk of recurrent vascular events (RR = 2.94, 95% CI 2.04-4.23), stroke recurrence (RR = 2.05; 95% CI 1.43-2.95), and all-cause mortality (RR = 2.43; 95% CI 1.83-3.22). Subgroup analysis showed that HTPR determined by optical aggregometry, Verify-Now system and 11dh TXB2 is related to a higher risk of recurrent vascular events (RR = 3.53, 95% CI 1.51-9.40; RR = 2.16, 95% CI 1.02-4.56; RR = 3.76, 95% CI 1.51-9.40, respectively). Moreover, patients with HTPR had an increased incidence of early neurological deterioration (RR = 2.75; 95% CI 1.76-4.30) and higher NIHSS scores at admission (Mean difference 0.19, 95% CI 0.01-0.36). CONCLUSIONS This meta-analysis demonstrates HTPR is associated with higher risk of recurrent vascular events, early neurological deterioration and increased severity in patients with ischemic stroke and TIA. HTPR measured by platelet function assays may guide the use of antiplatelet agents in ischemic stroke and TIA.
Collapse
Affiliation(s)
- Kun Zhou
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital, Sun Yat‐sen University Guangzhou China
| | - Shiyuan Yu
- Zhongshan Medical College Sun Yat‐Sen University Guangzhou China
| | - Jingjing Li
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital, Sun Yat‐sen University Guangzhou China
| | - Yan Tan
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital, Sun Yat‐sen University Guangzhou China
| | - Shihui Xing
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital, Sun Yat‐sen University Guangzhou China
| | - Yicong Chen
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital, Sun Yat‐sen University Guangzhou China
| | - Fubing Ouyang
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital, Sun Yat‐sen University Guangzhou China
| | - Jinsheng Zeng
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital, Sun Yat‐sen University Guangzhou China
| | - Jian Zhang
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital, Sun Yat‐sen University Guangzhou China
| |
Collapse
|
5
|
Subramanian A, Delaney S, Murphy SJX, Smith DR, Offiah C, McMahon J, de Borst GJ, Naylor AR, Hamilton G, Kinsella JA, McCabe DJH. Platelet Biomarkers in Patients with Atherosclerotic Extracranial Carotid Artery Stenosis: A Systematic Review. Eur J Vasc Endovasc Surg 2022; 63:379-389. [PMID: 35181225 DOI: 10.1016/j.ejvs.2021.10.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim was to enhance understanding of the role of platelet biomarkers in the pathogenesis of vascular events and risk stratifying patients with asymptomatic or symptomatic atherosclerotic carotid stenosis. DATA SOURCES Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. REVIEW METHODS A systematic review collated data from 1975 to 2020 on ex vivo platelet activation and platelet function/reactivity in patients with atherosclerotic carotid stenosis. RESULTS Forty-three studies met the inclusion criteria; the majority included patients on antiplatelet therapy. Five studies showed increased platelet biomarkers in patients with ≥ 30% asymptomatic carotid stenosis (ACS) vs. controls, with one neutral study. Preliminary data from one study suggested that quantification of "coated platelets" in combination with stenosis severity may aid risk stratification in patients with ≥ 50% - 99% ACS. Platelets were excessively activated in patients with ≥ 30% symptomatic carotid stenosis (SCS) vs. controls (≥ 11 positive studies and one neutral study). Antiplatelet-High on Treatment Platelet Reactivity (HTPR), previously called "antiplatelet resistance", was observed in 23% - 57% of patients on aspirin, with clopidogrel-HTPR in 25% - 100% of patients with ≥ 50% - 99% ACS. Aspirin-HTPR was noted in 9.5% - 64% and clopidogrel-HTPR in 0 - 83% of patients with ≥ 50% SCS. However, the data do not currently support the use of ex vivo platelet function/reactivity testing to tailor antiplatelet therapy outside of a research setting. Platelets are excessively activated (n = 5), with increased platelet counts (n = 3) in recently symptomatic vs. asymptomatic patients, including those without micro-emboli on transcranial Doppler (TCD) monitoring (n = 2). Most available studies (n = 7) showed that platelets become more reactive or activated following carotid endarterectomy or stenting, either as an acute phase response to intervention or peri-procedural treatment. CONCLUSION Platelets are excessively activated in patients with carotid stenosis vs. controls, in recently symptomatic vs. asymptomatic patients, and may become activated/hyper-reactive following carotid interventions despite commonly prescribed antiplatelet regimens. Further prospective multicentre studies are required to determine whether models combining clinical, neurovascular imaging, and platelet biomarker data can facilitate optimised antiplatelet therapy in individual patients with carotid stenosis.
Collapse
Affiliation(s)
- Arun Subramanian
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Stroke Service, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Siobhan Delaney
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Stroke Service, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Stephen J X Murphy
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Stroke Service, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Deirdre R Smith
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Vascular Neurology Research Foundation, Tallaght University Hospital/ Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Chika Offiah
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Stroke Service, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Jean McMahon
- Tallaght University Hospital Library, Tallaght University Hospital/ Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Netherlands
| | - A Ross Naylor
- The Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| | - George Hamilton
- Department of Vascular Surgery, University Department of Surgery, Royal Free Hampstead NHS Trust, London, UK
| | - Justin A Kinsella
- Department of Neurology, St Vincent's University Hospital/University College Dublin, Ireland
| | - Dominick J H McCabe
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Stroke Service, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Vascular Neurology Research Foundation, Tallaght University Hospital/ Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK; Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| |
Collapse
|
6
|
Cheng Y, Shao T, Huang L, Xu H, Shao P, Yang D, Ge W, Xu Y, Zhang M. Platelet Function Tests Predicting the Efficacy and Safety of Aspirin Secondary Prevention. Neurol Res 2021; 44:291-298. [PMID: 34581662 DOI: 10.1080/01616412.2021.1981103] [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: 10/20/2022]
Abstract
OBJECTIVE To precisely prevent stroke, we evaluated three platelet function tests and their associations with clinical outcomes in ischemic stroke patients. METHODS On-treatment platelet reactivity of acute minor stroke patients taking aspirin plus clopidogrel was tested by light transmittance aggregometry (LTA), thromboelastography (TEG) and platelet function analyzer (PFA). Mann-Whitney U tests and receiver operating characteristic (ROC) curve analysis were used to assess their associations with recurrent events and clinical outcome prediction. RESULTS 127 acute minor stroke patients were stringently selected and followed for 13 months. Eight patients (6.3%) self-reported the recurrence and 13 (10.2%) patients self-reported bleeding. Recurrent patients displayed significantly higher on-treatment platelet reactivity when measured with LTA (p = 0.030) and PFA (p < 0.001). Further ROC analysis demonstrated that LTA and PFA had modest-to-fair ability to predict stroke recurrence (LTA: area under the curve [AUC], 0.765; 95% CI, 0.584-0.945, PFA: AUC, 0.832; 95% CI, 0.658-1.000). However, TEG (measured by the platelet inhibition rate) could not detect the difference between recurrent patients and non-recurrent patients (p = 0.515) and predict recurrent events (AUC, 0.569; 95% CI, 0.368-0.770). None of the tests were associated with bleeding except for PFA (p < 0.001), with AUC of PFA reaching 0.772 (0.726-0.818). CONCLUSIONS Of the three tests assessed, the predictive accuracies of PFA and LTA were satisfying for aspirin secondary prevention, while TEG's performance was poor. Only PFA could provide accurate prognostic information for bleeding.
Collapse
Affiliation(s)
- Yue Cheng
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Nanjing Neurology Clinic Medical Center, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Tengfei Shao
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Nanjing Medical Center for Clinical Pharmacy, Nanjing, China
| | - Lili Huang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Nanjing Neurology Clinic Medical Center, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Hengheng Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Nanjing Neurology Clinic Medical Center, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Pengfei Shao
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Nanjing Neurology Clinic Medical Center, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Dan Yang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Nanjing Neurology Clinic Medical Center, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Weihong Ge
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Nanjing Medical Center for Clinical Pharmacy, Nanjing, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Nanjing Neurology Clinic Medical Center, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Meijuan Zhang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.,Nanjing Neurology Clinic Medical Center, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| |
Collapse
|
7
|
Prevention of Non-Cardiogenic Ischemic Stroke: Towards Personalized Stroke Care. Stroke 2021. [DOI: 10.36255/exonpublications.stroke.personalizedcare.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
8
|
Schrick D, Ezer E, Tokes-Fuzesi M, Szapary L, Molnar T. Novel Predictors of Future Vascular Events in Post-stroke Patients-A Pilot Study. Front Neurol 2021; 12:666994. [PMID: 34220675 PMCID: PMC8250147 DOI: 10.3389/fneur.2021.666994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/20/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: A modified platelet function test (mPFT) was recently found to be superior compared to impedance aggregometry for selection of post-stroke patients with high on-treatment platelet reactivity (HTPR). We aimed to explore some peripheral blood cell characteristics as predictors of recurrent ischemic episodes. The predictive value of mPFT was also assessed in a cohort followed up to 36 months regarding recurrent ischemic vascular events. Methods: As a novelty, not only whole blood (WB), but after 1-h gravity sedimentation the separated upper (UB) and lower half blood (LB) samples were analyzed including neutrophil antisedimentation rate (NAR) in 52 post-stroke patients taking clopidogrel. Area under the curve (AUC, AUCupper and AUClower, respectively) was separately measured by Multiplate in the WB, UB and LB samples to characterize ex vivo platelet aggregation in the presence of ADP. Next, the occurrence of vascular events (stroke, acute coronary syndrome, ACS) were evaluated during 36-month follow-up. Results: A total of 11 vascular events (stroke n = 5, ACS n = 6) occurred during the follow-up period. The AUCupper was significantly higher in patients with recurrent stroke compared to those with uneventful follow-up (p = 0.03). The AUCupper with a cut-off value ≥70 based on the mPFT, was able to predict all stroke events (p = 0.01), while the total vascular events were independently predicted by NAR with a sensitivity of 82% and specificity of 88%. Conclusions: A combination of NAR reflecting the inflammatory state and AUCupper indicating HTPR may provide a better prediction of recurrent ischemic events suggesting a better selection of patients at risk, thus providing an individually tailored vascular therapy.
Collapse
Affiliation(s)
- Diana Schrick
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, Pécs, Hungary
| | - Erzsebet Ezer
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, Pécs, Hungary
| | - Margit Tokes-Fuzesi
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Laszlo Szapary
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Tihamer Molnar
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, Pécs, Hungary
| |
Collapse
|
9
|
Alhazzani A, Venkatachalapathy P, Padhilahouse S, Sellappan M, Munisamy M, Sekaran M, Kumar A. Biomarkers for Antiplatelet Therapies in Acute Ischemic Stroke: A Clinical Review. Front Neurol 2021; 12:667234. [PMID: 34177775 PMCID: PMC8222621 DOI: 10.3389/fneur.2021.667234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Stroke is one of the world's leading causes of disability and death. Antiplatelet agents are administered to acute ischemic stroke patients as secondary prevention. Clopidogrel involves biotransformation by cytochrome P450 (CYP) enzymes into an active metabolite, and single nucleotide polymorphisms (SNPs) can influence the efficacy of this biotransformation. Despite the therapeutic advantages of aspirin, there is significant inter-individual heterogeneity in response to this antiplatelet drug. In this clinical review, the recent advances in the biomarkers of antiplatelet agents in acute ischemic stroke are discussed. The studies reviewed herein highlight the clinical relevance of antiplatelet resistance, pharmacotherapy of antiplatelet agents predicting drug response, strategies for identifying aspirin resistance, pharmacogenetic variants of antiplatelet agents, miRNAs, and extracellular vesicles (EVs) as biomarkers toward the personalized approach in the management of acute ischemic stroke. The precise pathways contributing to antiplatelet resistance are not very well known but are presumably multi-factorial. It is essential to understand the clinical relevance of clopidogrel and aspirin-related single nucleotide polymorphism (SNPs) as potential predictive and prognostic biomarkers. Prasugrel is a next-generation antiplatelet agent that prevents ADP-platelet activation by binding irreversibly to P2Y12 receptor. There are sporadic reports of prasugrel resistance and polymorphisms in the Platelet endothelial aggregation receptor-1 (PEAR1) that may contribute to a change in the pharmacodynamics response. Ticagrelor, a direct-acting P2Y12-receptor antagonist, is easily absorbed and partly metabolized to major AR-C124910XX metabolite (ARC). Ticagrelor's primary active metabolite, ARC124910XX (ARC), is formed via the most abundant hepatic cytochrome P450 (CYP) enzyme, CYP3A4, and CYP3A5. The integration of specific biomarkers, genotype as well as phenotype-related data in antiplatelet therapy stratification in patients with acute ischemic stroke will be of great clinical significance and could be used as a guiding tool for more effective, personalized therapy.
Collapse
Affiliation(s)
- Adel Alhazzani
- Neurology Unit, Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Sruthi Padhilahouse
- Department of Pharmacy Practice, Karpagam College of Pharmacy, Coimbatore, India
| | - Mohan Sellappan
- Department of Pharmacy Practice, Karpagam College of Pharmacy, Coimbatore, India
| | - Murali Munisamy
- Translational Medicine Centre, All India Institute of Medical Sciences, Bhopal, India
| | - Mangaiyarkarasi Sekaran
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Amit Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
10
|
Wiśniewski A, Sikora J, Karczmarska-Wódzka A, Sobczak P. A Combination of Aspirin and Clopidogrel Predict More Favorable Dynamics of Platelet Reactivity versus Clopidogrel Alone in the Acute Phase of Minor Stroke. Healthcare (Basel) 2021; 9:healthcare9060628. [PMID: 34070301 PMCID: PMC8225168 DOI: 10.3390/healthcare9060628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The combined use of clopidogrel and aspirin is recommended for the short-term (21 days) therapy of minor stroke or transient ischemic attack. Previous studies have demonstrated its efficacy and superiority over treatment with a single antiplatelet agent. However, there is insufficient support for the advantages of such therapy based on platelet function testing. We aimed to compare the effect of the concomitant use of clopidogrel and aspirin versus clopidogrel alone on the dynamics of platelet reactivity over time to determine the appropriate antiplatelet treatment strategy for minor strokes. METHODS We enrolled 74 ischemic stroke subjects, including 38 minor strokes. Platelet reactivity was assessed by impedance aggregometry (Multiplate Analyzer) 48 and 96 h after a first 75 mg dose of clopidogrel, using the acetylsalicylic acid platelet inhibition (ASPI) test and the adenosine diphosphate (ADP) test. Dual antiplatelet therapy was strictly reserved only to minor strokes, as the other strokes received clopidogrel alone in the secondary prevention. The dynamics of platelet reactivity refer to the difference between two assessments, and a decrease in values over time was considered favorable. RESULTS The incidence of clopidogrel non-responsiveness was 64.8%, and this was similar in the group of minor strokes and the group of more disabling strokes. We indicated diabetes mellitus as an independent predictor of high on-clopidogrel platelet reactivity (Odds ratio OR 5.69 95% Confidence Interval CI 1.13-41.26, p = 0.0386). Among minor strokes treated with dual antiplatelet therapy, in relation to clopidogrel, we reported a trend toward more favorable dynamics of platelet reactivity over time compared to the group using clopidogrel alone (p = 0.0652 vs. p = 0.3384, respectively). We identified five predictors (sex, female; small-vessel disease; no diabetes; no hyperlipidemia; and no alcohol abuse) related to a significant decrease in platelet reactivity over time with respect to clopidogrel. No significant dynamics of platelet reactivity when using aspirin were found. CONCLUSIONS Our findings, based on the favorable dynamics of platelet reactivity over time in relation to clopidogrel, confirm the usefulness of dual antiplatelet therapy in minor strokes and support the continuation of the secondary prevention with clopidogrel alone rather than aspirin, particularly among identified beneficiaries of such a strategy.
Collapse
Affiliation(s)
- Adam Wiśniewski
- Department of Neurology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-790813513
| | - Joanna Sikora
- Experimental Biotechnology Research and Teaching Team, Department of Transplantology and General Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland; (J.S.); (A.K.-W.); (P.S.)
| | - Aleksandra Karczmarska-Wódzka
- Experimental Biotechnology Research and Teaching Team, Department of Transplantology and General Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland; (J.S.); (A.K.-W.); (P.S.)
| | - Przemysław Sobczak
- Experimental Biotechnology Research and Teaching Team, Department of Transplantology and General Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland; (J.S.); (A.K.-W.); (P.S.)
| |
Collapse
|
11
|
Wiśniewski A. Multifactorial Background for a Low Biological Response to Antiplatelet Agents Used in Stroke Prevention. ACTA ACUST UNITED AC 2021; 57:medicina57010059. [PMID: 33435185 PMCID: PMC7827369 DOI: 10.3390/medicina57010059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/27/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022]
Abstract
Effective platelet inhibition is the main goal of the antiplatelet therapy recommended as a standard treatment in the secondary prevention of non-embolic ischemic stroke. Acetylsalicylic acid (aspirin) and clopidogrel are commonly used for this purpose worldwide. A low biological response to antiplatelet agents is a phenomenon that significantly reduces the therapeutic and protective properties of the therapy. The mechanisms leading to high on-treatment platelet reactivity are still unclear and remain multifactorial. The aim of the current review is to establish the background of resistance to antiplatelet agents commonly used in the secondary prevention of ischemic stroke and to explain the possible mechanisms. The most important factors influencing the incidence of a low biological response were demonstrated. The similarities and the differences in resistance to both drugs are emphasized, which may facilitate the selection of the appropriate antiplatelet agent in relation to specific clinical conditions and comorbidities. Despite the lack of indications for the routine assessment of platelet reactivity in stroke subjects, this should be performed in selected patients from the high-risk group. Increasing the detectability of low antiaggregant responders, in light of its negative impact on the prognosis and clinical outcomes, can contribute to a more individualized approach and modification of the antiplatelet therapy to maximize the therapeutic effect in the secondary prevention of stroke.
Collapse
Affiliation(s)
- Adam Wiśniewski
- Department of Neurology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej 9 Street, 85-094 Bydgoszcz, Poland
| |
Collapse
|
12
|
Park JH, Han SW, Yu HJ. The good genotype for clopidogrel metabolism is associated with decreased blood viscosity in clopidogrel-treated ischemic stroke patients. JOURNAL OF NEUROCRITICAL CARE 2020. [DOI: 10.18700/jnc.200023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
13
|
Rath CL, Jørgensen NR, Wienecke T. Clopidogrel responder status is uninfluenced by CYP2C19*2 in Danish patients with stroke. PLoS One 2020; 15:e0236260. [PMID: 33370281 PMCID: PMC7769274 DOI: 10.1371/journal.pone.0236260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 07/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background Antiplatelet therapy is a cornerstone of secondary stroke prevention, but the responsiveness to antiplatelet medication varies among patients. Clopidogrel is a pro-drug that requires hepatic transformation to reach its active metabolite. Single nucleotide polymorphisms (SNPs) in key enzymes or the target adenosine diphosphate (ADP) receptor on the platelet surface are believed to be involved in clopidogrel-mediated platelet inhibition and decreased antiplatelet effect with high-on-treatment platelet reactivity (HTPR). Objective This study investigated whether specific SNPs in key hepatic enzymes (CYP2C19*2, *3, *17, CYP3A4*1G, and NR1I2) or the ADP receptor (PR2Y12) are associated with HTPR to clopidogrel. Patients & methods This observational study included patients with ischemic stroke (IS) and transient ischemic attacks (TIAs) receiving clopidogrel at a dose of 75 mg/day. Patients were genotyped for eight different SNPs in the genes encoding CYP2C19, CYP3A4, NR1I2, and the P2Y12 receptor. Results Of the 103 patients that were included, 30.7% carried the CYP2C19*2 allele and had higher platelet reaction unit (PRU) values than non-carriers, but no patients showed HTPR. Carriers of the *17 allele had higher platelet inhibition but showed no difference in PRU values compared with non-carriers. The remaining SNPs were neither associated with PRU nor with platelet inhibition. Conclusions Patients with IS and TIAs treated with 75 mg clopidogrel/day do not have HTPR. A genetic analysis of CYP2C19*2, *3, *17, CYP3A4*1G, and NR1I2 revealed no associations with clopidogrel HTPR. CYP2C19*2 carriers and patients with HTPR in the acute phase after ischemic stroke or transient ischemic attacks exhibit higher PRU values, but not long-term treatment HTPR.
Collapse
Affiliation(s)
- Charlotte Lützhøft Rath
- Neurovascular Centre, Department of Neurology, Zealand University Hospital, Roskilde, Denmark
- * E-mail:
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Troels Wienecke
- Neurovascular Centre, Department of Neurology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
14
|
Inhibitory Effects of P2Y12 Receptor Antagonist on PAR1- and PAR4-AP-Induced Platelet Aggregation in Patients with Stroke or TIA. J Stroke Cerebrovasc Dis 2020; 30:105547. [PMID: 33360254 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/28/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The inhibitory effects of P2Y12 receptor antagonist on PAR1- and PAR4-activating peptide (AP)-induced platelet aggregation have not been fully elucidated. The present study aimed to investigate the inhibitory effects of P2Y12 receptor antagonist on PAR1- and PAR4-AP-induced platelet aggregation using platelet-rich plasma (PRP) from individuals including patients with stroke or transient ischemic attack (TIA). MATERIALS AND METHODS PRP was given to 10 healthy individuals pretreated in vitro with cangrelor, then stimulated with adenosine diphosphate (ADP), PAR4-AP, or PAR1-AP. Moreover, 20 patients were enrolled from 148 consecutive patients with acute ischemic stroke or TIA admitted to our institute between December 2017 and April 2019. PRP obtained from each patient before and >7 days after initiation of clopidogrel was similarly stimulated with these agonists. Platelet aggregation was measured using an automatic coagulation analyzer in all participants. RESULTS In healthy individuals, ADP- and PAR4-AP-induced platelet aggregations were significantly inhibited depending on the cangrelor concentration in vitro, while PAR1-AP-induced platelet aggregation was slightly inhibited. In patients with stroke or TIA, clopidogrel inhibited ADP-induced platelet aggregation at all concentrations, and significantly inhibited PAR4-AP-induced platelet aggregation at 50 µmol/L of PAR4-AP (p<0.05), especially in 5 patients who showed high reactivity to PAR4-AP. PAR1-AP-induced platelet aggregation was also slightly inhibited. CONCLUSIONS We showed significant inhibitory effects on PAR4-AP-induced platelet aggregation by clopidogrel in patients with stroke or TIA who had high reactivity to PAR4-AP.
Collapse
|
15
|
Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9123907. [PMID: 33271959 PMCID: PMC7760730 DOI: 10.3390/jcm9123907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Antiplatelet medications such as aspirin and clopidogrel are used following thrombotic stroke or transient ischemic attack (TIA) to prevent a recurrent stroke. However, the antiplatelet treatments fail frequently, and patients experience recurrent stroke. One approach to lower the rates of recurrence may be the individualized antiplatelet therapies (antiplatelet therapy modification (ATM)) based on the results of platelet function analysis (PFA). This review was undertaken to gather and analyze the evidence about the effectiveness of such approaches. Methods: We searched Medline, CINAHL, Embase, Web of Science, and Cochrane databases up to 7 January 2020. Results: Two observational studies involving 1136 patients were included. The overall effects of PFA-based ATM on recurrent strokes (odds ratio (OR) 1.05; 95% confidence interval (CI) 0.69 to 1.58), any bleeding risk (OR 1.39; 95% CI 0.92 to 2.10) or death hazard from any cause (OR 1.19; 95% CI 0.62 to 2.29) were not significantly different from the standard antiplatelet therapy without ATM. Conclusions: The two studies showed opposite effects of PFA-guided ATM on the recurrent strokes in aspirin non-responders, leading to an insignificant difference in the subgroup meta-analysis (OR 1.59; 95% CI 0.07 to 33.77), while the rates of any bleeding events (OR 1.04; 95% CI 0.49 to 2.17) or death from any cause (OR 1.17; 95% CI 0.41 to 3.35) were not significantly different between aspirin non-responders with ATM and those without ATM. There is a need for large, randomized controlled trials which account for potential confounders such as ischemic stroke subtypes, technical variations in the testing protocols, patient adherence to therapy and pharmacogenetic differences.
Collapse
|
16
|
Platelet function/reactivity testing and prediction of risk of recurrent vascular events and outcomes after TIA or ischaemic stroke: systematic review and meta-analysis. J Neurol 2020; 267:3021-3037. [DOI: 10.1007/s00415-020-09932-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022]
|
17
|
Thomason J, Mooney AP, Price JM, Whittemore JC. Effects of clopidogrel and prednisone on platelet function in healthy dogs. J Vet Intern Med 2020; 34:1198-1205. [PMID: 32246893 PMCID: PMC7255683 DOI: 10.1111/jvim.15759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/12/2020] [Indexed: 12/27/2022] Open
Abstract
Background Glucocorticoids cause hypercoagulability, but it is unknown if they counteract clopidogrel's antiplatelet effects. Hypothesis/Objectives Determine the effects of clopidogrel and prednisone on platelet function. Animals Twenty‐four healthy dogs. Methods Double‐blinded, placebo‐controlled randomized trial. Platelet function was evaluated using a platelet function analyzer and impedance aggregometry (days 0, 14, and 28) for dogs treated with placebo, clopidogrel (2‐3 mg/kg/d), prednisone (2 mg/kg/d), or prednisone with clopidogrel PO for 28 days. Results were categorized as nonresponder versus responder (platelet function analyzer), and inadequate, ideal, or excessive response (aggregometry). Results were compared using mixed model, split‐plot repeated measures analysis of variance and generalized estimating equation proportional odds models. P < .05 was considered significant. Results Closure times differed by treatment (F [3, 20] = 10.5; P < .001), time (F [2, 40] = 14.3; P < .001), and treatment‐by‐time (F [6, 40] = 3.4; P = .01). Area under the curve (AUC) differed by treatment (F [3, 20] = 19.6; P < .001), time (F [2, 40] = 35.4; P < .001), and treatment‐by‐time (F [6, 40] = 13.5; P < .001). Based on closure times, 5/6 dogs each in the clopidogrel and prednisone/clopidogrel groups were responders. All dogs in the prednisone/clopidogrel group were overcontrolled based on AUC (days 14 and 28), whereas 5/6 (day 14) and 2/6 (day 28) dogs treated with clopidogrel were overcontrolled. Compared to clopidogrel, dogs receiving prednisone/clopidogrel were 11 times (P = .03) more likely to have an excessive response. Conclusions and Clinical Importance Administration of clopidogrel/prednisone increases platelet dysfunction in healthy dogs.
Collapse
Affiliation(s)
- John Thomason
- The Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Allison P Mooney
- The Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Joshua M Price
- The Office of Information Technology, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Jacqueline C Whittemore
- The Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| |
Collapse
|
18
|
Fu H, Hu P, Ma C, Peng F, He Z. Association of clopidogrel high on-treatment reactivity with clinical outcomes and gene polymorphism in acute ischemic stroke patients: An observational study. Medicine (Baltimore) 2020; 99:e19472. [PMID: 32282698 PMCID: PMC7220491 DOI: 10.1097/md.0000000000019472] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
High on-treatment platelet reactivity (HTPR) was suggested to be better correlated with recurrent ischemic events as compared with gene polymorphism, whereas most of the results were from white populations with acute coronary disease. The evidence is relatively limited regarding HTPR and its genetic determinants in predicting clinical outcomes of stroke among Chinese-Han patients.A prospective study including 131 Chinese-Han stroke patients treated with clopidogrel was analyzed. Platelet function was assessed by light transmission aggregometry (LTA)- adenosine diphosphate (ADP) method. HTPR was defined as 5 μM ADP induced platelet aggregation > 46%. CYP2C19 and P2Y12 genotype were detected using the PCR-RFLP method. The difference in the occurrence of the primary endpoint was analyzed according to platelet function and genetic status.Sixty-three (48.1%) subjects displayed HTPR after administering clopidogrel for 1 week. The prevalence of HTPR was significantly higher in CYP2C19 loss-of-function (LOF) alleles (2, 3) carriers vs wild-type homozygotes (71.7% vs 32.1%, P < .01), and logistic regression analysis showed that carriers of CYP2C19 LOF alleles were an independent risk factor of HTPR. Survival analysis indicated that patients with HTPR had an increased risk of primary endpoints (20.6% vs 7.3%, P = .04), whereas the presence of CYP2C19 LOF alleles or P2Y12 H2 haplotype did not increase the incidence of ischemic events. Cox regression analysis demonstrated that HTPR was an independent predictor of the primary composite endpoint (HR, 3.1; 95% CI, 1.07-8.99; P = .04).We identified a high prevalence of clopidogrel-HTPR in a cohort of Chinese-Han patients with acute ischemic stroke, and patients with HTPR may have an increased risk of recurrent ischemic stroke events. CYP2C19 LOF alleles are associated with HTPR but not with stroke prognosis. Further clinical trials with large samples are needed to confirm these findings.
Collapse
Affiliation(s)
- Hefei Fu
- Department of Neurology, The First Affiliated Hospital of China Medical University
| | - Pan Hu
- Department of Neurology, The First Affiliated Hospital of China Medical University
| | - Chunmei Ma
- Department of Neurology, Liaoning Electric Power Center Hospital
| | - Fei Peng
- Department of Neurology, Jinqiu Hospital of Liaoning Province, Shenyang, China
| | - Zhiyi He
- Department of Neurology, The First Affiliated Hospital of China Medical University
| |
Collapse
|
19
|
Hovhannisyan IG, Hovhanessyan RA. [A comparative assessment of indicators of platelet aggregation and interleukins in patients with different outcomes of ischemic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:22-25. [PMID: 30499555 DOI: 10.17116/jnevro201811809222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To compare indicators of platelet aggregation (PA) and the level of interleukins IL-1β, IL-4, IL-6, IL-18 in patients with ischemic stroke (IS). MATERIAL AND METHODS A prospective clinical cohort study involved 108 IS patients classified into group 1 (survivors) and group 2 (fatal outcomes). The studies were conducted in the most acute and acute phases of IS. The level of interleukins was measured by enzyme immunoassay method. PA was evaluated by the nephelometric method. RESULTS AND CONCLUSION PA, IL-1β and IL-6 indicators in the most acute phase of IS were significantly higher in the 2nd group compared to the 1st group. In the 1st group, there was a reduction in the levels of IL-1β and IL-6, and an increase in the level of IL-4 in the acute phase compared to the most acute period of IS, whereas patients of the 2nd group showed further increase in IL-1β and IL-6, and reduction of IL-4 levels. In surviving acute IS patients, the reduction in PA and the level of pro-inflammatory interleukins IL-1b, IL-6 and IL-18, and the increase in the level of anti-inflammatory interleukin IL-4 were accompanied with improvements in the clinical condition, whereas the negative dynamics of the aforementioned indicators was recorded in deceased patients.
Collapse
Affiliation(s)
- I G Hovhannisyan
- Medical Center 'St. Gregory the Illuminator', Ministry of Health, Republic of Armenia, Yerevan, Republic of Armenia
| | - R A Hovhanessyan
- Yerevan State University, Ministry of Education and Science, Republic of Armenia, Yerevan, Republic of Armenia
| |
Collapse
|
20
|
Hovhannesyan RA, Hovhannisyan IG. Platelet Aggregation and Interleukins Indicators Impacting the Outcomes of Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 28:2038-2044. [PMID: 30878372 DOI: 10.1016/j.jstrokecerebrovasdis.2019.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/11/2019] [Accepted: 02/17/2019] [Indexed: 12/15/2022] Open
Abstract
AIM Relative assessment and relationship between of platelet aggregation and the level of interleukins IL-1β, IL-4, IL-6, and IL-18 among ischemic stroke (IS) patients. METHODS A prospective clinical cohort study involved 108 IS patients, classified into group 1-surviving (93; 86.1%) and group 2-lethal outcomes (15; 13.9%). The studies were conducted in the most acute (first day of hospitalization) and acute (7 days of hospitalization) phases of IS. The level of interleukins was defined by enzyme immunoassay method. The platelet aggregation research was performed by the nephelometric method. RESULTS In the acute phase of the IS the first group, patients showed reduction in the level of IL-1β and IL-6, and increase in the level of IL-4, compared to the most acute period, whereas in patients of the second group further increase in IL-1β and IL-6, and reduction of IL-4 levels were recorded. Both in the most acute and acute phases of the IS, in parallel to the aggravation of platelet aggregation (PA) disturbances, the lethal outcome probability grew. The latter also grew together with increase in the synthesis of IL-1β and IL-6, in the most acute phase of the IS. In the acute phase of the IS, lethal outcome was recorded in all patients with high values of IL-1β and IL-6, and all patients with low values of IL-1β showed improvement. CONCLUSIONS Vivid disturbances of PA, IL-1β, IL-6, and IL-18 synthesis, in the most acute phase of the IS, signal higher probability of lethal outcome. Reduction in the levels of IL-1β, IL-6, and IL-18, and increase of IL-4 in the acute phase, means improvement in conditions.
Collapse
Affiliation(s)
| | - Iren G Hovhannisyan
- Department of Neurology, Medical Center 'St. Gregory the Illuminator', Yerevan, Republic of Armenia, YSMU after Mkhitar Heratsi, Department of Neurology, Yerevan, Republic of Armenia
| |
Collapse
|
21
|
Murphy SJX, Naylor AR, Ricco JB, Sillesen H, Kakkos S, Halliday A, de Borst GJ, Vega de Ceniga M, Hamilton G, McCabe DJH. Optimal Antiplatelet Therapy in Moderate to Severe Asymptomatic and Symptomatic Carotid Stenosis: A Comprehensive Review of the Literature. Eur J Vasc Endovasc Surg 2018; 57:199-211. [PMID: 30414802 DOI: 10.1016/j.ejvs.2018.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/11/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Carotid stenosis patients are at risk of vascular events despite antiplatelet therapy. Data on prescribed antiplatelet regimens have not been comprehensively collated from trials to guide optimal therapy in this population. METHODS This review was conducted in line with the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Medline, Ovid, Embase, Web of Science, and Google Scholar from 1988 to 2018 were searched using the search terms "carotid stenosis", "asymptomatic", "symptomatic", "antiplatelet", and "anti-platelet" to identify randomised trials in patients with asymptomatic or symptomatic extracranial moderate-severe carotid stenosis on any form of antiplatelet therapy in which vascular events and pre specified composite outcome events were reported. RESULTS Twenty-five studies were judged eligible for inclusion. Data from one randomised controlled trial showed no significant difference in benefit with aspirin versus placebo in asymptomatic carotid stenosis, but it is still reasonable to recommend aspirin (81-325 mg daily) for prevention of vascular events in these patients. Low to medium dose aspirin (81-325 mg daily) is superior to higher doses (>650 mg daily) at preventing recurrent vascular events in patients undergoing endarterectomy. Data from endovascular treatment (EVT) trials support peri-procedural treatment of asymptomatic and symptomatic patients with 81-325 mg of aspirin daily. The use of peri-procedural aspirin-clopidogrel in patients undergoing EVT is based on one pilot trial, but appears safe. Short-term aspirin-dipyridamole or aspirin-clopidogrel treatments are equally effective at reducing micro-embolic signals on transcranial Doppler ultrasound in patients with ≥50% symptomatic carotid stenosis. There is insufficient evidence to recommend routine aspirin-clopidogrel combination therapy to reduce the risk of recurrent clinical ischaemic events in patients with symptomatic moderate-severe carotid stenosis. CONCLUSIONS This comprehensive review outlines an evidence based approach to antiplatelet therapy in carotid stenosis patients. Future trials should randomise such patients to receive different antiplatelet regimens to assess their efficacy and safety and to optimise peri-procedural and long-term preventive treatment in this patient cohort.
Collapse
Affiliation(s)
- Stephen J X Murphy
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
| | - A Ross Naylor
- Department of Vascular Surgery, Glenfield Hospital, Leicester, UK
| | - Jean-Baptiste Ricco
- Department of Vascular Surgery, University of Strasbourg, Strasbourg, France
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | - Stavros Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Alison Halliday
- Nuffield Dept. of Surgical Sciences, University of Oxford, Oxford, UK
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, The Netherlands
| | - Melina Vega de Ceniga
- Department of Angiology and Vascular Surgery, Hospital de Galdakao-Usansolo, Bizkaia, Spain
| | - George Hamilton
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, University College London Medical School, London, UK
| | - Dominick J H McCabe
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland; Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland; Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK; Irish Centre for Vascular Biology, Dublin, Ireland; Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland.
| |
Collapse
|
22
|
Association of platelet response to cilostazol with clinical outcome and CYP genotype in patients with cerebral infarction. Thromb Res 2018; 172:14-20. [PMID: 30342278 DOI: 10.1016/j.thromres.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/11/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cilostazol, an anti-platelet drug that inhibits phosphodiesterase 3, is beneficial for patients with atherothrombosis. In contrast to other anti-platelet drugs such as aspirin and thienopyridines, little information is available on the relationship between platelet responses to cilostazol and clinical outcomes. MATERIALS AND METHODS We conducted a prospective study on patients with cerebral infarction who were treated with cilostazol. The platelet response to cilostazol was assessed with our new assay for the phosphorylation of vasodilator-stimulated phosphoprotein (VASP) subsequent to the pharmacological action of cilostazol. Patients were followed up for 2 years and the relationship between VASP assay results and the recurrence of thrombotic events was examined. We also investigated the effects of CYP3A5 and CYP2C19 genotypes involved in the metabolism of cilostazol on the platelet response to cilostazol. RESULTS Among the 142 patients enrolled, 130 completed the 2-year follow-up and the recurrence of thrombotic events was noted in 8 (6.2%). VASP phosphorylation levels were significantly lower in patients with than in those without recurrence. The combined genotype of CYP3A5*1/*3 and CYP2C19*1/*1 was associated with a low level of VASP phosphorylation, while either genotype was not. A multivariate analysis showed that high residual platelet reactivity during the cilostazol treatment, which was defined by a low response of platelet VASP phosphorylation to cilostazol, was an independent risk factor for the recurrence of thrombotic events. CONCLUSION A low platelet response to cilostazol determined by a new platelet assay was associated with the recurrence of thrombotic events in patients with cerebral infarction.
Collapse
|
23
|
Dannenberg L, Petzold T, Achilles A, Naguib D, Zako S, Helten C, M'Pembele R, Mourikis P, Podsvyadek Y, Grandoch M, Levkau B, Zeus T, Kelm M, Hohlfeld T, Polzin A. Dose reduction, oral application, and order of intake to preserve aspirin antiplatelet effects in dipyrone co-medicated chronic artery disease patients. Eur J Clin Pharmacol 2018; 75:13-20. [PMID: 30251061 DOI: 10.1007/s00228-018-2560-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/17/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Dipyrone comedication in aspirin-treated patients is associated with impaired pharmacodynamic response to aspirin (high on-treatment platelet reactivity [HTPR]). Additionally, in small observational studies, an association with impaired outcome has been described. In this uncontrolled, hypothesis-generating study, we aimed to investigate strategies to prevent this drug-drug interaction in patients with coronary artery disease (CAD). METHODS We analyzed pharmacodynamic response to aspirin in 80 dipyrone co-medicated CAD patients. Aspirin antiplatelet effects were measured using arachidonic acid (AA)-induced light-transmission aggregometry (LTA). Platelet reactivity was associated with daily dose, administration form, and frequency. Additionally, we conducted a time-series analysis in patients with HTPR to aspirin with re-evaluation of pharmacodynamic response to aspirin after 5 days. RESULTS Patients' mean age was 75.5 ± 9.8 years. Forty-three (54%) were male, 22 (27.5%) obese, and 38 (47.5%) diabetics. Baseline characteristics, cardiovascular risk factors, comorbidities, comedication, or laboratory parameters did not differ between patients with or without HTPR. HTPR to aspirin occurred in 34 out of 80 patients (42.5%). The incidence of HTPR was associated with dipyrone daily dose (< 1 g/day: HTPR 20% vs. > 3 g/day: HTPR 50%, p > 0.0001) and form of administration (i.v. 87.5% vs. oral 37.5%; p < 0.0001). A strict order of intake (aspirin 30 min prior to dipyrone) restored aspirin antiplatelet effects in all patients (HTPR before 100% vs. HTPR after 0%, p = 0.0002). CONCLUSION This study shows that dipyrone should be used with caution in aspirin-treated patients. If dipyrone seems indispensable, the lowest effective dose and a strict order of intake seem favorable.
Collapse
Affiliation(s)
- Lisa Dannenberg
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany.
| | - Tobias Petzold
- Department of Cardiology, LMU München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
| | - Alina Achilles
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - David Naguib
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Saif Zako
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Carolin Helten
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - René M'Pembele
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Philipp Mourikis
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Yanina Podsvyadek
- Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany
| | - Maria Grandoch
- Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany
| | - Bodo Levkau
- West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Institute of Pathophysiology, Essen, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Thomas Hohlfeld
- Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| |
Collapse
|
24
|
Rath CL, Rye Jørgensen N, Wienecke T. High On-Treatment Platelet Reactivity in Danish Hyper-Acute Ischaemic Stroke Patients. Front Neurol 2018; 9:712. [PMID: 30210437 PMCID: PMC6121143 DOI: 10.3389/fneur.2018.00712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/06/2018] [Indexed: 12/28/2022] Open
Abstract
Objective: Early anti-platelet therapy is a cornerstone in the prevention of recurrent ischaemic stroke (IS) and transient ischaemic attacks (TIAs), although the responsiveness to anti-platelet medications varies among patients. Several studies have reported that patients with ischaemic stroke who exhibit high on-treatment platelet reactivity (HTPR) 5-10 days after antiplatelet medication onset, have an increased risk of vascular events. In this study we aim to determine the prevalence of HTPR in the hyper-acute stroke phase less than 48 h from symptom onset, after the administration of a 300 mg bolus of oral clopidogrel in a real-world setting in Danish IS and TIA patients. Material and Methods: In total, 219 Danish patients with acute IS or TIA received 300 mg of oral clopidogrel on admission. Blood samples from all patients were analyzed using the VerifyNow P2Y12 system at 8-24 h after clopidogrel intake. Concomitant therapy and the intervals between ictus and blood collection, clopidogrel intake and blood collection, and blood sampling and analysis were recorded for all patients. Results: HTPR in the hyper-acute stroke phase was observed in 28.8% (63/219) samples. After adjustment for age, sex, co-morbidities, and co-medications, none of the tested variables exhibited an association with HTPR or the platelet reaction unit value measured using the VerifyNow P2Y12 system. Conclusions: The recognition of HTPR to specific anti-platelet agents in the hyper-acute phase after stroke may be the first step toward interventions that may further minimize the early recurrent stroke risk. Further large randomized trials including clinical outcome assessments are necessary.
Collapse
Affiliation(s)
- Charlotte L Rath
- Department of Neurology, Neurovascular Centre, Zealand University Hospital, Roskilde, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Troels Wienecke
- Department of Neurology, Neurovascular Centre, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
25
|
Secondary Stroke Prophylaxis with Clopidogrel Produces Sufficient Antiplatelet Response. J Stroke Cerebrovasc Dis 2018; 27:2683-2690. [PMID: 29945766 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/25/2018] [Accepted: 05/22/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Antiplatelet therapy is a cornerstone prevention strategy for secondary ischemic stroke (IS) and transient ischemic attack (TIA). Yet, a proportion of patients who receive antiplatelet therapy experience recurrent ischemic cerebrovascular events. A recent meta-analysis found an increased risk of recurrent stroke in clopidogrel- or aspirin-treated patients with ischemic stroke who had high on-treatment platelet reactivity (HTPR). Few studies have focused specifically on clopidogrel HTPR. Therefore, the aim of this study was to examine the relationship between clopidogrel HTPR and recurrent ischemic events in a population of Danish patients with IS. METHODS We performed a prospective observational study to evaluate the relationship between HTPR defined as platelet reaction units >208 and a composite primary endpoint of recurrent stroke, TIA, acute myocardial infarction (AMI), or vascular death over a 2-year follow-up period. RESULTS A total of 142 patients were included in the final statistical analysis, but only 3 patients (2.1%) demonstrated clopidogrel HTPR. The median time of on-treatment platelet testing was 75 days. Recurrent IS, TIA, AMI, or vascular death occurred in 14 patients (10%). Of these, 1 new ischemic event (AMI) occurred in a HTPR patient. There was no difference in the frequency of new ischemic events between the HTPR and non-HTPR groups (P = .27); moreover, the number of patients with HTPR was too small for statistical analysis. CONCLUSIONS Clopidogrel HTPR does not seem to be a major contributor to recurrent ischemic events in Danish ischemic stroke patients.
Collapse
|
26
|
Zhang S, Zhu J, Li H, Wang L, Niu J, Zhu B, He L, Shen L, Qin S, Fang S. Study of the Association of PEAR1, P2Y12, and UGT2A1 Polymorphisms with Platelet Reactivity in Response to Dual Antiplatelet Therapy in Chinese Patients. Cardiology 2018; 140:21-29. [DOI: 10.1159/000488101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/02/2018] [Indexed: 11/19/2022]
Abstract
Objectives: Genetic variation is thought to contribute to considerable interindividual variability in platelet function, and there is a pressing need to identify genetic markers that can be used to predict the response to treatment. Our study investigated whether PEAR1, P2Y12, and UGT2A1 polymorphisms were associated with platelet reactivity in response to dual antiplatelet therapy in Chinese patients with acute coronary syndrome. Methods: Patients with inhibition of platelet aggregation (IPA) < 30% after treatment were classified as the high platelet reactivity (HPR) group. Patients with IPA > 30% were classified as the normal platelet reactivity (NPR) group. ADP-induced platelet aggregation was measured by thromboelastography (TEG) platelet-mapping assay. Thirteen single nucleotide polymorphisms (SNPs) of PEAR1, P2Y12 and UGT2A1 were genotyped using the MassARRAY platform. Results: Seven SNPs were significantly associated with ADP-induced platelet aggregation by univariate analysis. Major allele G at rs12041331, minor allele G at rs2644592, minor allele C at rs11264580, and minor allele C at rs11249454 were significantly associated with HPR, whereas minor allele T at rs57731889, minor allele A at rs16863356, and minor allele T at rs7634096 were significantly associated with NPR. The mean IPA was significantly lower in patients suffering recurrent ischemic events than in patients without recurrent events in our study (p = 0.048). Conclusions: Our findings suggest that PEAR1, P2Y12, and UGT2A1 genetic variants may be potential biomarkers that can be used to guide clinical applications of clopidogrel and aspirin in Chinese patients.
Collapse
|
27
|
Hovhannisyan IG. [Prognostic significance of indices of platelets aggregation and interleukin-1β in the acute period of ischemic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 117:34-37. [PMID: 29411743 DOI: 10.17116/jnevro201711712234-37] [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: 11/17/2022]
Abstract
AIM To determine the prognostic significance of indices of platelet aggregation (PA) and the level of interleukin IL-1β in the outcome of ischemic stroke (IS). MATERIAL AND METHODS One hundred and eight patients were studied. According to disease outcome, two groups of patients were identified: survivors (group 1) and patients with fatal outcome (group 2). Patients were examined in the very early stage (the 1st day of hospitalization) and in the early stage (the 7th day of hospitalization) of IS. The level of interleukin IL-1β in blood serum was defined by enzyme immunoassay method. PA was measured by nephelometric method. RESULTS AND CONCLUSION According to PA indices, a posteriori prognosis of fatal outcome was 10%, but according to IL-1β indices, it was 0.90%. Consequently, the prognostic significance of PA indices with regard to fatal outcome of IS patients in the acute period is higher than that of IL-1b indices. Taking into consideration the expenses of both methods of diagnosis, the authors conclude that with regard to economic availability, PA measurement as a prognostic-diagnostic method is more acceptable in clinical practice.
Collapse
Affiliation(s)
- I G Hovhannisyan
- Medical Center 'St. Gregory the Illuminator', Ministry of Health, Yerevan, Republic of Armenia
| |
Collapse
|
28
|
Mohring A, Piayda K, Dannenberg L, Zako S, Schneider T, Bartkowski K, Levkau B, Zeus T, Kelm M, Hohlfeld T, Polzin A. Thromboxane Formation Assay to Identify High On-Treatment Platelet Reactivity to Aspirin. Pharmacology 2017; 100:127-130. [DOI: 10.1159/000477303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/28/2017] [Indexed: 01/29/2023]
Abstract
Platelet inhibition by aspirin is indispensable in the secondary prevention of cardiovascular events. Nevertheless, impaired aspirin antiplatelet effects (high on-treatment platelet reactivity [HTPR]) are frequent. This is associated with an enhanced risk of cardiovascular events. The current gold standard to evaluate platelet hyper-reactivity despite aspirin intake is the light-transmittance aggregometry (LTA). However, pharmacologically, the most specific test is the measurement of arachidonic acid (AA)-induced thromboxane (TX) B2 formation. Currently, the optimal cut-off to define HTPR to aspirin by inhibition of TX formation is not known. Therefore, in this pilot study, we aimed to calculate a TX formation cut-off value to detect HTPR defined by the current gold standard LTA. We measured platelet function in 2,507 samples. AA-induced TX formation by ELISA and AA-induced LTA were used to measure aspirin antiplatelet effects. TX formation correlated nonlinearly with the maximum of aggregation in the AA-induced LTA (Spearman's rho R = 0.7396; 95% CI 0.7208-0.7573, p < 0.0001). Receiver operating characteristic analysis and Youden's J statistics revealed 209.8 ng/mL as the optimal cut-off value to detect HTPR to aspirin with the TX ELISA (area under the curve: 0.92, p < 0.0001, sensitivity of 82.7%, specificity of 90.3%). In summary, TX formation ELISA is reliable in detecting HTPR to aspirin. The calculated cut-off level needs to be tested in trials with clinical end points.
Collapse
|
29
|
Assessment of ‘on-treatment platelet reactivity’ and relationship with cerebral micro-embolic signals in asymptomatic and symptomatic carotid stenosis. J Neurol Sci 2017; 376:133-139. [DOI: 10.1016/j.jns.2017.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/14/2017] [Accepted: 03/11/2017] [Indexed: 11/20/2022]
|
30
|
Rao Z, Zheng H, Wang F, Wang A, Liu L, Dong K, Zhao X, Wang Y, Cao Y. The association between high on-treatment platelet reactivity and early recurrence of ischemic events after minor stroke or TIA. Neurol Res 2017; 39:719-726. [PMID: 28398139 DOI: 10.1080/01616412.2017.1312793] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Zilong Rao
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Fei Wang
- Department of Information Engineering, Tangshan Vocational and Technical College, Tangshan, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Kehui Dong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yibin Cao
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, China
| |
Collapse
|
31
|
Sabra A, Stanford SN, Storton S, Lawrence M, D'Silva L, Morris RHK, Evans V, Wani M, Potter JF, Evans PA. Assessment of platelet function in patients with stroke using multiple electrode platelet aggregometry: a prospective observational study. BMC Neurol 2016; 16:254. [PMID: 27938345 PMCID: PMC5148854 DOI: 10.1186/s12883-016-0778-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/05/2016] [Indexed: 11/13/2022] Open
Abstract
Background There is a link between high on-treatment platelet reactivity (HPR) and adverse vascular events in stroke. This study aimed to compare multiple electrode platelet aggregometry (MEA), in healthy subjects and ischaemic stroke patients, and between patients naive to antiplatelet drugs (AP) and those on regular low dose AP. We also aimed to determine prevalence of HPR at baseline and at 3–5 days after loading doses of aspirin. Methods Patients with first ever ischaemic stroke were age and sex-matched to a healthy control group. Three venous blood samples were collected: on admission before any treatment given (baseline); at 24 h and 3–5 days after standard treatment. MEA was determined using a Mutliplate® analyser and agonists tested were arachidonic acid (ASPI), adenosine diphosphate (ADP) and collagen (COL). Results Seventy patients (mean age 73 years [SD 13]; 42 men, 28 women) were age and sex-matched to 72 healthy subjects. Thirty-three patients were on antiplatelet drugs (AP) prior to stroke onset and 37 were AP-naive. MEA results for all agonists were significantly increased in AP-naive patients compared to healthy subjects: ADP 98 ± 31 vs 81 ± 24, p < 0.005; ASPI 117 ± 31 vs 98 ± 27, p < 0.005; COL 100 ± 25 vs 82 ± 20, p < 0.005. For patients on long term AP, 33% (10/30) of patients were considered aspirin-resistant. At 3–5 days following loading doses of aspirin, only 11.1% were aspirin resistant based on an ASPI cut-off value of 40 AU*min. Conclusions Many patients receiving low dose aspirin met the criteria of aspirin resistance but this was much lower at 3–5 days following loading doses of aspirin. Future studies are needed to establish the causes of HPR and potential benefits of individualizing AP treatment based on platelet function testing.
Collapse
Affiliation(s)
- Ahmed Sabra
- Medical School, Swansea University, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK.,Cardiology Department, Singleton Hospital, ABMU Health Board, Swansea, UK
| | - Sophia N Stanford
- Medical School, Swansea University, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK
| | - Sharon Storton
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK
| | - Matthew Lawrence
- Medical School, Swansea University, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK
| | - Lindsay D'Silva
- Medical School, Swansea University, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK
| | - Roger H K Morris
- School of Applied Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Vanessa Evans
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK
| | - Mushtaq Wani
- Department of Stroke Medicine, Morriston Hospital, Swansea, UK
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Phillip A Evans
- Medical School, Swansea University, Swansea, UK. .,NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK. .,Emergency Department, Morriston Hospital, ABMU Health Board, Swansea, SA6 6NL, UK.
| |
Collapse
|
32
|
Lifshits GI, Slepukhina AA, Subbotovskaya AI, Apartsin KA, Dolgushin SA. Measurement of Hemostasis Parameters: Equipment and Potential for Development. BIOMEDICAL ENGINEERING-MEDITSINSKAYA TEKNIKA 2016. [DOI: 10.1007/s10527-016-9638-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
33
|
Pearson C, Przyklenk K, Mika VH, Ayaz SI, Ellis M, Varade P, Tolomello R, Welch RD. Utility of point of care assessment of platelet reactivity (using the PFA-100®) to aid in diagnosis of stroke. Am J Emerg Med 2016; 35:802.e1-802.e5. [PMID: 27955971 DOI: 10.1016/j.ajem.2016.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Rapid and accurate diagnosis of patients presenting with symptoms of stroke is needed to facilitate the timely delivery of proven effective treatment for patients with acute ischemic stroke (AIS). The aim of this study was to determine whether early assessment of platelet reactivity in patients presenting with symptoms of AIS was associated with a diagnosis of AIS, transient ischemic attack (TIA), or stroke mimic. METHODS This prospective study included patients with symptoms of AIS treated at an inner-city emergency department (ED). Blood samples were obtained and assayed for platelet reactivity (quantified by closure time). Patients were grouped by discharge diagnosis into: AIS, TIA, or stroke mimic. Binary logistic regression model was used to predict the association of closure time with the final diagnosis of 1) either AIS or TIA or, 2) stroke mimic. RESULTS Of 114 patients enrolled, 32 were diagnosed with AIS, 33 TIA, and 49 were diagnosed as a stroke mimic. There was no significant difference in closure times among patients with a diagnosis of AIS or TIA versus stroke mimic. A history of migraines and history of seizures were independently associated with lower odds of an AIS or TIA diagnosis (OR 0.31, 95% CI 0.10 to 0.94 and OR 0.08, 95% CI 0.01 to 0.88, respectively). CONCLUSION Closure time was not found to be a clinically reliable differentiator of patients with a diagnosis of AIS, TIA, or stroke mimic in the ED.
Collapse
Affiliation(s)
- Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Karin Przyklenk
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA; Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA; Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Valerie H Mika
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Syed Imran Ayaz
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Morgan Ellis
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Preet Varade
- Department of Neurology/Neurocritical Care, Lehigh Valley Physician Group, Allentown, PA, USA
| | - Rosa Tolomello
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Robert D Welch
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA; Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
34
|
Thames BE, Lovvorn J, Papich MG, Wills R, Archer T, Mackin A, Thomason J. The effects of clopidogrel and omeprazole on platelet function in normal dogs. J Vet Pharmacol Ther 2016; 40:130-139. [PMID: 27452307 DOI: 10.1111/jvp.12340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/24/2016] [Indexed: 12/12/2022]
Abstract
Omeprazole is used concurrently with clopidogrel to reduce gastrointestinal adverse effects. In humans, the concurrent use of these two drugs can reduce the antiplatelet efficacy of clopidogrel. Our objective was to determine the effects of omeprazole and clopidogrel on platelet function in healthy dogs. A crossover study utilized turbidimetric aggregometry (ADP and collagen) and the PFA-100® with the collagen/ADP cartridge to evaluate platelet function in eight healthy dogs during the administration of clopidogrel (1 mg/kg/24 h p.o.), omeprazole (1 mg/kg/24 h p.o.), and a combination of clopidogrel and omeprazole. Drug metabolite concentrations were also measured. Compared to pretreatment, on Days 3 and 5, with ADP as the agonist, there was a significant decrease in maximum amplitude on aggregometry for both clopidogrel and clopidogrel/omeprazole groups. The following revealed no significant differences between clopidogrel and clopidogrel/omeprazole groups when compared on Days 3 and 5: maximum amplitude on aggregometry with ADP or collagen agonists, and PFA-100® closure times. When compared to the clopidogrel group, clopidogrel metabolite concentrations in the clopidogrel/omeprazole group were significantly higher on Days 3 and 5. The concurrent administration of omeprazole and clopidogrel in healthy dogs was associated with an increase in the plasma concentration of an inactive metabolite of clopidogrel, but does not significantly alter the antiplatelet effects of clopidogrel.
Collapse
Affiliation(s)
- B E Thames
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - J Lovvorn
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - M G Papich
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - R Wills
- Departments of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - T Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - A Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - J Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| |
Collapse
|
35
|
Hovannisyan IG, Hovanessyan RA. Relationship between platelet aggregation and interleukins IL-1β and IL-4 in the acute stage of ischemic stroke. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:7-9. [DOI: 10.17116/jnevro20161161227-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
36
|
de Villiers S, Swanepoel A, Bester J, Pretorius E. Novel Diagnostic and Monitoring Tools in Stroke: an Individualized Patient-Centered Precision Medicine Approach. J Atheroscler Thromb 2015; 23:493-504. [PMID: 26686739 DOI: 10.5551/jat.32748] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Central to the pathogenesis of ischaemic stroke are the normally protective processes of platelet adhesion and activation. Experimental evidence has shown that the ligand-receptor interactions in ischaemic stroke represent a thrombo-inflammatory cascade, which presents research opportunities into new treatment. However, as anti-platelet drugs have the potential to cause severe side effects in ischaemic stroke patients (as well as other vascular disease patients), it is important to carefully monitor the risk of bleeding and risk of thrombus in patients receiving treatment. Because thrombo-embolic ischaemic stroke is a major health issue, we suggest that the answer to adequate treatment is based on an individualized patient-centered approach, inline with the latest NIH precision medicine approach. A combination of viscoelastic methodologies may be used in a personalized patient-centered regime, including thromboelastography (TEG®) and the lesser used scanning electron microscopy approach (SEM). Thromboelastography provides a dynamic measure of clot formation, strength, and lysis, whereas SEM is a visual structural tool to study patient fibrin structure in great detail. Therefore, we consider the evidence for TEG® and SEM as unique means to confirm stroke diagnosis, screen at-risk patients, and monitor treatment efficacy. Here we argue that the current approach to stroke treatment needs to be restructured and new innovative thought patterns need to be applied, as even approved therapies require close patient monitoring to determine efficacy, match treatment regimens to each patient's individual needs, and assess the risk of dangerous adverse effects. TEG® and SEM have the potential to be a useful tool and could potentially alter the clinical approach to managing ischaemic stroke. As envisaged in the NIH precision medicine approach, this will involve a number of role players and innovative new research ideas, with benefits that will ultimately only be realized in a few years. Therefore, with this ultimate goal in mind, we suggest that an individualized patient-orientated approach is now available and therefore already within our ability to use.
Collapse
Affiliation(s)
- Sulette de Villiers
- Department of Physiology, Faculty of Health Sciences, University of Pretoria
| | | | | | | |
Collapse
|