1
|
Yao Y, Li X, Wang Z, Xu S, Lv Q. The impact of high on-treatment platelet reactivity and fibrinogen levels on ischemic events in patients with ST elevation myocardial infarction: a prospective observational study. Int J Clin Pharm 2023; 45:461-472. [PMID: 36639521 DOI: 10.1007/s11096-022-01525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/28/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND After treatment, high residual platelet reactivity (HRPR) is considered as an essential risk factor for recurrent ischemic events. AIM To evaluate the impact of fibrinogen on HRPR after implantation of emergency drug-eluting stents (DES) in patients treated with aspirin and clopidogrel or ticagrelor due to ST-elevation myocardial infarction (STEMI) and to explore the predictive values of HRPR and fibrinogen for adverse ischemic events at 12 months. METHOD This single-center prospective observational study analyzed patients with STEMI who underwent primary percutaneous coronary intervention (PCI) with second-generation DES implantation from January 2017 to December 2018. Platelet reactivity was measured by thromboelastography (TEG) at 60-72 h after primary PCI. HRPR was defined as the adenosine diphosphate-induced maximum amplitude (MAADP) > 47 mm. RESULTS A total of 919 patients were analyzed, of which 512 (55.8%) received aspirin and clopidogrel and 406 (44.2%) received aspirin and ticagrelor. Elevated fibrinogen levels were associated with an increased prevalence of HRPR (P < 0.001). High fibrinogen (quartile IV, ≥ 410 mg/dL) was an independent risk factor for HRPR after multivariate regression (odds ratio 6.556, 95% confidence interval [CI]: 3.200-13.431, P < 0.001). When analyzed by Kaplan-Meier survival curves, the combination of high fibrinogen and HRPR was strongly predictive for ischemic major adverse cardiac events at 12 months compared to the group without HRPR and with low fibrinogen (hazard ratio 9.681, 95% CI: 4.467-20.98, log-rank P < 0.001). Similar results were confirmed in subgroups according to different dual antiplatelet therapies. CONCLUSION A combination of high fibrinogen and HRPR may identify recurrent adverse ischemic events over 12 months. Ticagrelor exhibited more potent platelet inhibition and a better prognosis than clopidogrel.
Collapse
Affiliation(s)
- Yao Yao
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoye Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zi Wang
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shikun Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
2
|
Chen F, Zhang L, Bai X, Wang X, Geng Z. Clinical Application of Thromboelastography in Acute Ischemic Stroke. Clin Appl Thromb Hemost 2022; 28:10760296221131801. [PMID: 36285384 PMCID: PMC9608017 DOI: 10.1177/10760296221131801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute ischemic stroke (AIS), characterized by high morbidity and mortality, has imposed a considerable burden on society. Despite rapid development in the treatment of AIS, there is still a high risk of recurrence. Furthermore, there is a time delay in waiting for the results of conventional coagulation tests in candidate patients for intravenous thrombolysis therapy. Heterogeneous responses to antiplatelet, intravascular thrombolysis, and endovascular therapies also worsen the situation. Thromboelastography (TEG), as a global and portable detection method for hemostasis, facilitates clinicians in disease monitoring, treatment evaluation, and prognosis prediction in AIS. In this narrative review, we provided a comprehensive summary of the clinical application of TEG in ischemic stroke and gave insights to further studies.
Collapse
Affiliation(s)
- Feng Chen
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liren Zhang
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolin Bai
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiuzhe Wang
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,Zhi Geng, 600 Yishan Road, Xuhui District, Shanghai, 200233 China.
Xiuzhe Wang, 600 Yishan Road, Xuhui District, Shanghai, 200233 China
| | - Zhi Geng
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Net platelet clot strength of thromboelastography platelet mapping assay for the identification of high on-treatment platelet reactivity in post-PCI patients. Biosci Rep 2021; 40:225736. [PMID: 32639536 PMCID: PMC7364512 DOI: 10.1042/bsr20201346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
High-on treatment platelet reactivity (HTPR) leads to more prevalence of thrombotic event in patients undergoing percutaneous coronary interventions (PCI). Dual antiplatelet therapy with aspirin in addition to one P2Y12 inhibitor is commonly administrated to reduce HTPR. However, ‘one size fits all’ antiplatelet strategy is widely implemented due to lacking benefits with tailored strategy. One reason for the failure of tailored treatment might be less specificity of the current indicators for HTPR. Therefore, searching for specific indicators for HTPR is critical. Thromboelastograph with platelet mapping (TEGpm) assay has been explored for identifying HTRP. Variables of TEGpm assay, including maximum amplitude (MA) induced by thrombin (MAthrombin), R time, platelet aggregation rate induced by ADP (TEGaradp) and MA induced by ADP (MAadp) have been demonstrated to be able to identify HTPR in post-PCI patients. However, these variables for HTPR might be less specific. Thus, in the present study, a novel variable nMAadp was derived by removing fibrin contribution from MAadp and analyzed for its usefulness in determining HTPR. In addition, MAthrombin, R time, MAadp and TEGaradp were also examined for determining HTPR. In conclusion, nMAadp and TEGaradp were demonstrated to be independent indicators for HTPR; nMAadp had the strongest power to identify HTPR with cutoff value of 26.3 mm; MAthrombin and R time were not significantly different between patients with and without HTPR; combination of TEGaradp and nMAadp further improved the ability to identify HTPR with an AUC of 0.893.
Collapse
|
4
|
Abstract
: Platelets play a pivotal role in controlling hemorrhaging from vessels of the human body. The impairment of platelets may lead to the development of bleeding manifestations. Unraveling the precise defects of platelets by means of suitable laboratory methods paves the way for the effective control and management of platelet disorders. Choosing the most appropriate approach for the detection of platelet disorders may be difficult for a researcher or clinical internist when faced with ordering a platelet-function test. The aim of the current study was to provide a user-friendly overview of the advantages and disadvantages of the available detection systems. To reach this goal, 11 commonly used methods of studying platelet activity were evaluated and compared in detail. A literature search, with no time or language limitations, was conducted in Google Scholar and Medline. All publications published before June 2019 were analyzed. The following laboratory methods were compared: number and size of platelets, bleeding time, clot retraction time, platelet function assay 100 & 200, Rapid platelet function assay, flow cytometry, light transmission aggregometry, multiple electrode aggregometry, 96-well plate aggregometry, cone and plate(let) analyzer (Impact-R), and Plateletworks (single platelet counting system). This article provides the reader with a rapid comparison of the different systems used to study platelets activities.
Collapse
|
5
|
Cheung NK, Carr MW, Ray U, McKenzie D, Froelich JJ. Platelet Function Testing in Neurovascular Procedures: Tool or Gimmick? INTERVENTIONAL NEUROLOGY 2019; 8:123-134. [PMID: 32508894 DOI: 10.1159/000496702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 01/07/2019] [Indexed: 12/12/2022]
Abstract
Background Platelet inhibitors are used to prevent thromboembolic complications related to neurovascular stenting (NVS) procedures. Despite substantial inter-individual variability of functional platelet inhibition, the value of platelet function tests (PFT) to assess inhibition remains controversial. Objective This study was conducted to compare differences in thromboembolic complication rates associated with NVS in platelet-inhibited patients with and without PFT. Clinical neurological outcomes were assessed by differences in the modified Rankin Scale (mRS). Materials and Methods One hundred seventeen consecutive patients underwent elective NVS procedures within a 7-year period. All patients received aspirin and clopidogrel 8 days before the procedure. Fifty-two patients were treated without assessment of platelet inhibition, and 65 patients were tested for clopidogrel resistance. When clopidogrel resistance was revealed, corresponding patients were converted to ticagrelor. Changes in mRS and thromboembolic event rates were compared between the 2 cohorts. Results Thirty-five percent of patients from the cohort subjected to PFT tests showed inadequate platelet inhi-bition under clopidogrel and were converted to ticagrelor. Compared to the non-PFT test -cohort, neurological deficits were significantly reduced (12 vs. 0%; p = 0.009) and a lower number of thromboembolic events was found (12 vs. 3%; p > 0.05) within the test cohort. Conclusion PFT appears to identify patients with clopidogrel resistance prior to NVS procedures. When non-responders are converted to alternative platelet inhibitors, neurological outcomes and thromboembolic complication rates may improve. Consequently, this study provides preliminary evidence that PFT may be a useful clinical tool to enhance procedural safety and improve clinical outcomes in NVS procedures.
Collapse
Affiliation(s)
- Nicholas K Cheung
- Department of Medical Imaging, Neuroradiology, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael W Carr
- Department of Medical Imaging, Neuroradiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Udayan Ray
- Department of Pathology, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Duncan McKenzie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Department of Pharmacy, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Jens J Froelich
- Department of Medical Imaging, Neuroradiology, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
6
|
Nash KJ, Bacek LM, Christopherson PW, Spangler EA. In vitro effect of blood cell counts on multiple-electrode impedance aggregometry in dogs. Am J Vet Res 2017; 78:1380-1386. [PMID: 29182390 DOI: 10.2460/ajvr.78.12.1380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effect of decreased platelet and WBC counts on platelet aggregation as measured by a multiple-electrode impedance aggregometer in dogs. ANIMALS 24 healthy dogs. PROCEDURES From each dog, 9 mL of blood was collected into a 10-mL syringe that contained 1 mL of 4% sodium citrate solution to yield a 10-mL sample with a 1:9 citrate-to-blood ratio. Each sample was then divided into unmanipulated and manipulated aliquots with progressively depleted buffy-coat fractions such that 2 to 3 blood samples were evaluated per dog. The Hct for manipulated aliquots was adjusted with autologous plasma so that it was within 2% of the Hct for the unmanipulated aliquot for each dog. All samples were analyzed in duplicate with a multiple-electrode impedance aggregometer following the addition of ADP as a platelet agonist. The respective effects of platelet count, plateletcrit, Hct, and WBC count on platelet aggregation area under the curve (AUC), aggregation, and velocity were analyzed with linear mixed models. RESULTS WBC count was positively associated with platelet AUC, aggregation, and velocity; blood samples with leukopenia had a lower AUC, aggregation, and velocity than samples with WBC counts within the reference range. Platelet count, plateletcrit, and Hct did not have an independent effect on AUC, aggregation, or velocity. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that WBC count was positively associated with platelet aggregation when ADP was used to activate canine blood samples for impedance aggregometry. That finding may be clinically relevant and needs to be confirmed by in vivo studies.
Collapse
|
7
|
Platelet Aggregometry Testing: Molecular Mechanisms, Techniques and Clinical Implications. Int J Mol Sci 2017; 18:ijms18081803. [PMID: 28820484 PMCID: PMC5578190 DOI: 10.3390/ijms18081803] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 12/18/2022] Open
Abstract
Platelets play a fundamental role in normal hemostasis, while their inherited or acquired dysfunctions are involved in a variety of bleeding disorders or thrombotic events. Several laboratory methodologies or point-of-care testing methods are currently available for clinical and experimental settings. These methods describe different aspects of platelet function based on platelet aggregation, platelet adhesion, the viscoelastic properties during clot formation, the evaluation of thromboxane metabolism or certain flow cytometry techniques. Platelet aggregometry is applied in different clinical settings as monitoring response to antiplatelet therapies, the assessment of perioperative bleeding risk, the diagnosis of inherited bleeding disorders or in transfusion medicine. The rationale for platelet function-driven antiplatelet therapy was based on the result of several studies on patients undergoing percutaneous coronary intervention (PCI), where an association between high platelet reactivity despite P2Y12 inhibition and ischemic events as stent thrombosis or cardiovascular death was found. However, recent large scale randomized, controlled trials have consistently failed to demonstrate a benefit of personalised antiplatelet therapy based on platelet function testing.
Collapse
|
8
|
Affiliation(s)
- Lauren D.C. Casa
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332;,
| | - David N. Ku
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332;,
| |
Collapse
|
9
|
Augustine TN, van der Spuy WJ, Kaberry LL, Shayi M. Thrombin-Mediated Platelet Activation of Lysed Whole Blood and Platelet-Rich Plasma: A Comparison Between Platelet Activation Markers and Ultrastructural Alterations. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2016; 22:630-639. [PMID: 27329313 DOI: 10.1017/s1431927616000854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Platelet ultrastructural alterations representing spurious activation have been identified in pathological conditions. A limitation of platelet studies is that sample preparation may lead to artifactual activation processes which may confound results, impacting the use of scanning electron microscopy as a supplemental diagnostic tool. We used scanning electron microscopy and flow cytometry to analyze platelet activation in platelet-rich plasma (PRP) and whole blood (WB) samples. PRP generated using a single high g force centrifugation, and WB samples treated with a red blood cell lysis buffer, were exposed to increasing concentrations of the agonist thrombin. Platelets in lysed WB samples responded to thrombin by elevating the activation marker CD62p definitively, with corresponding ultrastructural changes indicating activation. Conversely, CD62p expression in PRP preparations remained static. Ultrastructural analysis revealed fully activated platelets even under low concentration thrombin stimulation, with considerable fibrin deposition. It is proposed that the method for PRP production induced premature platelet activation, preventable by using an inhibitor of platelet aggregation and fibrin polymerization. Nevertheless, our results show a definitive correspondence between flow cytometry and scanning electron microscopy in platelet activation studies, highlighting the potential of the latter technique as a supplemental diagnostic tool.
Collapse
Affiliation(s)
- Tanya N Augustine
- School of Anatomical Sciences, Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa
| | - Wendy J van der Spuy
- School of Anatomical Sciences, Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa
| | - Lindsay L Kaberry
- School of Anatomical Sciences, Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa
| | - Millicent Shayi
- School of Anatomical Sciences, Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa
| |
Collapse
|
10
|
Zanuzzo FS, Teixeira-Neto FJ, Thomazini CM, Takahira RK, Conner B, Diniz MS. Effects of dipyrone, meloxicam, or the combination on hemostasis in conscious dogs. J Vet Emerg Crit Care (San Antonio) 2015; 25:512-20. [DOI: 10.1111/vec.12336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 05/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Felipe S. Zanuzzo
- Department of Anesthesiology, Faculdade de Medicina, Universidade Estadual Paulista (UNESP); CEP 18618-970 Botucatu Brazil
| | | | - Camila M. Thomazini
- Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP); CEP 18618-970 Botucatu Brazil
| | - Regina K. Takahira
- Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista (UNESP); CEP 18618-970 Botucatu Brazil
| | - Bobbi Conner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville FL 32610
| | - Miriely S. Diniz
- Department of Anesthesiology, Faculdade de Medicina, Universidade Estadual Paulista (UNESP); CEP 18618-970 Botucatu Brazil
| |
Collapse
|
11
|
Abstract
In physiological hemostasis a prompt recruitment of platelets on the vessel damage prevents the bleeding by the rapid formation of a platelet plug. Qualitative and/or quantitative platelet defects promote bleeding, whereas the high residual reactivity of platelets in patients on antiplatelet therapies moves forward thromboembolic complications. The biochemical mechanisms of the different phases of platelet activation – adhesion, shape change, release reaction, and aggregation – have been well delineated, whereas their complete translation into laboratory assays has not been so fulfilled. Laboratory tests of platelet function, such as bleeding time, light transmission platelet aggregation, lumiaggregometry, impedance aggregometry on whole blood, and platelet activation investigated by flow cytometry, are traditionally utilized for diagnosing hemostatic disorders and managing patients with platelet and hemostatic defects, but their use is still limited to specialized laboratories. To date, a point-of-care testing (POCT) dedicated to platelet function, using pertinent devices much simpler to use, has now become available (ie, PFA-100, VerifyNow System, Multiplate Electrode Aggregometry [MEA]). POCT includes new methodologies which may be used in critical clinical settings and also in general laboratories because they are rapid and easy to use, employing whole blood without the necessity of sample processing. Actually, these different platelet methodologies for the evaluation of inherited and acquired bleeding disorders and/or for monitoring antiplatelet therapies are spreading and the study of platelet function is strengthening. In this review, well-tried and innovative platelet function tests and their methodological features and clinical applications are considered.
Collapse
Affiliation(s)
- Rita Paniccia
- Department of Experimental and Clinical Medicine, Thrombosis Center, University of Florence, Florence, Italy ; Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Raffaella Priora
- Department of Experimental and Clinical Medicine, Thrombosis Center, University of Florence, Florence, Italy ; Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Rosanna Abbate
- Department of Experimental and Clinical Medicine, Thrombosis Center, University of Florence, Florence, Italy ; Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| |
Collapse
|
12
|
Morshuis M, Özpeker C, Schulz U, Gummert J, Koster A. Herzunterstützungssysteminduzierte Störungen der Gerinnung. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-013-1050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Paniccia R, Priora R, Liotta AA, Maggini N, Abbate R. Assessment of platelet function: Laboratory and point-of-care methods. World J Transl Med 2014; 3:69-83. [DOI: 10.5528/wjtm.v3.i2.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/14/2014] [Accepted: 04/29/2014] [Indexed: 02/05/2023] Open
Abstract
In the event of blood vessel damage, human platelets are promptly recruited on the site of injury and, after their adhesion, activation and aggregation, prevent blood loss with the formation of a clot. The consequence of abnormal regulation can be either hemorrhage or the development of thrombosis. Qualitative and/or quantitative defects in platelets promote bleeding, whereas the residual reactivity of platelets, despite antiplatelet therapies, play an important role in promoting arterial thrombotic complications. Platelet function is traditionally assessed to investigate the origin of a bleeding syndrome, to predict the risk of bleeding prior surgery or during pregnancy or to monitor the efficacy of antiplatelet therapy in thrombotic syndromes that, now, can be considered a new discipline. “Old” platelet function laboratory tests such as the evaluation of bleeding time and the platelet aggregation analysis in platelet-rich plasma are traditionally utilized to aid in the diagnosis and management of patients with platelet and hemostatic disorders and used as diagnostic tools both in bleeding and thrombotic diathesis in specialized laboratories. Now, new and renewed automated systems have been introduced to provide a simple, rapid assessment of platelet function including point of care methods. These new methodologies are also suitable for being used in non-specialized laboratories and in critical area for assessing platelet function in whole blood without the requirement of sample processing. Some of these methods are also beginning to be incorporated into routine clinical use and can be utilized as not only as first panel for the diagnosis of platelet dysfunction, but also for monitoring anti-platelet therapy and to potentially assess risk of both bleeding and/or thrombosis.
Collapse
|
14
|
Mannu GS, Macartney A, Lambert JRA, Bettencourt-Silva JH, Lawn M, Lyall H, Metcalf AK, Potter JF, Wood J, Clark A, Baglin T, Myint PK, Bowles KM. The clinical utility of Multiplate analyser measurement in platelet function testing following stroke and transient ischaemic attack. Eur J Haematol 2014; 94:138-44. [PMID: 24981148 DOI: 10.1111/ejh.12406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Platelet responsiveness to aspirin in people with cerebrovascular disease is poorly understood. OBJECTIVES To determine: (i) normal reference range, imprecision and reproducibility of the Multiplate instrument in healthy volunteers naive to aspirin; (ii) imprecision and reproducibility of the Multiplate instrument in acute stroke and transient ischaemic attack (TIA); (iii) the relationship between aspirin responsiveness and clinical outcome. MATERIALS AND METHODS We evaluated platelet function response to three agonists [Adenosine Diphosphate (ADP), Arachidonic Acid (AA), Collagen (Col)] using the Mulitplate platelet function analyser in a two-phase pilot study. In phase 1, we recruited healthy volunteers to determine the normal reference range and imprecision of the Multiplate instrument. In phase 2, we assessed platelet function in acute stroke or TIA patients presenting to hospital. These patients were bled within 24 h of presentation and between 12 and 24 h after ≥75 mg dose of Aspirin. Patients were followed up to 1 yr to assess mortality and recurrent cardiovascular event. RESULTS Overall, 29 healthy volunteers and 81 stroke/TIA patients were recruited. On assessing components of variance, Multiplate testing is reproducible and precise in volunteers and stroke/TIA patients. In stroke patients receiving aspirin, Bland-Altman plots show initial day 1 measurement provided a reliable measure of continuing response to aspirin at day 3. We defined one-third of patients as aspirin resistant [31.8% (95% CI: 22.1%-42.8%)] using cut off mean aggregation of ≥23.08% for AA and mean aggregation of ≥80.76% for ADP. CONCLUSION The Multiplate device gives reproducible, precise results in volunteers and stroke/TIA patients.
Collapse
Affiliation(s)
- Gurdeep S Mannu
- Oxford University Hospitals NHS Trust, Oxford, UK; Norfolk and Norwich University Hospital, Norfolk, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Adamson K, Spain E, Prendergast U, Forster RJ, Moran N, Keyes TE. Ligand capture and activation of human platelets at monolayer modified gold surfaces. Biomater Sci 2014; 2:1509-1520. [DOI: 10.1039/c4bm00241e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The effect of RGD peptides, alkane and PEG in self assembled mixed monolayers on gold on platelet adhesion and activation is explored.
Collapse
Affiliation(s)
- Kellie Adamson
- School of Chemical Sciences
- Dublin City University
- Dublin 9, Ireland
- Department of Molecular and Cellular Therapeutics
- Royal College of Surgeons in Ireland
| | - Elaine Spain
- School of Chemical Sciences
- Dublin City University
- Dublin 9, Ireland
| | - Una Prendergast
- School of Chemical Sciences
- Dublin City University
- Dublin 9, Ireland
| | | | - Niamh Moran
- Department of Molecular and Cellular Therapeutics
- Royal College of Surgeons in Ireland
- Dublin 2, Ireland
| | - Tia E. Keyes
- School of Chemical Sciences
- Dublin City University
- Dublin 9, Ireland
| |
Collapse
|
16
|
Mills HL, Abdel-Baki MS, Teruya J, Dietrich JE, Shah MD, Mahoney D, Yee DL, Srivaths LV. Platelet function defects in adolescents with heavy menstrual bleeding. Haemophilia 2013; 20:249-54. [DOI: 10.1111/hae.12293] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 11/30/2022]
Affiliation(s)
- H. L. Mills
- Department of Pediatrics; Baylor College of Medicine; Houston TX
- Section of Hematology/Oncology; Department of Pediatrics; Baylor College of Medicine; Houston TX
| | - M. S. Abdel-Baki
- Department of Pediatrics; Baylor College of Medicine; Houston TX
- Section of Hematology/Oncology; Department of Pediatrics; Baylor College of Medicine; Houston TX
| | - J. Teruya
- Department of Pediatrics; Baylor College of Medicine; Houston TX
- Section of Hematology/Oncology; Department of Pediatrics; Baylor College of Medicine; Houston TX
- Division of Transfusion Medicine; Baylor College of Medicine; Houston TX
| | - J. E. Dietrich
- Department of Pediatrics; Baylor College of Medicine; Houston TX
- Department of Obstetrics & Gynecology; Baylor College of Medicine; Houston TX USA
| | - M. D. Shah
- Department of Pediatrics; Baylor College of Medicine; Houston TX
- Section of Hematology/Oncology; Department of Pediatrics; Baylor College of Medicine; Houston TX
| | - D. Mahoney
- Department of Pediatrics; Baylor College of Medicine; Houston TX
- Section of Hematology/Oncology; Department of Pediatrics; Baylor College of Medicine; Houston TX
| | - D. L. Yee
- Department of Pediatrics; Baylor College of Medicine; Houston TX
- Section of Hematology/Oncology; Department of Pediatrics; Baylor College of Medicine; Houston TX
| | - L. V. Srivaths
- Department of Pediatrics; Baylor College of Medicine; Houston TX
- Section of Hematology/Oncology; Department of Pediatrics; Baylor College of Medicine; Houston TX
| |
Collapse
|
17
|
Serebruany VL, Pokov AN, Aradi D, Can M, DiNicolantonio J, Kipshidze N, Atar D. Effect of aliskiren and valsartan combination versus aliskiren monotherapy on hemostatic biomarkers in hypertensive diabetics: Aliskiren and Valsartan Impact in Diabetics pilot trial. Am J Ther 2013; 21:482-90. [PMID: 23698186 DOI: 10.1097/mjt.0b013e31826915ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Valsartan is known to inhibit platelet activity in both in vitro and ex vivo clinical setting, whereas aliskiren in vitro modulates antithrombin-III in plasma. The authors tested how aliskiren and valsartan combination versus aliskiren monotherapy will affect hemostatic biomarkers in mild-to-moderate hypertensive diabetics in the frame of the Aliskiren and Valsartan Impact in Diabetics (AVID) trial. A total of 52 patients with type 2 diabetes and mild-to-moderate hypertension were equally randomized to aliskiren (150-300 mg/d) and valsartan (160 mg/d) versus aliskiren (150-300 mg/d) alone for 4 weeks. A total of 25 biomarkers were serially measured, of which 16 are related to platelet function, 6 to coagulation, and 3 to fibrinolysis. Aliskiren monotherapy has no significant impact on any of the assessed biomarkers. In contrast, valsartan on top of aliskiren provided significant inhibition of ADP-induced platelet aggregation (P=0.032), decreased shear-induced activation measured with PFA-100 analyzer (P=0.041), and diminished expression of GP IIb/IIIa activity (P=0.027) measured by PAC-1 antibody, GP Ib (CD42b, P=0.033), vitronectin receptor (CD51/61, P=0.046), P-selectin (CD62p, P=0.026), lysosome-associated membrane protein (CD107a, P=0.042), and CD40-ligand (CD154, P=0.048). In AVID trial, valsartan in combination with aliskiren mildly but significantly inhibited platelets, confirming previous observations. In contrast, aliskiren monotherapy does not enhance antithrombin activity, suggesting that previous data probably represent a laboratory artifact. Importantly, these randomized data were generated on top of low-dose daily aspirin, supporting extra benefit for combination use of angiotensin receptor blockers and renin inhibitors in high-risk diabetic population.
Collapse
Affiliation(s)
- Victor L Serebruany
- 1HeartDrug Research Laboratories, Johns Hopkins University, Baltimore, MD; 2Heart Institute, University of Pécs, Pécs, Hungary; 3Wegmans Pharmacy, Ithaca, NY; 4Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway; and 5Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | | |
Collapse
|
18
|
Arya SC, Agarwal N. Thrombocytopenia progression in dengue cases during the 2010 outbreak in Indian capital metropolis. Platelets 2011; 22:476-7. [PMID: 21388248 DOI: 10.3109/09537104.2011.556276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|