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Kimmelstiel C, Stevenson R, Nguyen N, Van Doren L, Zhang P, Perkins J, Kapur NK, Weintraub A, Castaneda V, Kuliopulos A, Covic L. Enhanced potency of prasugrel on protease-activated receptors following bivalirudin treatment for PCI as compared to clopidogrel. Thromb Res 2019; 177:59-69. [PMID: 30851630 DOI: 10.1016/j.thromres.2019.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/20/2018] [Accepted: 01/28/2019] [Indexed: 01/22/2023]
Abstract
ACS patients undergoing percutaneous coronary intervention (PCI) when treated with bivalirudin and clopidogrel had increased frequency of early stent thrombosis. 24 patients referred for intervention with planned bivalirudin therapy, not previously treated with a P2Y12 inhibitor and not receiving heparins or αIIbβ3 inhibitors were randomized to treatment with either clopidogrel (600 mg) or prasugrel (60 mg). Platelet aggregation (PA) was measured by light transmission aggregometry (LTA) of platelet-rich plasma in response to ADP, PAR1/PAR4 thrombin receptor agonists and collagen at baseline and at 1, 2, 4 and 16 h following the cessation of bivalirudin infusion. Prasugrel-mediated inhibition of PA was significantly greater than that of clopidogrel at all time points for ADP as well as PAR1. There was an unanticipated, significantly greater protection of PAR4-mediated platelet aggregation only detected with prasugrel and not observed with clopidogrel. We further examined the effect of the hyperreactive PAR4 Thr120 variant in the protease-activated receptor 4 (PAR4), single nucleotide polymorphism (SNP) rs773902 on aggregation protection. The PAR4 protective effect with prasugrel was lost in individuals carrying the PAR4 Thr120 variant, and not in Ala120 homozygote. PAR1, ADP and collagen inhibition was not significantly affected in the hyperreactive PAR4 Thr120 variant. We documented that the P2Y12 ADP receptor-mediated regulation of the strength of the high-affinity conformation of αIIbβ3 as detected by PAC-1 ab, and in control of platelet adhesiveness through Rap1 GTPase protein activation. Importantly, the PAR4 Thr120 variant resulted in the increased rate and magnitude of Rap1 activation. Human platelet PAR4 mediated-activation of αIIbβ3 was phospholipase C beta (PLCβ)-dependent and unlike mouse platelet PI3K-independent. These data identify a PAR4-dependent inhibitory mechanism for the prasugrel-mediated platelet inhibition, not seen with clopidogrel that could explain the reduction in stent thrombosis documented in clinical trials with prasugrel.
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Affiliation(s)
- Carey Kimmelstiel
- Cardiac Catheterization Laboratory and the Division of Cardiology, Tufts Medical Center, Boston, MA 02111, United States of America
| | - Ryan Stevenson
- Hemostasis and Thrombosis Laboratory, Division of Hematology/Oncology, Tufts Medical Center, Boston, MA 02111, United States of America
| | - Nga Nguyen
- Hemostasis and Thrombosis Laboratory, Division of Hematology/Oncology, Tufts Medical Center, Boston, MA 02111, United States of America
| | - Layla Van Doren
- Hemostasis and Thrombosis Laboratory, Division of Hematology/Oncology, Tufts Medical Center, Boston, MA 02111, United States of America
| | - Ping Zhang
- Hemostasis and Thrombosis Laboratory, Division of Hematology/Oncology, Tufts Medical Center, Boston, MA 02111, United States of America
| | - James Perkins
- Hemostasis and Thrombosis Laboratory, Division of Hematology/Oncology, Tufts Medical Center, Boston, MA 02111, United States of America
| | - Navin K Kapur
- Cardiac Catheterization Laboratory and the Division of Cardiology, Tufts Medical Center, Boston, MA 02111, United States of America
| | - Andrew Weintraub
- Cardiac Catheterization Laboratory and the Division of Cardiology, Tufts Medical Center, Boston, MA 02111, United States of America
| | - Vilma Castaneda
- Cardiac Catheterization Laboratory and the Division of Cardiology, Tufts Medical Center, Boston, MA 02111, United States of America
| | - Athan Kuliopulos
- Hemostasis and Thrombosis Laboratory, Division of Hematology/Oncology, Tufts Medical Center, Boston, MA 02111, United States of America
| | - Lidija Covic
- Hemostasis and Thrombosis Laboratory, Division of Hematology/Oncology, Tufts Medical Center, Boston, MA 02111, United States of America.
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Castaneda V, Cerda M, Santibanez F, Jara J, Pulgar E, Palma K, Lemus C, Osorio-Reich M, Concha M, Hartel S. Computational Methods for Analysis of Dynamic Events in Cell Migration. Curr Mol Med 2014; 14:291-307. [DOI: 10.2174/1566524014666140128113952] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 07/05/2013] [Accepted: 12/02/2013] [Indexed: 11/22/2022]
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Kimmelstiel C, Zhang P, Kapur NK, Weintraub A, Krishnamurthy B, Castaneda V, Covic L, Kuliopulos A. Bivalirudin is a dual inhibitor of thrombin and collagen-dependent platelet activation in patients undergoing percutaneous coronary intervention. Circ Cardiovasc Interv 2011; 4:171-9. [PMID: 21364148 DOI: 10.1161/circinterventions.110.959098] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bivalirudin, a direct thrombin inhibitor, is a widely used adjunctive therapy in patients undergoing percutaneous intervention (PCI). Thrombin is a highly potent agonist of platelets and activates the protease-activated receptors, PAR1 and PAR4, but it is not known whether bivalirudin exerts antiplatelet effects in PCI patients. We tested the hypothesis that bivalirudin acts as an antiplatelet agent in PCI patients by preventing activation of PARs on the platelet surface. METHODS AND RESULTS The effect of bivalirudin on platelet function and systemic thrombin levels was assessed in patients undergoing elective PCI. Mean plasma levels of bivalirudin were 2.7±0.5 μmol/L during PCI, which correlated with marked inhibition of thrombin-induced platelet aggregation and significantly inhibited cleavage of PAR1. Unexpectedly, bivalirudin also significantly inhibited collagen-platelet aggregation during PCI. Collagen induced a conversion of the platelet surface to a procoagulant state in a thrombin-dependent manner that was blocked by bivalirudin. Consistent with this result, bivalirudin reduced systemic thrombin levels by >50% during PCI. Termination of the bivalirudin infusion resulted in rapid clearance of the drug with a half-life of 29.3 minutes. CONCLUSIONS Bivalirudin effectively suppresses thrombin-dependent platelet activation via inhibition of PAR1 cleavage and inhibits collagen-induced platelet procoagulant activity as well as systemic thrombin levels in patients undergoing PCI.
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Affiliation(s)
- Carey Kimmelstiel
- The Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts 02111, USA
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