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Calderone D, Ingala S, Mauro MS, Angiolillo DJ, Capodanno D. Appraising the contemporary role of aspirin for primary and secondary prevention of atherosclerotic cardiovascular events. Expert Rev Cardiovasc Ther 2021; 19:1097-1117. [PMID: 34915778 DOI: 10.1080/14779072.2021.2020100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Although the role of aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) has been disputed, its use in secondary ASCVD prevention is well established. Recent trials of primary prevention do not suggest a significant net benefit with aspirin, whereas accruing evidence supports adopting aspirin-free strategies in the context of potent P2Y12 inhibition for the secondary prevention of selected patients undergoing percutaneous coronary intervention. AREAS COVERED This updated review aims at summarizing and appraising the pharmacological characteristics and the contemporary role of aspirin for the primary and secondary prevention of ASCVD. EXPERT OPINION Recent trials and metanalyses in the context of primary prevention highlighted a modest reduction in ischemic events with aspirin use, counterbalanced by a significant increase in bleeding events. However, ongoing studies on cancer prevention could modify the current paradigm of the unfavorable benefit-risk ratio of aspirin in patients with no overt ASCVD. Conversely, aspirin use is crucial for secondary ASCVD prevention, both in chronic and acute coronary syndromes. Nevertheless, after a brief period of dual antiplatelet therapy, patients at high bleeding risk may benefit from discontinuation of aspirin if a P2Y12 inhibitor is used, hence reducing the bleeding risk with no rebound in thrombotic events.
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Affiliation(s)
- Dario Calderone
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco" University of Catania, Catania, Italy
| | - Salvatore Ingala
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco" University of Catania, Catania, Italy
| | - Maria Sara Mauro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco" University of Catania, Catania, Italy
| | - Dominick J Angiolillo
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco" University of Catania, Catania, Italy
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Kang HG, Lee SJ, Heo SH, Chang DI, Kim BJ. Clopidogrel Resistance in Patients With Stroke Recurrence Under Single or Dual Antiplatelet Treatment. Front Neurol 2021; 12:652416. [PMID: 34447343 PMCID: PMC8383201 DOI: 10.3389/fneur.2021.652416] [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: 01/12/2021] [Accepted: 07/19/2021] [Indexed: 01/01/2023] Open
Abstract
Background: The factors associated with clopidogrel resistance in patients with stroke recurrence receiving single or dual antiplatelet treatment (SAPT or DAPT) may differ. This study compared the high on-treatment platelet reactivities (HPRs) and the factors associated with clopidogrel resistance in recurrent ischemic stroke patients receiving clopidogrel or aspirin and clopidogrel. Methods: We enrolled and allocated 275 recurrent ischemic stroke patients to the clopidogrel and DAPT groups and compared their demographics, conventional risk factors, and P2Y12 reaction units (PRUs). Clopidogrel resistance was categorized as PRU higher than 275. We performed a multivariate logistic regression analysis to determine the factors underlying clopidogrel resistance during SAPT and DAPT. Results: In total, 145 (52.7%) and 130 (47.3%) patients received clopidogrel and DAPT, respectively at recurrence. The risk factors of the two groups were not significantly different, except that coronary artery disease was more frequent in the DAPT group. The PRU was higher (255 ± 91 vs. 221 ± 84; p = 0.002) and clopidogrel resistance was more frequent (45.5 vs. 31.5%; p = 0.018) in the SAPT than in the DAPT group. Hyperlipidemia was associated with clopidogrel resistance during SAPT, and smoking (Odds ratio = 0.426, 95% confidence interval 0.210–0.861; p = 0.018) had a protective effect against clopidogrel resistance. For those receiving DAPT, old age, female, low hemoglobin A1c level, and high ARU were associated with clopidogrel resistance. Conclusions: HPR and clopidogrel resistance were more frequent in recurrent ischemic stroke patients receiving clopidogrel than in those receiving DAPT. Smoking was independently associated with less clopidogrel resistance among those receiving clopidogrel SAPT but not in those receiving DAPT.
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Affiliation(s)
- Hyun Goo Kang
- Department of Neurology, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Seung Jae Lee
- Institute for Molecular Biology and Genetics and Department of Chemistry, Jeonbuk National University, Jeonju, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, School of Medicine, Seoul, South Korea
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Afolalu EF, Spies E, Bacso A, Clerc E, Abetz-Webb L, Gallot S, Chrea C. Impact of tobacco and/or nicotine products on health and functioning: a scoping review and findings from the preparatory phase of the development of a new self-report measure. Harm Reduct J 2021; 18:79. [PMID: 34330294 PMCID: PMC8325199 DOI: 10.1186/s12954-021-00526-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measuring self-reported experience of health and functioning is important for understanding the changes in the health status of individuals switching from cigarettes to less harmful tobacco and/or nicotine products (TNP) or reduced-risk products (RRP) and for supporting tobacco harm reduction strategies. METHODS This paper presents insights from three research activities from the preparatory phase of the development of a new self-report health and functioning measure. A scoping literature review was conducted to identify the positive and negative impact of TNP use on health and functioning. Focus groups (n = 29) on risk perception and individual interviews (n = 40) on perceived dependence in people who use TNPs were reanalyzed in the context of health and functioning, and expert opinion was gathered from five key opinion leaders and five technical consultants. RESULTS Triangulating the findings of the review of 97 articles, qualitative input from people who use TNPs, and expert feedback helped generate a preliminary conceptual framework including health and functioning and conceptually-related domains impacted by TNP use. Domains related to the future health and functioning measurement model include physical health signs and symptoms, general physical appearance, functioning (physical, sexual, cognitive, emotional, and social), and general health perceptions. CONCLUSIONS This preliminary conceptual framework can inform future research on development and validation of new measures for assessment of overall health and functioning impact of TNPs from the consumers' perspective.
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Affiliation(s)
- Esther F Afolalu
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland.
| | - Erica Spies
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Agnes Bacso
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Emilie Clerc
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Linda Abetz-Webb
- Patient-Centered Outcomes Assessments Ltd., 1 Springbank, Bollington, Macclesfield, Cheshire, SK10 5LQ, UK
| | - Sophie Gallot
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Christelle Chrea
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
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4
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Ambrose JA, Najafi A, Jain V, Muller JE, Ranka S, Barua RS. Reducing Tobacco-Related Disability in Chronic Smokers. Am J Med 2020; 133:908-915. [PMID: 32325048 DOI: 10.1016/j.amjmed.2020.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 02/02/2023]
Abstract
Tobacco consumption (predominantly cigarettes) is the leading preventable cause of mortality worldwide. Although the major focus of strategies to reduce mortality from tobacco must include prevention of future generations from initially gaining access, some smokers are unwilling or unable to quit. Can the higher risk chronic smoker be identified and can their risk be reduced? The risk of adverse events in cigarette smokers is influenced by the intensity and duration of cigarette smoking or secondhand exposure, associated conventional risk factors, environmental stressors, and certain genetic variants and epigenetic modifiers. Recent data suggest that inflammatory markers such as high-sensitivity C-reactive protein (hs CRP) and targeted imaging can identify some smokers at higher risk. As smoking is prothrombotic, aspirin initiation and expanded statin use might reduce cardiovascular risk in those who do not presently meet criteria for these therapies, but further study is required. Thus, although advocacy for smoking cessation should always be the primary approach, increased efforts are needed to identify and potentially treat those who are unable or unwilling to quit.
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Affiliation(s)
- John A Ambrose
- University of California, San Francisco, Fresno Medical Education Program, Fresno, Calif.
| | - Amir Najafi
- University of California, San Francisco, Fresno Medical Education Program, Fresno, Calif
| | - Vipul Jain
- University of California, San Francisco, Fresno Medical Education Program, Fresno, Calif
| | | | - Sagar Ranka
- University of Kansas Medical Center, Kansas City Veterans' Administration, Kansas City, Mo
| | - Rajat S Barua
- University of Kansas Medical Center, Kansas City Veterans' Administration, Kansas City, Mo
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Cai Y, Xu W, Liu H, Wang F, Duan L, Li H, Li M, Li Y, Han L, Xiao H. Effects of cigarette smoking on older chinese men treated with clopidogrel monotherapy or aspirin monotherapy: a prospective study. Platelets 2019; 31:667-673. [PMID: 31556777 DOI: 10.1080/09537104.2019.1667494] [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: 01/25/2023]
Abstract
We investigated the comparative effects of smoking status on outcomes in older Chinese men receiving aspirin or clopidogrel monotherapy. This was a prospective observational study of outcomes in 668 men aged ≥ 60 years undergoing annual health examination in the Chinese People's Liberation Army General Hospital from March-April 2017. All patients received regular treatment with aspirin or clopidogrel. Platelet aggregation and phenotyping for rs762551 were measured in all patients. We recorded all major adverse cardiovascular and cerebrovascular events; namely, all-cause death, myocardial infarction, stroke, transient ischemic attack, and unstable angina. In the clopidogrel subgroup, homozygous carriers (AA) of the CYP1A2*1F gene (rs762551, 163C>A) appeared more frequently in smokers than in nonsmokers (45.6% vs 32.7%, p = .035). Adenosine diphosphate-induced platelet aggregation using light transmittance aggregometry was lower in smokers compared with nonsmokers (44.97 ± 20.05% vs 51.98 ± 19.38%, respectively; p = .0018). Smokers (n = 103) had a decreased risk of major adverse cardiovascular and cerebrovascular events, compared with nonsmokers [n = 159; hazard ratio, 0.466; 95% confidence interval: 0.262-0.829, p = .008]. In the aspirin subgroup, AA-induced platelet aggregation showed no significant difference regarding smoking vs nonsmoking status (30.90 ± 32.21 vs 29.78 ± 31.47, respectively; p = .771). However, we saw a significant increase in adverse clinical events in the smoking group (n = 148) compared with the nonsmoking group (n = 258; hazard ratio = 1.907, 95% confidence interval: 1.128-3.225; p = .016). In older Chinese men, active smokers benefitted from clopidogrel therapy compared with aspirin. Long-term cigarette smoking may contribute to increased variations in CYP1A2*1F, but the variations do not fully explain the smoking paradox.
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Affiliation(s)
- Yulun Cai
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital , Beijing, China
| | - Weihao Xu
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital , Beijing, China
| | - Hongbin Liu
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital , Beijing, China
| | - Fan Wang
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital , Beijing, China
| | - Lei Duan
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital , Beijing, China
| | - Huiying Li
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital , Beijing, China
| | - Man Li
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital , Beijing, China
| | - Yuerui Li
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital , Beijing, China
| | - Lina Han
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital , Beijing, China
| | - Hunan Xiao
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital , Beijing, China
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Yuan J, Xu GM, Ding J. Aspirin Versus Clopidogrel Monotherapy for the Treatment of Patients with Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis. Adv Ther 2019; 36:2062-2071. [PMID: 31154631 PMCID: PMC6822863 DOI: 10.1007/s12325-019-01004-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Indexed: 12/17/2022]
Abstract
Introduction Although aspirin (ASA) is the mainstay of treatment for the prevention of recurrent ischemic stroke, the Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial showed ASA monotherapy to be inferior to clopidogrel in preventing recurrent adverse cardiovascular outcomes in patients with high cardiac risks. Here, we aimed to systematically compare ASA versus clopidogrel monotherapy for the treatment of patients with stable coronary artery disease (CAD). Methods Electronic databases were searched and studies were included if they compared ASA versus clopidogrel monotherapy for the treatment of patients with CAD and they reported adverse clinical outcomes. The latest version of RevMan software (version 5.3) was used as the statistical tool for the data analysis. Odds ratios (OR) and 95% confidence intervals (CI) were generated to interpret the data. Results A total number of 5497 patients (from years 2003 to 2011) were treated with ASA monotherapy, whereas 2544 patients were treated with clopidogrel monotherapy. Results of this analysis showed no significant difference in composite endpoints (cardiovascular death, myocardial infarction, and stroke) (OR 0.99, 95% CI 0.47–2.10; P = 0.98), all-cause mortality (OR 1.05, 95% CI 0.82–1.33; P = 0.71), cardiac death (OR 0.89, 95% CI 0.17–4.74; P = 0.89, myocardial infarction (OR 0.84, 95% CI 0.52–1.36; P = 0.48), stroke (OR 1.26, 95% CI 0.39–4.06; P = 0.70), and bleeding defined by the Bleeding Academic Research Consortium (BARC [grade 3 or above]) (OR 1.28, 95% CI 0.78–2.12; P = 0.33). Conclusion This analysis did not show any significant difference in all-cause mortality, cardiac death, myocardial infarction, stroke, and BARC grade 3 or above among CAD patients who were treated with either ASA or clopidogrel monotherapy. However, as a result of the limited data, this hypothesis should be confirmed in other major trials.
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Affiliation(s)
- Jun Yuan
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
| | - Guang Ma Xu
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jiawang Ding
- Department of Cardiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China
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Liu Z, Xiang Q, Mu G, Xie Q, Zhou S, Wang Z, Chen S, Hu K, Gong Y, Jiang J, Cui Y. Effectiveness and Safety of Platelet ADP -P2Y12 Receptor Inhibitors Influenced by Smoking Status: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 8:e010889. [PMID: 30898054 PMCID: PMC6509729 DOI: 10.1161/jaha.118.010889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/30/2019] [Indexed: 02/07/2023]
Abstract
Background As reports on the influence of cigarette smoking, an important cardiovascular risk factor, on platelet ADP -P2Y12 receptor inhibitors lack consistency, we aimed to assess the effectiveness and safety of platelet ADP -P2Y12 receptor inhibitors influenced by smoking status. Methods and Results PubMed, Web of Science, EMBASE , Clinical Trials, and the Cochrane Library were searched from inception until June 2018. Among the 5076 citations retrieved, 22 studies, including 163 011 patients with or without percutaneous coronary intervention, were included for meta-analysis. Compared with nonsmokers within the first year of follow-up, the reductions of stroke and major adverse cardiovascular event rate were 18% ( P=0.008) and 26% ( P=0.02), respectively. A 20% reduction in stroke ( P=0.02) and a 34% reduction in major adverse cardiovascular event ( P=0.0001) rates were observed in smoking patients without percutaneous coronary intervention. No significant difference was observed in clinical outcome rates among prasugrel, ticagrelor, and clopidogrel in different smoking status. No significant difference was found in myocardial infarction and bleeding event incidence between current smokers and nonsmokers. Conclusions We concluded that current smokers had a lower incidence of major adverse cardiovascular events and stroke events than did nonsmokers, particularly in the early period (1 year) and among patients without percutaneous coronary intervention. However, because of the lack of original adjusted data, smoker's paradox still needs to consider the impact of age and other covariates. Thus, a differential risk-benefit evaluation should be considered, according to different smoking status, patient conditions, and therapy time points.
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Affiliation(s)
- Zhiyan Liu
- Department of PharmacyPeking University First HospitalBeijingChina
- School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Qian Xiang
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Guangyan Mu
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Qiufen Xie
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Shuang Zhou
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Zining Wang
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Shuqing Chen
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Kun Hu
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Yanjun Gong
- Department of CardiologyPeking University First HospitalBeijingChina
| | - Jie Jiang
- Department of CardiologyPeking University First HospitalBeijingChina
| | - Yimin Cui
- Department of PharmacyPeking University First HospitalBeijingChina
- School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
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Capodanno D, Mehran R, Valgimigli M, Baber U, Windecker S, Vranckx P, Dangas G, Rollini F, Kimura T, Collet JP, Gibson CM, Steg PG, Lopes RD, Gwon HC, Storey RF, Franchi F, Bhatt DL, Serruys PW, Angiolillo DJ. Aspirin-free strategies in cardiovascular disease and cardioembolic stroke prevention. Nat Rev Cardiol 2018; 15:480-496. [DOI: 10.1038/s41569-018-0049-1] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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9
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Franchi F, Rollini F, Cho JR, King R, Phoenix F, Bhatti M, DeGroat C, Tello-Montoliu A, Zenni MM, Guzman LA, Bass TA, Ajjan RA, Angiolillo DJ. Effects of dabigatran on the cellular and protein phase of coagulation in patients with coronary artery disease on dual antiplatelet therapy with aspirin and clopidogrel. Thromb Haemost 2018; 115:622-31. [DOI: 10.1160/th15-06-0467] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/29/2015] [Indexed: 01/12/2023]
Abstract
SummaryThere is growing interest in understanding the effects of adding an oral anticoagulant in patients on dual antiplatelet therapy (DAPT). Vitamin K antagonists (VKAs) and clopidogrel represent the most broadly utilised oral anticoagulant and P2Y12 receptor inhibitor, respectively. However, VKAs can interfere with clopidogrel metabolism via the cytochrome P450 (CYP) system which in turn may result in an increase in platelet reactivity. Dabigatran is a direct acting (anti-II) oral anticoagulant which does not interfere with CYP and has favourable safety and efficacy profiles compared with VKAs. The pharmacodynamic (PD) effects on platelet reactivity and clot kinetic of adjunctive dabigatran therapy in patients on DAPT are poorly explored. In this prospective, randomised, double-blind, placebo-controlled PD study, patients (n=30) on maintenance DAPT with aspirin and clopidogrel were randomised to either dabigatran 150 mg bid or placebo for seven days. PD testing was performed before and after treatment using four different assays exploring multiple pathways of platelet aggregation and fibrin clot kinetics: light transmittance aggregometry (LTA), multiple electrode aggregometry (MEA), kaolin-activated thromboelastography (TEG) and turbidimetric assays. There were no differences in multiple measures of platelet reactivity investigating purinergic and non-purinergic signaling pathways assessed by LTA, MEA and TEG platelet mapping. Dabigatran significantly increased parameters related to thrombin activity and thrombus generation, and delayed fibrin clot formation, without affecting clot structure or fibrinolysis. In conclusion, in patients on DAPT with aspirin and clopidogrel, adjunctive dabigatran therapy is not associated with modulation of profiles of platelet reactivity as determined by several assays assessing multiple platelet signalling pathways. However, dabigatran significantly interferes with parameters related to thrombin activity and delays fibrin clot formation.
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Sun J, Yang GH, Liu JX, Liu XL, Ma YQ, Lu RY, Zhang YY, Chen SB, Zhao JH, Ji WJ, Zhou X, Li YM. Discordance Between VASP Phosphorylation and Platelet Aggregation in Defining High On-Clopidogrel Platelet Reactivity After ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost 2017; 24:47-54. [PMID: 28877606 DOI: 10.1177/1076029617726600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To investigate potential clinical characteristics associated with discordance between platelet vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) flow cytometry (FCM) assay and light transmission aggregometry (LTA) in defining high on-clopidogrel platelet reactivity (HPR) after ST-segment elevation myocardial infarction (STEMI). In this study, platelet responsiveness was measured by the above 2 methods simultaneously on day 1 and on day 6 of STEMI onset in 90 consecutive patients who underwent primary percutaneous coronary intervention. The FCM-derived platelet reactivity index and LTA-derived platelet aggregation rate were both significantly reduced after dual antiplatelet therapy on day 6. Multiple variable-adjusted logistic regression analysis revealed that smoking (odds ratio [OR]: 4.507, 95% confidence interval [CI]: 1.123-18.09, P = .034) and onset-to-admission time (per 1 hour increase, OR: 1.196, 95% CI: 1.023-1.398, P = .025) both were independent predictors for the discordance between the 2 methods. Additionally, improved correlation and concordance was observed in nonsmokers compared with smokers. Our data show that smoking and prolonged onset-to-admission time are associated with discordance between platelet VASP-P and LTA in defining HPR after STEMI, which should be considered when planning personalized antiplatelet therapy.
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Affiliation(s)
- Jing Sun
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China.,The first two authors contributed equally to this work
| | - Guo-Hong Yang
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China.,The first two authors contributed equally to this work
| | - Jun-Xiang Liu
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Xin-Lin Liu
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Yong-Qiang Ma
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Rui-Yi Lu
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Ying-Ying Zhang
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Shao-Bo Chen
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Ji-Hong Zhao
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Wen-Jie Ji
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Xin Zhou
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Yu-Ming Li
- 1 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
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11
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Gargiulo G, Windecker S, Vranckx P, Gibson CM, Mehran R, Valgimigli M. A Critical Appraisal of Aspirin in Secondary Prevention: Is Less More? Circulation 2017; 134:1881-1906. [PMID: 27920074 DOI: 10.1161/circulationaha.116.023952] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Aspirin represents the sine qua non for antiplatelet pharmacotherapy in patients with cardiovascular diseases because of its well-established role in secondary prevention and its widespread availability and affordability. Historical studies, conducted in an era that bears little resemblance to contemporary clinical practice, demonstrated large reductions in thrombotic risk when aspirin was compared with placebo, thus forming the evidence base promulgated in practice guidelines and recommendations. P2Y12 inhibitors have mostly been studied in addition to aspirin; dual-antiplatelet therapy proved superiority compared with aspirin monotherapy for the prevention of ischemic events, despite increased bleeding risks. An alternative approach currently under investigation includes evaluation of single-antiplatelet therapy with P2Y12 inhibitors alone versus dual-antiplatelet therapy after acute coronary syndromes or coronary stent implantation. As the availability of more effective antiplatelet agents increases, it is time to revisit the existing and long-standing paradigm supporting aspirin use for secondary prevention of atherothrombotic events. Ongoing trials will provide new evidence whether the less-is-more strategy is justified.
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Affiliation(s)
- Giuseppe Gargiulo
- From Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (G.G., S.W., M.V.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G.); Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Belgium (P.V.); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.); The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); and Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (M.V.)
| | - Stephan Windecker
- From Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (G.G., S.W., M.V.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G.); Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Belgium (P.V.); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.); The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); and Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (M.V.)
| | - Pascal Vranckx
- From Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (G.G., S.W., M.V.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G.); Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Belgium (P.V.); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.); The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); and Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (M.V.)
| | - Charles Michael Gibson
- From Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (G.G., S.W., M.V.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G.); Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Belgium (P.V.); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.); The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); and Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (M.V.)
| | - Roxana Mehran
- From Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (G.G., S.W., M.V.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G.); Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Belgium (P.V.); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.); The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); and Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (M.V.)
| | - Marco Valgimigli
- From Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (G.G., S.W., M.V.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (G.G.); Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Belgium (P.V.); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.); The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.); and Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (M.V.).
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Abstract
The optimal duration and type of antiplatelet therapy after implantation of a drug-eluting stent (DES) remains uncertain. At the time of the first-in-man implantation of the sirolimus DES in 1999, the protocol-defined dual antiplatelet therapy (DAPT) duration was only 2 months. Subsequently, DAPT duration was extended to 1 year on the basis of anecdotal historical data, and this practice was then incorporated into clinical guidelines. For >1 decade, trialists have sought to compare the safety and efficacy of abbreviated (<6 months) and prolonged (>12 months) DAPT regimens. However, the body of evidence is limited by the heterogeneity of end points, time of randomization, and bleeding criteria used in each trial. Pharmaceutical advances led to the introduction of new ADP-receptor antagonists, which are thought to be more effective than clopidogrel. The ADP-receptor antagonists moved the focus from the optimal duration of DAPT to the potential efficacy of single antiplatelet therapy after DES implantation. In this Review, we summarize the current evidence on the duration of DAPT and the risk of bleeding and adverse cardiac events after DES implantation, and describe the pitfalls of trial interpretation. The ongoing, prospective trials to test single antiplatelet therapy after DES implantation are also discussed.
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Zhang Q, Wang Y, Song H, Hou C, Cao Q, Dong K, Huang X, Feng W, Ovbiagele B, Wang M, Ji X. Clopidogrel and ischemic stroke outcomes by smoking status: Smoker's paradox? J Neurol Sci 2016; 373:41-44. [PMID: 28131222 DOI: 10.1016/j.jns.2016.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 12/13/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Active smokers with myocardial infarction were shown to have enhanced benefit with clopidogrel compared with aspirin. Whether this "paradox" exists in ischemic stroke patients is unknown. We aimed to investigate whether smoking status has a differential impact on the efficacy of clopidogrel vs. aspirin in patients with non-cardioembolic strokes. METHODS This single-center study retrospectively assessed 1792 non-cardioembolic ischemic stroke patients discharged from January 2013 to October 2014, and followed for 12months. Patients were categorized as current-smokers and never-smokers. Primary outcome was a composite of secondary ischemic stroke, myocardial infarction and all-cause death. Secondary outcome was secondary ischemic stroke. RESULTS 1066 patients were current-smokers and 726 were never-smokers. Compared with never-smokers, current-smokers had significantly higher rates of ischemic stroke (4.3% vs. 1.2%; adjusted OR: 3.60, 95%CI: 1.50-8.64, p=0.004). Regarding the primary outcome, among smokers, rates showed a lower trend in clopidogrel vs. aspirin groups (3.7% vs. 6.4%; adjusted OR 0.57, 95%CI: 0.31-1.07, p=0.08), but no difference among never-smokers (2.1% vs. 1.0%; adjusted OR: 1.67, 95%CI: 0.47-5.89, p=0.42). Similarly, among smokers, trending lower rates for recurrent ischemic stroke were observed in clopidogrel vs. aspirin group (3.1% vs. 5.0%; adjusted OR: 0.60, 95%CI: 0.31-1.18, p=0.14); but no difference between the two groups among never-smokers (1.7% vs. 1.0%; adjusted OR 1.36, 95%CI: 0.36-5.52, p=0.65). CONCLUSIONS Smoking is a major risk factor for recurrent stroke in our retrospective non-cardioembolic ischemic stroke cohort. Active-smokers trend toward better cardiovascular outcomes when on clopidogrel. This finding needs to be confirmed in a prospective cohort.
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Affiliation(s)
- Qian Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yuan Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chengbei Hou
- Evidence-Based Medicine Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Qingyu Cao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Kai Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiaoqin Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Moli Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
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14
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Park TK, Song YB, Ahn J, Carriere KC, Hahn JY, Yang JH, Choi SH, Choi JH, Lee SH, Gwon HC. Clopidogrel Versus Aspirin as an Antiplatelet Monotherapy After 12-Month Dual-Antiplatelet Therapy in the Era of Drug-Eluting Stents. Circ Cardiovasc Interv 2016; 9:e002816. [PMID: 26755571 DOI: 10.1161/circinterventions.115.002816] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of dual-antiplatelet therapy (DAPT) exceeding 12 months may increase a bleeding risk despite a lower risk of ischemic events. There is no study to compare clinical outcomes in patients treated with a single-antiplatelet drug after DAPT in the era of drug-eluting stents (DES). We sought to investigate the efficacy and safety of clopidogrel versus aspirin monotherapy after 12-month DAPT after DES implantation using an institutional registry. METHODS AND RESULTS This observational study was conducted on consecutive patients receiving DES between January 2003 and December 2010. A total of 3243 patients receiving 12-month DAPT after DES implantation without adverse clinical outcomes were divided into 2 groups based on prescribed antiplatelet status: aspirin (n=2472) and clopidogrel (n=771). Clinical, angiographic, and procedural characteristics revealed more comorbidities and more complex lesions in the clopidogrel group than in the aspirin group. At 36 months after initiation of antiplatelet monotherapy, clopidogrel was associated with a reduction in risk for a composite of cardiac death, myocardial infarction, or stroke (aspirin versus clopidogrel; 3.8% versus 2.6%; hazard ratio, 0.54; 95% confidence interval, 0.32-0.92; P=0.02). The risk of cardiac death was lower with clopidogrel monotherapy than with aspirin monotherapy (1.4% versus 0.5%; hazard ratio, 0.31; 95% confidence interval, 0.11-0.93; P=0.04). Thrombolysis in myocardial infarction major bleeding occurred similarly between both groups (0.9% versus 1.3%; hazard ratio, 1.03; 95% confidence interval, 0.46-2.32; P=0.95). CONCLUSIONS After 12-month DAPT, clopidogrel monotherapy, when compared with aspirin monotherapy, might be associated with a reduced risk of recurrent ischemic events in patients receiving DES.
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Affiliation(s)
- Taek Kyu Park
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.K.P., Y.B.S., J.-Y.H., J.H.Y., S.-H.C., J.-H.C., S.H.L., H.-C.G.); Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada (K.C.C.)
| | - Young Bin Song
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.K.P., Y.B.S., J.-Y.H., J.H.Y., S.-H.C., J.-H.C., S.H.L., H.-C.G.); Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada (K.C.C.).
| | - Joonghyun Ahn
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.K.P., Y.B.S., J.-Y.H., J.H.Y., S.-H.C., J.-H.C., S.H.L., H.-C.G.); Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada (K.C.C.)
| | - K C Carriere
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.K.P., Y.B.S., J.-Y.H., J.H.Y., S.-H.C., J.-H.C., S.H.L., H.-C.G.); Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada (K.C.C.)
| | - Joo-Yong Hahn
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.K.P., Y.B.S., J.-Y.H., J.H.Y., S.-H.C., J.-H.C., S.H.L., H.-C.G.); Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada (K.C.C.)
| | - Jeong Hoon Yang
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.K.P., Y.B.S., J.-Y.H., J.H.Y., S.-H.C., J.-H.C., S.H.L., H.-C.G.); Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada (K.C.C.)
| | - Seung-Hyuk Choi
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.K.P., Y.B.S., J.-Y.H., J.H.Y., S.-H.C., J.-H.C., S.H.L., H.-C.G.); Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada (K.C.C.)
| | - Jin-Ho Choi
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.K.P., Y.B.S., J.-Y.H., J.H.Y., S.-H.C., J.-H.C., S.H.L., H.-C.G.); Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada (K.C.C.)
| | - Sang Hoon Lee
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.K.P., Y.B.S., J.-Y.H., J.H.Y., S.-H.C., J.-H.C., S.H.L., H.-C.G.); Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada (K.C.C.)
| | - Hyeon-Cheol Gwon
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.K.P., Y.B.S., J.-Y.H., J.H.Y., S.-H.C., J.-H.C., S.H.L., H.-C.G.); Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea (J.A., K.C.C.); and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada (K.C.C.)
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Binderup HG, Houlind K, Madsen JS, Brasen CL. Aspirin resistance may be identified by miR-92a in plasma combined with platelet distribution width. Clin Biochem 2016; 49:1167-1172. [PMID: 27208561 DOI: 10.1016/j.clinbiochem.2016.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Aspirin is a widely used drug for prevention of thrombotic events in cardiovascular patients, but approximately 25% of patients experience insufficient platelet inhibition due to aspirin, and remain in risk of cardiovascular events. This study aimed to investigate the value of circulating miR-92a and platelet size as biomarkers of the individual response to aspirin therapy. METHODS Blood samples were collected from 50 healthy blood donors without antithrombotic medication and 50 patients with intermittent claudication on daily aspirin therapy. Based on results from the arachidonic acid stimulated aggregation test on Multiplate®analyzer (ASPItest), patients were defined as aspirin resistant (n=10) or aspirin responders (n=40). Plasma levels of miR-92a were evaluated by RT-qPCR analysis and platelet distribution width (PDW) was used to assess platelet size variability. Receiver operating characteristic curves for miR-92a levels and PDW were used to set cut-off values for discrimination between aspirin responding and aspirin resistant patients. RESULTS When defining aspirin resistance as an ASPItest ≥30U, the optimal cut-off values for discrimination of aspirin responders and aspirin resistant patients were found to be PDW>11.8fL and a relative expression level of miR-92a>4.5. Using these cut-off values we could define a PDW/miR-92a-score with a specificity of 97.5% and a sensitivity of 80.0% in relation to detect aspirin resistance. The corresponding positive and negative predictive values were found to be 88.9% and 95.1%, respectively. CONCLUSION Aspirin resistance can potentially be identified by miR-92a levels in plasma combined with PDW.
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Affiliation(s)
- Helle Glud Binderup
- Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Kabbeltoft 25, 7100 Vejle and Skovvangen 2-8, 6000 Kolding, Denmark.
| | - Kim Houlind
- Department of Vascular Surgery, Lillebaelt Hospital, Skovvangen 2-8, 6000 Kolding, Denmark; Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Jonna Skov Madsen
- Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Kabbeltoft 25, 7100 Vejle and Skovvangen 2-8, 6000 Kolding, Denmark; Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Claus Lohman Brasen
- Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Kabbeltoft 25, 7100 Vejle and Skovvangen 2-8, 6000 Kolding, Denmark
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16
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Affiliation(s)
- Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine-Jacksonville
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine-Jacksonville
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Barbato E, Barton PJ, Bartunek J, Huber S, Ibanez B, Judge DP, Lara-Pezzi E, Stolen CM, Taylor A, Hall JL. Review and Updates in Regenerative and Personalized Medicine, Preclinical Animal Models, and Clinical Care in Cardiovascular Medicine. J Cardiovasc Transl Res 2015; 8:466-74. [DOI: 10.1007/s12265-015-9657-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 12/22/2022]
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Jalkanen J, Yegutkin GG, Hollmén M, Aalto K, Kiviniemi T, Salomaa V, Jalkanen S, Hakovirta H. Aberrant circulating levels of purinergic signaling markers are associated with several key aspects of peripheral atherosclerosis and thrombosis. Circ Res 2015; 116:1206-15. [PMID: 25645301 DOI: 10.1161/circresaha.116.305715] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
RATIONALE Purinergic signaling plays an important role in inflammation and vascular integrity, but little is known about purinergic mechanisms during the pathogenesis of atherosclerosis in humans. OBJECTIVE The objective of this study is to study markers of purinergic signaling in a cohort of patients with peripheral artery disease. METHODS AND RESULTS Plasma ATP and ADP levels and serum nucleoside triphosphate diphosphohydrolase-1 (NTPDase1/CD39) and ecto-5'-nucleotidase/CD73 activities were measured in 226 patients with stable peripheral artery disease admitted for nonurgent invasive imaging and treatment. The major findings were that ATP, ADP, and CD73 values were higher in atherosclerotic patients than in controls without clinically evident peripheral artery disease (P<0.0001). Low CD39 activity was associated with disease progression (P=0.01). In multivariable linear regression models, high CD73 activity was associated with chronic hypoxia (P=0.001). Statin use was associated with lower ADP (P=0.041) and tended to associate with higher CD73 (P=0.054), while lower ATP was associated with the use of angiotensin receptor blockers (P=0.015). CONCLUSIONS Purinergic signaling plays an important role in peripheral artery disease progression. Elevated levels of circulating ATP and ADP are especially associated with atherosclerotic diseases of younger age and smoking. The antithrombotic and anti-inflammatory effects of statins may partly be explained by their ability to lower ADP. We suggest that the prothrombotic nature of smoking could be a cause of elevated ADP, and this may explain why cardiovascular patients who smoke benefit from platelet P2Y12 receptor antagonists more than their nonsmoking peers.
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Affiliation(s)
- Juho Jalkanen
- From the Department of Vascular Surgery (J.J., H.H.) and Heart Center (T.K.), Turku University Hospital, Turku, Finland; Medicity Research Laboratory, Department of Microbiology and Immunology, University of Turku, Turku, Finland (G.G.Y., M.H., K.A., S.J.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.)
| | - Gennady G Yegutkin
- From the Department of Vascular Surgery (J.J., H.H.) and Heart Center (T.K.), Turku University Hospital, Turku, Finland; Medicity Research Laboratory, Department of Microbiology and Immunology, University of Turku, Turku, Finland (G.G.Y., M.H., K.A., S.J.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.)
| | - Maija Hollmén
- From the Department of Vascular Surgery (J.J., H.H.) and Heart Center (T.K.), Turku University Hospital, Turku, Finland; Medicity Research Laboratory, Department of Microbiology and Immunology, University of Turku, Turku, Finland (G.G.Y., M.H., K.A., S.J.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.)
| | - Kristiina Aalto
- From the Department of Vascular Surgery (J.J., H.H.) and Heart Center (T.K.), Turku University Hospital, Turku, Finland; Medicity Research Laboratory, Department of Microbiology and Immunology, University of Turku, Turku, Finland (G.G.Y., M.H., K.A., S.J.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.)
| | - Tuomas Kiviniemi
- From the Department of Vascular Surgery (J.J., H.H.) and Heart Center (T.K.), Turku University Hospital, Turku, Finland; Medicity Research Laboratory, Department of Microbiology and Immunology, University of Turku, Turku, Finland (G.G.Y., M.H., K.A., S.J.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.)
| | - Veikko Salomaa
- From the Department of Vascular Surgery (J.J., H.H.) and Heart Center (T.K.), Turku University Hospital, Turku, Finland; Medicity Research Laboratory, Department of Microbiology and Immunology, University of Turku, Turku, Finland (G.G.Y., M.H., K.A., S.J.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.)
| | - Sirpa Jalkanen
- From the Department of Vascular Surgery (J.J., H.H.) and Heart Center (T.K.), Turku University Hospital, Turku, Finland; Medicity Research Laboratory, Department of Microbiology and Immunology, University of Turku, Turku, Finland (G.G.Y., M.H., K.A., S.J.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.).
| | - Harri Hakovirta
- From the Department of Vascular Surgery (J.J., H.H.) and Heart Center (T.K.), Turku University Hospital, Turku, Finland; Medicity Research Laboratory, Department of Microbiology and Immunology, University of Turku, Turku, Finland (G.G.Y., M.H., K.A., S.J.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.)
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Franchi F, Hammad JS, Rollini F, Tello-Montoliu A, Patel R, Darlington A, Kraemer DF, Cho JR, DeGroat C, Bhatti M, Taha M, Angiolillo DJ. Role of thromboelastography and rapid thromboelastography to assess the pharmacodynamic effects of vitamin K antagonists. J Thromb Thrombolysis 2014; 40:118-25. [DOI: 10.1007/s11239-014-1130-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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