1
|
Regan IE, Cox D, Kelleher ST, McMahon CJ. The Effects of Aspirin dose in Children with Congenital and Acquired Heart Disease. Results from the Paediatric Study of Aspirin Efficacy using Diagnostic and Monitoring Tools (PAED-M). Pediatr Cardiol 2024:10.1007/s00246-024-03509-6. [PMID: 38755451 DOI: 10.1007/s00246-024-03509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
The optimal dose of aspirin required in children with congenital and acquired heart disease is not known. The primary aim of this prospective observational study was to evaluate the effects of aspirin dose on platelet inhibition. The secondary aim was to determine the prevalence and clinical predictors of aspirin non-responsiveness. Measurements were by Thromboelastography with Platelet Mapping (TEGPM) only in children less than 2 years (y) of age with particular emphasis on the parameter known as maximum amplitude with arachidonic acid (MAAA) and using both TEGPM, and light transmission aggregometry (LTA) in children greater than 2 y. We prospectively studied 101 patients with congenital and acquired cardiac disease who were receiving empirical doses of aspirin for a minimum of 4 weeks but no other antiplatelet agents. Patients were stratified according to dose concentration and age. There was a trend toward lower age in patients with no response or semi-response to aspirin. All patients were considered responsive to aspirin in the higher-dose quartile (Q4) with a median dose of 4.72 (4.18-6.05) mg/kg/day suggesting that patients in this age group may require 5 mg/kg/day as an empirical dose. In children > 2 y, there was no significant difference in inhibition found in patients dosed at higher doses in Q3 versus Q4 suggesting that patients in this cohort are responsive with 3 mg/kg/day dose. The current practices may lead to reduced platelet inhibition in some children due to under-dosing or overdosing in others. In conclusion, younger children require higher doses of aspirin. Laboratory assessment is warranted in this population to mitigate against under and overdosing.
Collapse
Affiliation(s)
- Irene E Regan
- Department of Coagulation/Haematology, Children's Health Ireland at Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
| | - Dermot Cox
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Sean T Kelleher
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland.
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, Netherlands.
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland.
| |
Collapse
|
2
|
Majumdar M, Waller D, Poyant J, McElroy I, Lella S, Feldman ZM, Levine E, Kim Y, Nuzzolo K, Kirshkaln A, DeCarlo C, Dua A. Variability of antiplatelet response in patients with peripheral artery disease. J Vasc Surg 2023; 77:208-215.e3. [PMID: 36028157 DOI: 10.1016/j.jvs.2022.08.015] [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: 06/02/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Antiplatelet therapy has been a pillar of management for peripheral artery disease (PAD). However, a significant subset of patients with PAD will be resistant to certain antiplatelet medications and, therefore, have an increased risk of graft and/or stent thrombosis unknown to the surgeon. At present, no point-of-care testing to identity which patients will experience benefit from these medications has been incorporated into the treatment guidelines. Thromboelastography with platelet mapping affords an opportunity to evaluate real-time coagulation dynamics and platelet function. In the present prospective, observational study, we aimed to delineate the variation in response to antiplatelet therapy in patients with PAD undergoing revascularization. METHODS All patients who were undergoing named vessel revascularization during December 2020 through April 2022 were prospectively enrolled. Platelet mapping assays were performed in three clinical phases: preoperative, postoperative inpatient, and postoperative outpatient. The distribution of platelet reactivity within patients receiving mono- vs dual antiplatelet therapy was assessed, and a between-group inferential analysis was performed. The effect of comorbidities and intervention subtype on platelet inhibition was also analyzed. RESULTS A total of 521 platelet mapping samples from 143 individual patients were analyzed using thromboelastography with platelet mapping. We found wide variability in the distribution of platelet inhibition, with a range of 0 to 100 and an interquartile range of 37.6. Although platelet inhibition with clopidogrel 75 mg was higher on average (44.8 ± 30.2) than that with aspirin 81 mg (24.6 ± 23.7) or aspirin 325 mg (27.1 ± 26.4; P = .001), clopidogrel at 75 mg demonstrated the highest variability in response. CONCLUSIONS These data have demonstrated significant variability in the response to both mono- and dual antiplatelet therapy in PAD patients undergoing lower extremity revascularization. Future research on the effect of this variability in response on the clinical outcomes could provide invaluable understanding of the perioperative thrombotic risk.
Collapse
Affiliation(s)
- Monica Majumdar
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Davis Waller
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Janelle Poyant
- Department of Pharmacy, Tufts Medical Center, Boston, MA
| | - Imani McElroy
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Srihari Lella
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Zach M Feldman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Emma Levine
- Larner College of Medicine, University of Vermont Medical Center, Burlington, VT
| | - Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Kathryn Nuzzolo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Amanda Kirshkaln
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA.
| |
Collapse
|
3
|
Genetic Association Study and Machine Learning to Investigate Differences in Platelet Reactivity in Patients with Acute Ischemic Stroke Treated with Aspirin. Biomedicines 2022; 10:biomedicines10102564. [PMID: 36289824 PMCID: PMC9599820 DOI: 10.3390/biomedicines10102564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
Aspirin resistance (AR) is a pressing problem in current ischemic stroke care. Although the role of genetic variations is widely considered, the data still remain controversial. Our aim was to investigate the contribution of genetic features to laboratory AR measured through platelet aggregation with arachidonic acid (AA) and adenosine diphosphate (ADP) in ischemic stroke patients. A total of 461 patients were enrolled. Platelet aggregation was measured via light transmission aggregometry. Eighteen single-nucleotide polymorphisms (SNPs) in ITGB3, GPIBA, TBXA2R, ITGA2, PLA2G7, HMOX1, PTGS1, PTGS2, ADRA2A, ABCB1 and PEAR1 genes and the intergenic 9p21.3 region were determined using low-density biochips. We found an association of rs1330344 in the PTGS1 gene with AR and AA-induced platelet aggregation. Rs4311994 in ADRA2A gene also affected AA-induced aggregation, and rs4523 in the TBXA2R gene and rs12041331 in the PEAR1 gene influenced ADP-induced aggregation. Furthermore, the effect of rs1062535 in the ITGA2 gene on NIHSS dynamics during 10 days of treatment was found. The best machine learning (ML) model for AR based on clinical and genetic factors was characterized by AUC = 0.665 and F1-score = 0.628. In conclusion, the association study showed that PTGS1, ADRA2A, TBXA2R and PEAR1 polymorphisms may affect laboratory AR. However, the ML model demonstrated the predominant influence of clinical features.
Collapse
|
4
|
Hummel T, Meves SH, Breuer-Kaiser A, Düsterwald JO, Mühlberger D, Mumme A, Neubauer H. [Evaluation of treatment adaptation for low response to ASA in vascular surgery]. Chirurg 2021; 92:640-646. [PMID: 32945920 PMCID: PMC8484201 DOI: 10.1007/s00104-020-01280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hintergrund Eine verminderte antithrombozytäre Prophylaxe („Low-Response [LR]“/„high on-treatment platelet reactivity [HPR]“) mit Acetylsalicylsäure (ASS) ist mit einem erhöhten Risiko für thrombembolische Ereignisse assoziiert. Die Prävalenz einer Low-Response ist mit ca. 20 % häufig und ein Therapieregime wurde bisher noch nicht etabliert. Das Ziel dieser prospektiven Studie war es, die Effektivität eines Therapieschemas zur Therapieanpassung bei detektierter LR/HPR bei gefäßchirurgischen Patienten zu evaluieren. Methodik Insgesamt wurden 36 gefäßchirurgischen Patienten mit einer antithrombozytären Dauermedikation mit ASS 100 mg/Tag und einer nachgewiesenen ASS-Low-Response (ALR) in die Studie eingeschlossen. Entsprechend dem festgelegten Therapieplan wurde bei diesen Patienten eine Therapieanpassung durchgeführt und eine Kontrollaggregometrie zur Erfolgskontrolle durchgeführt. Das verwendete Therapieschema folgte dem Test-and-treat-Prinzip. Zur Beurteilung der Wirkung von ASS diente die Impedanzaggregometrie mittels Mehrelektrodenaggregometer (Multiplate). Ergebnisse Insgesamt konnten alle 36 Patienten erfolgreich in eine Response überführt werden. Bei 32 (88,89 %) Patienten erfolgte eine Dosiserhöhung auf 300 mg ASS, 2 (5,56 %) Patienten wurden von ASS auf Clopidogrel umgestellt. Bei weiteren 2 (5,56 %) Patienten wurde auf eine orale Antikoagulation mit Phenprocoumon aufgrund anderer Indikationen umgestellt. Blutungskomplikationen oder Nebenwirkungen traten nicht auf. Schlussfolgerung Das gewählte Therapieschema zur Behandlung einer Low-Response erwies sich als effektiv und sicher bei gefäßchirurgischen Patienten. Überwiegend führte eine leitliniengerechte Dosiserhöhung der Prophylaxe von 100 mg auf 300 mg ASS zu einer effektiven Thrombozytenaggregationshemmung in der Aggregometrie.
Collapse
Affiliation(s)
- T Hummel
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
| | - S H Meves
- Klinik für Neurologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - A Breuer-Kaiser
- Klinik für Anästhesiologie und Intensivmedizin, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - J O Düsterwald
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - D Mühlberger
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - A Mumme
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - H Neubauer
- Klinik für Kardiologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| |
Collapse
|
5
|
Rolling CC, Tomada J, Frölich AM, Holst B, Holstein K, Voigtländer M, Janjetovic S, Haddad M, Renné T, Fiehler J, Bokemeyer C, Rolling T, Langer F. Comparison of acetylsalicylic acid and clopidogrel non-responsiveness assessed by light transmittance aggregometry and PFA-100® in patients undergoing neuroendovascular procedures. Clin Chem Lab Med 2020; 59:383-392. [PMID: 32866112 DOI: 10.1515/cclm-2020-0737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022]
Abstract
Objectives Dual platelet inhibition is commonly used for prevention of cardiovascular events in patients undergoing neuroendovascular procedures. Non-responsiveness to platelet inhibitors may be associated with adverse outcomes. The aim of this study was to evaluate the reliability of the platelet function analyzer PFA-100® in comparison to light transmittance aggregometry (LTA) for monitoring clopidogrel and acetylsalicylic acid (ASA) non-responsiveness in a cohort of patients treated for intracranial aneurysm or cranial artery stenosis. Methods Non-responsiveness to clopidogrel and ASA was assessed by LTA using adenosine diphosphate (ADP) and arachidonic acid and by PFA-100® with the ADP/prostaglandin E1 (PGE1) and collagen/epinephrine cartridges, respectively. Results A total of 203 patients (145 females; median age, 57 years) were analyzed. Agreement between the two tests was poor for clopidogrel non-responsiveness (ƙ=0.19) and not better than chance for ASA non-responsiveness (ƙ=0.01). Clopidogrel non-responsiveness by LTA and PFA-100® was associated with higher von Willebrand factor antigen and activity levels. ADP-induced platelet disaggregation was lower in patients with clopidogrel non-responsiveness as assessed by PFA-100®. Clopidogrel non-responsiveness by LTA was associated with a higher prevalence of diabetes and a higher body mass index (BMI). Adverse outcomes (death, thromboembolism, or in-stent thrombosis) occurred in 13% (n=26) of all patients independently of ASA and clopidogrel non-responsiveness as assessed by both devices. Conclusions Our results show that LTA and PFA-100® are not interchangeable in the assessment of ASA and clopidogrel non-responsiveness in patients undergoing neuroendovascular interventions.
Collapse
Affiliation(s)
- Christina C Rolling
- Department of Oncology/Hematology and BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Tomada
- Department of Oncology/Hematology and BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas M Frölich
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Brigitte Holst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Holstein
- Department of Oncology/Hematology and BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Minna Voigtländer
- Department of Oncology/Hematology and BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Snjezana Janjetovic
- Department of Oncology/Hematology and BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Munif Haddad
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Renné
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology/Hematology and BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thierry Rolling
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Langer
- Department of Oncology/Hematology and BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
6
|
Shao T, Cheng Y, Jin J, Huang L, Yang D, Luo C, Han Z, Wang Z, Ge W, Xu Y. A comparison of three platelet function tests in ischemic stroke patients with antiplatelet therapy. J Clin Neurosci 2020; 78:91-96. [PMID: 32624366 DOI: 10.1016/j.jocn.2020.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/20/2020] [Accepted: 06/06/2020] [Indexed: 12/31/2022]
Abstract
Predicting the effectiveness of antiplatelet drugs is critical to precision antiplatelet therapy. However, there is a lack of an acceptable method, although there are a variety of methods for detecting platelet function. In this study, we compared three major platelet function tests to assess their performance and found better methods for platelet function evaluation after aspirin or clopidogrel treatment in ischemic stroke patients by comparative study. A total of 249 ischemic stroke patients were enrolled who were treated with aspirin or clopidogrel or both. Three platelet function tests including light transmittance aggregometry (LTA), thromboelastography (TEG), platelet function analyzer (PFA) were performed as well as CYP2C19 genotype determination. Correlation analyses and kappa statistics were used. All three methods were effective in evaluating aspirin function. However, only LTA and TEG had good correlation and consistency (r = -0.37, kappa = 0.634). TEG-ADP was the least sensitive for clopidogrel, as the platelet inhibition ratio did not differ between the clopidogrel-user group and the control (P = 0.074), while LTA and PFA were sensitive (P < 0.001). Correlations between platelet assays were poor for clopidogrel (the absolute value of r range from 0.13 to 0.35) and so was the agreement (Kappa from 0.232 to 0.314). LTA and PFA have a good correlation with CYP2C19 genotyping (P = 0.034 and 0.014). In conclusion, all three tests were able to evaluate aspirin effect, LTA-AA and TEG-AA had a good correlation. TEG perform badly for clopidogrel effect detection. The fair-to-modest agreement among assays indicated further study was indispensable.
Collapse
Affiliation(s)
- Tengfei Shao
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yue Cheng
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Jiali Jin
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Lili Huang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Dan Yang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Caimei Luo
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Zhou Han
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Zhongyuan Wang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Weihong Ge
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
| |
Collapse
|
7
|
Association among PlA1/A2 gene polymorphism, laboratory aspirin resistance and clinical outcomes in patients with coronary artery disease: An updated meta-analysis. Sci Rep 2019; 9:13177. [PMID: 31511539 PMCID: PMC6739359 DOI: 10.1038/s41598-019-49123-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/20/2019] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to investigate the association among the PlA1/A2 gene polymorphism, laboratory aspirin resistance and adverse clinical outcomes in coronary artery disease (CAD) patients who were on aspirin maintainance therapy. A comprehensive literature search was performed and 35 eligible clinical trials including 19025 CAD patients were recruited. Adverse clinical outcomes involving all-cause death, non-fatal myocardial infarction (MI), ischemic stroke and target vessel revascularization (TVR) were analyzed. The definition of aspirin resistance in each study was accepted. Meta-analysis was performed using the Review Manager 5.3.5 System. In CAD patients, the PlA2 gene carriers had similar incidence of laboratory aspirin resistance compared to those with PlA1/A1 genotype [29.7% vs 28.3%, OR = 0.94 (95% CI 0.63 to 1.40, P = 0.74)], and there were no significant differences in the adverse clinical outcomes between the PlA2 carriers and the PlA1/A1 genotype patients. However, the laboratory aspirin non-responders had higher risks of death [7.9% vs. 2.5%, OR = 2.42 (95% CI 1.86 to 3.15, P < 0.00001)] and TVR [4.5% vs. 1.7%, OR = 2.20 (95% CI 1.19 to 4.08, P = 0.01)] compared to the responders. In aspirin-treated CAD patients, the laboratory aspirin resistance predicts all-cause death and TVR. However, the PlA1/A2 gene polymorphism predicts neither the laboratory aspirin response nor the clinical outcomes.
Collapse
|
8
|
Obesity and laboratory aspirin resistance in high-risk pregnant women treated with low-dose aspirin. Am J Obstet Gynecol 2019; 220:385.e1-385.e6. [PMID: 30786253 DOI: 10.1016/j.ajog.2019.01.222] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Low-dose aspirin is used for preeclampsia prevention in high-risk women, but the precise mechanism and optimal dose are unknown. Evidence suggests that an imbalance in prostacyclin and thromboxane A2 (TXA2) plays a key role in the pathogenesis of preeclampsia. Aspirin has a dose-dependent effect blocking production of TXA2, a potent stimulator of platelet aggregation and promoter of vasoconstriction. Incomplete inhibition of platelet aggregation, designated aspirin resistance, can be reduced by increasing the aspirin dose. Evidence in the nonobstetric literature suggests that aspirin resistance may be more common among patients with a high body mass index. OBJECTIVE To investigate the association of obesity on platelet-derived thromboxane inhibition in high-risk women treated with low-dose aspirin. MATERIALS AND METHODS This was a secondary analysis of a prospective multi-centered study investigating the effect of low-dose aspirin (60-mg) administration in women at high risk for preeclampsia. Maternal serum TXB2 (an indirect measure of TxA2) levels were drawn at 3 time points: randomization (13-26 weeks' gestation), second trimester (at least 2 weeks after randomization and 24-28 weeks' gestation), and third trimester (34-38 weeks' gestation). Patients were included in the analysis if a TXB2 level was recorded at randomization and at least 1 time point thereafter. Patients were stratified by body mass index category and treatment arm. Median TXB2 levels were calculated at each time point, as well as rates of complete TXB2 inhibition (<0.01 ng/mL). A multivariate logistic regression analysis was performed to generate odds ratios (OR) for complete TXB2 inhibition by body mass index category, adjusting for maternal age, race, high-risk group at randomization, nulliparity, and rate of randomization less than 16 weeks' gestation. RESULTS A total of 1002 patients were included in the analysis, 496 (49.5%) and 506 (50.5%) in the low-dose aspirin and placebo groups respectively. There were substantial decreases in TXB2 levels among low-dose aspirin-treated women in all body mass index categories. In contrast, women assigned to placebo did not show a marked decrease in TXB2 levels after randomization, and obese women had higher median TXB2 levels in both the second (16.5, interquartile range [IQR] 8.0-31.8 vs 14.0, IQR 6.9-26.7, ng/mL; P = .032) and third (15.7, IQR 7.6-28.5 vs 11.9, IQR 4.6-25.9, ng/mL; P = .043) trimesters. When comparing among stratified body mass index low-dose aspirin groups, women with class III obesity had the lowest odds of undetectable TXB2 levels in the second trimester (adjusted odds ratio [aOR], 0.33; 95% confidence interval [CI], 0.15-0.72) and third trimester (aOR, 0.30; 95% CI, 0.11-0.78) as well as at both time points (aOR, 0.09; 95% CI, 0.02-0.41). CONCLUSION High-risk obese women receiving low-dose aspirin for the prevention of preeclampsia have lower rates of complete inhibition of TXB2. These data suggest that an increase in aspirin dosing or frequency may be necessary in this population.
Collapse
|
9
|
Westphal ES, Wisniewski C, Rainka M, Smith NM, Bates V, Gengo FM. The Development of an In Vitro Assay for the Prospective Determination of Aspirin Sensitivity. J Clin Pharmacol 2018; 58:1150-1156. [PMID: 29775202 DOI: 10.1002/jcph.1260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/16/2018] [Indexed: 01/10/2023]
Abstract
Aspirin remains the standard for stroke prophylaxis. However, as many as 20%-25% of patients may fail to show a full response to aspirin. Ideally, patients who are resistant to aspirin could be identified, then receive an increased dose of aspirin or be changed to an alternative therapy more efficiently. We have developed an in vitro assay that may make this possible. Healthy volunteers (n = 13) between 18 and 50 years of age were tested for both ex vivo and in vivo responses to aspirin. Dimethyl sulfoxide (DMSO) was selected as the solvent for aspirin in the assay. DMSO can exhibit antiplatelet effects, necessitating the use of a concentration low enough to avoid such antiplatelet effects. Blood samples were tested against DMSO 0%, 0.05%, 0.5%, and 1% w/v with and without aspirin 0, 50, and 100 μM. The effects of both agents were measured via whole-blood aggregometry. A 3-dimensional response model described the data well, quantifying the combinatorial effect of DMSO and aspirin on platelet aggregation. Across all participants, baseline aggregation stimulated with collagen 1 μM or arachidonate 0.5 mM was approximately 18 and 13 Ω, respectively. The response model showed that 0.05% DMSO with 100 μM aspirin would provide platelet aggregation of 3.4 Ω. A DMSO concentration of 0.05% in the absence of aspirin would result in no discernable effects on platelet aggregation (17.7 Ω). Overall, the use of 100 μM of aspirin in 0.05% DMSO provides a robust method to test for ex vivo inhibition of platelet aggregation.
Collapse
Affiliation(s)
| | - Caitlin Wisniewski
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Michelle Rainka
- Dent Neurologic Institute, Amherst, NY, USA.,School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Nicholas M Smith
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA.,NYS Center for Excellence in Bioinformatics and Life Sciences, Buffalo, NY, USA
| | | | - Fran M Gengo
- Dent Neurologic Institute, Amherst, NY, USA.,School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
10
|
Cattaneo M. High on-treatment platelet reactivity – definition and measurement. Thromb Haemost 2017; 109:792-8. [DOI: 10.1160/th12-10-0758] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/23/2013] [Indexed: 12/31/2022]
Abstract
SummaryIn the last decade, several studies revealed inter-patient response variability to antiplatelet agents: patients who display negligible or no responses to these drugs are considered poor responders, or “resistant” to treatment. In order to identify poor responders to an antiplatelet drug, laboratory tests of platelet function that specifically explore the platelet activation pathway that is targeted by the drug should be utilised. In addition, they should be performed both at baseline and during treatment: however, most studies explored platelet function during antiplatelet treatment, in order to identify those patients with “high on-treatment platelet reactivity” (HPR), which exposes them to increased risk of major adverse cardiovascular events (MACE). Many tests of platelet function have been used, most of which are able to identify patients at risk of MACE. Unfortunately, universal cut-off values for HPR have not been clearly established yet. In addition, the concordance among different tests in the identification of patients at risk is very poor and the most effective and safe treatment for patients at risk is still unknown.
Collapse
|
11
|
|
12
|
O'connor CT, Kiernan TJ, Yan BP. The genetic basis of antiplatelet and anticoagulant therapy: A pharmacogenetic review of newer antiplatelets (clopidogrel, prasugrel and ticagrelor) and anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban). Expert Opin Drug Metab Toxicol 2017; 13:725-739. [PMID: 28571507 DOI: 10.1080/17425255.2017.1338274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The study of pharmacogenomics presents the possibility of individualised optimisation of drug therapy tailored to each patients' unique physiological traits. Both antiplatelet and anticoagulant drugs play a key role in the management of cardiovascular disease. Despite their importance, there is a substantial volume of literature to suggest marked person-to-person variability in their effect. Areas covered: This article reviews the data available for the genetic cause for this inter-patient variability of antiplatelet and anticoagulant drugs. The genetic basis for traditional antiplatelets (i.e. aspirin) is compared with the newly available antiplatelet medicines (clopidogrel, prasugrel and ticagrelor). Similarly, the pharmacogenetics of warfarin is compared with the newer direct oral anticoagulants (DOACs) in detail. Expert Opinion: We identify strengths and weaknesses in the research thus far; including shortcomings in trial design and a review of newer analytical techniques. The direction of this research and its real-world implications are discussed.
Collapse
Affiliation(s)
- Cormac T O'connor
- a Cardiology Department , University Hospital Limerick , Limerick , Ireland
| | - Thomas J Kiernan
- a Cardiology Department , University Hospital Limerick , Limerick , Ireland
| | - Bryan P Yan
- b Division of Cardiology, Department of Medicine and Therapeutics , The Chinese University of Hong Kong, Prince of Wales Hospital , Hong Kong SAR , China
| |
Collapse
|
13
|
Abheiden CNH, Fuijkschot WW, Arduç A, van Diemen JJK, Harmsze AM, de Boer MA, Thijs A, de Vries JIP. Post-pregnancy aspirin resistance appears not to be related with recurrent hypertensive disorders of pregnancy. Eur J Obstet Gynecol Reprod Biol 2016; 210:139-143. [PMID: 28033561 DOI: 10.1016/j.ejogrb.2016.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/01/2016] [Accepted: 12/19/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The FRUIT-RCT concluded that low-molecular-weight heparin added to aspirin compared to treatment with aspirin alone is beneficial in the prevention of early-onset hypertensive disorders of pregnancy (HD) in women with inheritable thrombophilia and prior HD and/or a small-for-gestational age (SGA) infant leading to delivery before 34 weeks gestation. The aim of this study is to answer the question whether aspirin resistance is associated with recurrent HD. STUDY DESIGN Women with and without recurrent HD matched for age, study arm, and chronic hypertension were invited for this follow-up study 6-16 years after they participated in the FRUIT-RCT. Aspirin resistance was tested after 10days of aspirin intake using three complementary tests: PFA-200, VerifyNow® and serum thromboxane B2 (TXB2). An independent t-test, Mann-Whitney U test, Fisher's Exact test and Chi2 test were used for the statistical analyses. RESULTS Thirteen of 24 women with recurrent HD and 16 of 24 women without recurrent HD participated. The prevalence of laboratory aspirin resistance was 34.5% according to the PFA-200, 3.4% according to the VerifyNow® and 24.1% according to TXB2. The prevalence of aspirin resistance by any test was 51.7%. Aspirin resistance per individual test did not differ between women with and without recurrent HD. Aspirin resistance measured by any test occurred more frequently in women without recurrent HD (p<0.01), irrespective of low-molecular-weight heparin. CONCLUSIONS No relation could be demonstrated between recurrent HD and aspirin resistance per test, measured up to 16 years after pregnancy. On the contrary, complementary aspirin resistance measurements were encountered more frequently in women without recurrent HD.
Collapse
Affiliation(s)
- Carolien N H Abheiden
- Department of Obstetrics and Gynecology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Wessel W Fuijkschot
- Department of Internal Medicine, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Arda Arduç
- Department of Obstetrics and Gynecology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Jeske J K van Diemen
- Department of Internal Medicine, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Ankie M Harmsze
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynecology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Abel Thijs
- Department of Internal Medicine, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Johanna I P de Vries
- Department of Obstetrics and Gynecology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| |
Collapse
|
14
|
Mansur ADP, Roggerio A, Takada JY, Caribé PMV, Avakian SD, Strunz CMC. Gene mutations of platelet glycoproteins and response to tirofiban in acute coronary syndrome. SAO PAULO MED J 2016; 134:199-204. [PMID: 26786608 PMCID: PMC10496600 DOI: 10.1590/1516-3180.2015.00650808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 03/26/2015] [Accepted: 08/08/2015] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVES Glycoprotein inhibitors (abciximab, eptifibatide and tirofiban) are used in patients with unstable angina and non-ST-segment elevation myocardial infarction before percutaneous coronary intervention. Of these, tirofiban is the least effective. We hypothesized that the response to tirofiban might be associated with glycoprotein gene mutations. DESIGN AND SETTING Prospective study at Emergency Unit, Heart Institute (InCor), University of São Paulo. METHOD Intrahospital evolution and platelet aggregation in response to tirofiban were analyzed in relation to four glycoprotein mutations in 50 patients indicated for percutaneous coronary intervention: 17 (34%) with unstable angina and 33 (66%) with non-ST-segment elevation myocardial infarction. Platelet aggregation was analyzed using the Born method. Blood samples were obtained before and one hour after tirofiban infusion. Glycoproteins Ia (807C/T ), Ib (Thr/Met) , IIb (Ile/Ser ) and IIIa (PIA ) were the mutations selected. RESULTS Hypertension, dyslipidemia, diabetes, smoking, previous coronary artery disease and stroke were similar between the groups. Mutant glycoprotein IIIa genotypes had lower platelet aggregation before tirofiban administration than that of the wild genotype (41.0% ± 22.1% versus 55.9% ± 20.8%; P = 0.035). Mutant glycoprotein IIIa genotypes correlated moderately with lower platelet inhibition (r = -0.31; P = 0.030). After tirofiban administration, platelet glycoprotein Ia, Ib, IIb and IIIa mutations did not influence the degree of inhibition of platelet aggregation or intrahospital mortality. CONCLUSIONS Mutations of glycoproteins Ia, Ib, IIb and IIIa did not influence platelet aggregation in response to tirofiban in patients with unstable angina and non-ST-segment elevation myocardial infarction.
Collapse
Affiliation(s)
- Antonio de Padua Mansur
- MD, PhD. Associate Professor, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Alessandra Roggerio
- BSc, PhD. Biochemist, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Júlio Yoshio Takada
- MD, PhD. Attending Physician, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Pérola Michelle Vasconcelos Caribé
- MD, MSc. Doctoral Student, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Solange Desirée Avakian
- MD, PhD. Attending Physician, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Célia Maria Cassaro Strunz
- BSc. Central Laboratory Director, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
15
|
Postula M, Janicki PK, Eyileten C, Rosiak M, Kaplon-Cieslicka A, Sugino S, Wilimski R, Kosior DA, Opolski G, Filipiak KJ, Mirowska-Guzel D. Next-generation re-sequencing of genes involved in increased platelet reactivity in diabetic patients on acetylsalicylic acid. Platelets 2015; 27:357-64. [PMID: 26599574 DOI: 10.3109/09537104.2015.1109071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The objective of this study was to investigate whether rare missense genetic variants in several genes related to platelet functions and acetylsalicylic acid (ASA) response are associated with the platelet reactivity in patients with diabetes type 2 (T2D) on ASA therapy. Fifty eight exons and corresponding introns of eight selected genes, including PTGS1, PTGS2, TXBAS1, PTGIS, ADRA2A, ADRA2B, TXBA2R, and P2RY1 were re-sequenced in 230 DNA samples from T2D patients by using a pooled PCR amplification and next-generation sequencing by Illumina HiSeq2000. The observed non-synonymous variants were confirmed by individual genotyping of 384 DNA samples comprising of the individuals from the original discovery pools and additional verification cohort of 154 ASA-treated T2DM patients. The association between investigated phenotypes (ASA induced changes in platelets reactivity by PFA-100, VerifyNow and serum thromboxane B2 level [sTxB2]), and accumulation of rare missense variants (genetic burden) in investigated genes was tested using statistical collapsing tests. We identified a total of 35 exonic variants, including 3 common missense variants, 15 rare missense variants, and 17 synonymous variants in 8 investigated genes. The rare missense variants exhibited statistically significant difference in the accumulation pattern between a group of patients with increased and normal platelet reactivity based on PFA-100 assay. Our study suggests that genetic burden of the rare functional variants in eight genes may contribute to differences in the platelet reactivity measured with the PFA-100 assay in the T2DM patients treated with ASA.
Collapse
Affiliation(s)
- Marek Postula
- a Department of Experimental and Clinical Pharmacology , Medical University of Warsaw, Center for Preclinical Research and Technology CEPT , Warsaw , Poland.,b Perioperative Genomics Laboratory , Penn State College of Medicine , Hershey , PA , USA
| | - Piotr K Janicki
- b Perioperative Genomics Laboratory , Penn State College of Medicine , Hershey , PA , USA
| | - Ceren Eyileten
- a Department of Experimental and Clinical Pharmacology , Medical University of Warsaw, Center for Preclinical Research and Technology CEPT , Warsaw , Poland
| | - Marek Rosiak
- a Department of Experimental and Clinical Pharmacology , Medical University of Warsaw, Center for Preclinical Research and Technology CEPT , Warsaw , Poland.,c Department of Cardiology and Hypertension , Central Clinical Hospital, The Ministry of the Interior , Warsaw , Poland
| | | | - Shigekazu Sugino
- b Perioperative Genomics Laboratory , Penn State College of Medicine , Hershey , PA , USA
| | - Radosław Wilimski
- e Department of Cardiac Surgery , Medical University of Warsaw , Warsaw , Poland
| | - Dariusz A Kosior
- c Department of Cardiology and Hypertension , Central Clinical Hospital, The Ministry of the Interior , Warsaw , Poland.,f Department of Applied Physiology , Mossakowski Medical Research Centre, Polish Academy of Sciences , Warsaw , Poland
| | - Grzegorz Opolski
- d Department of Cardiology , Medical University of Warsaw , Warsaw , Poland
| | | | - Dagmara Mirowska-Guzel
- a Department of Experimental and Clinical Pharmacology , Medical University of Warsaw, Center for Preclinical Research and Technology CEPT , Warsaw , Poland
| |
Collapse
|
16
|
Yang Y, Lewis JP, Hulot JS, Scott SA. The pharmacogenetic control of antiplatelet response: candidate genes and CYP2C19. Expert Opin Drug Metab Toxicol 2015; 11:1599-617. [PMID: 26173871 DOI: 10.1517/17425255.2015.1068757] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Aspirin, clopidogrel, prasugrel and ticagrelor are antiplatelet agents for the prevention of ischemic events in patients with acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) and other indications. Variability in response is observed to different degrees with these agents, which can translate to increased risks for adverse cardiovascular events. As such, potential pharmacogenetic determinants of antiplatelet pharmacokinetics, pharmacodynamics and clinical outcomes have been actively studied. AREAS COVERED This article provides an overview of the available antiplatelet pharmacogenetics literature. Evidence supporting the significance of candidate genes and their potential influence on antiplatelet response and clinical outcomes are summarized and evaluated. Additional focus is directed at CYP2C19 and clopidogrel response, including the availability of clinical testing and genotype-directed antiplatelet therapy. EXPERT OPINION The reported aspirin response candidate genes have not been adequately replicated and few candidate genes have thus far been implicated in prasugrel or ticagrelor response. However, abundant data support the clinical validity of CYP2C19 and clopidogrel response variability among ACS/PCI patients. Although limited prospective trial data are available to support the utility of routine CYP2C19 testing, the increased risks for reduced clopidogrel efficacy among ACS/PCI patients that carry CYP2C19 loss-of-function alleles should be considered when genotype results are available.
Collapse
Affiliation(s)
- Yao Yang
- a 1 Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences , New York, NY, USA +1 212 241 3780 ; +1 212 241 0139 ;
| | - Joshua P Lewis
- b 2 University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition, and Program for Personalized and Genomic Medicine , Baltimore, MD, USA
| | - Jean-Sébastien Hulot
- c 3 Icahn School of Medicine at Mount Sinai, Cardiovascular Research Center , New York, NY, USA.,d 4 Sorbonne Universités, UPMC Univ Paris 06, INSERM , UMR_S 1166 ICAN, F-75005 Paris, France
| | - Stuart A Scott
- a 1 Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences , New York, NY, USA +1 212 241 3780 ; +1 212 241 0139 ;
| |
Collapse
|
17
|
Postula M, Janicki PK, Rosiak M, Kaplon-Cieslicka A, Kondracka A, Trzepla E, Filipiak KJ, Kosior DA, Czlonkowski A, Opolski G. Effect of common single nucleotide polymorphisms in COX-1 gene on related metabolic activity in diabetic patients treated with acetylsalicylic acid. Arch Med Sci 2014; 10:1198-205. [PMID: 25624859 PMCID: PMC4296057 DOI: 10.5114/aoms.2013.35442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 03/20/2012] [Accepted: 04/10/2012] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION The objective of this study was to investigate the effect of common single nucleotide genomic polymorphisms in the cyclooxygenase-1 (COX-1) gene on the thromboxane A2 (TxA2) metabolite concentrations in serum and urine, as well as on prostaglandin F2α (PGF2α) urinary excretion in the diabetic population on acetylsalicylic acid (ASA) therapy. MATERIAL AND METHODS The study cohort consisted of 284 Caucasians with diabetes type 2 who had been taking ASA tablets at the dose of 75 mg/day for at least 3 months. Genotyping for the 4 selected SNPs within the COX-1 gene (two nonsynonymous-coding variants, rs3842787 [C50T, P17L] and rs5789 [C174A, L237M]; and two other synonymous SNPs, rs3842788 [G128A, Q41Q] and rs5788 [C644A]) was performed using the Sequenom iPLEX platform. RESULTS No statistically significant results were observed for the investigated SNPs and measured metabolites in the investigated cohort of patients. Statistically significant differences in S-TxB2 could however be observed for rs5788 in the subgroup of patients with very high S-TxB2 concentrations. In particular, more patients who were carriers of the minor allele for this polymorphism were observed in the group with S-TxB2 levels > 95(th) percentile, when compared with similar carriers in the group with S-TxB2 < 95(th) percentile (20% vs. 1.1%, respectively, p < 0.001, Mann-Whitney test). CONCLUSIONS The results of our study suggest that the four investigated common SNPs in the COX1 gene are not associated with obviously altered TxA2 metabolism and PGF2α synthesis in the investigated diabetic cohort treated with ASA.
Collapse
Affiliation(s)
- Marek Postula
- Department of Cardiology and Hypertension, Central Clinical Hospital, the Ministry of the Interior, Warsaw, Poland
- Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr K. Janicki
- Perioperative Genomics Laboratory, Department of Anesthesiology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Marek Rosiak
- Department of Cardiology and Hypertension, Central Clinical Hospital, the Ministry of the Interior, Warsaw, Poland
- Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | | | - Agnieszka Kondracka
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Trzepla
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Dariusz A. Kosior
- Department of Cardiology and Hypertension, Central Clinical Hospital, the Ministry of the Interior, Warsaw, Poland
- Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Andrzej Czlonkowski
- Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
18
|
Floyd CN, Ferro A. The PlA1/A2 polymorphism of glycoprotein IIIa in relation to efficacy of antiplatelet drugs: a systematic review and meta-analysis. Br J Clin Pharmacol 2014; 77:446-57. [PMID: 23834376 DOI: 10.1111/bcp.12204] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022] Open
Abstract
AIM The PlA1/A2 polymorphism of glycoprotein IIIa (GPIIIa) has been associated with both antiplatelet drug resistance and increased cardiovascular events. The aim of this study was to conduct the first meta-analysis investigating the association between carriage of the PlA2 allele and resistance to currently licensed antiplatelet drugs. METHODS Electronic databases (MEDLINE and EMBASE) were searched for all articles evaluating genetic polymorphisms of GPIIIa. For studies where antiplatelet resistance was measured using validated techniques, pooled odds ratios (ORs) were calculated using fixed effects and random effects models. RESULTS Sixteen studies were eligible for statistical analysis and included 1650 PlA1 homozygous subjects and 668 carriers of the PlA2 allele. For carriers of the PlA2 allele, OR 0.924 (n = 2318; 95% CI 0.743, 1.151; P = 0.481) was observed for resistance to any antiplatelet drug, OR 0.862 (n = 2085; 95% CI 0.685, 1.086; P = 0.208) for resistance to aspirin and OR 1.429 (n = 233; 95% CI 0.791, 2.582; P = 0.237) for resistance to clopidogrel. In the aspirin cohort, sub-group analysis revealed no statistical association in either healthy subjects or those with cardiovascular disease. PlA2 carriage was marginally associated with aspirin sensitivity using the fixed effects model when identified by the PFA-100 assay (n = 1151; OR 0.743, 95% CI 0.558, 0.989; P = 0.041) but with significant heterogeneity (I(2) = 55%; P = 0.002). Significance was lost with analysis using a random effects model. CONCLUSIONS The totality of published data does not support an association between carriage of the PlA2 allele and antiplatelet drug resistance. Significant heterogeneity indicates the need for larger studies using validated and standardized assays.
Collapse
Affiliation(s)
- Christopher N Floyd
- Department of Clinical Pharmacology, Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
| | | |
Collapse
|
19
|
Bachmair EM, Ostertag LM, Zhang X, de Roos B. Dietary manipulation of platelet function. Pharmacol Ther 2014; 144:97-113. [PMID: 24858060 DOI: 10.1016/j.pharmthera.2014.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/05/2014] [Indexed: 01/24/2023]
Abstract
Activated platelets contribute to plaque formation within blood vessels in the early and late stages of atherogenesis, and therefore they have been proposed as risk factor for cardiovascular disease. Anti-platelet drugs, such as aspirin, are now the most prescribed pharmacological treatment in Europe. Certain dietary bioactives also beneficially affect platelet function, and with less side effects, albeit that effects are generally more subtle. Therefore, consumption of dietary bioactives could play a role in the prevention of atherothrombotic vascular disease. Here we review the efficacy of dietary treatment strategies, especially those involving certain dietary fatty acids and polyphenols, to modulate platelet function in healthy subjects or in patients with cardiovascular disease. Variation in study populations, small study sizes and lack of comparability between methods to assess platelet function currently limit robust evidence on the efficacy of dietary bioactives in healthy subjects or specific patient groups. Also, limited knowledge of the metabolism of dietary bioactives, and therefore of the bioavailability of bioactive ingredients, restricts our ability to identify the most effective dietary regimes to improve platelet function. Implementation of uniform point-of-care tests to assess platelet function, and enhanced knowledge of the efficacy by which specific dietary compounds and their metabolites affect platelet function, may enable the identification of functional anti-platelet ingredients that are eligible for a health claim, or combined treatment strategies, including both pharmacological anti-platelet treatment as well as dietary intervention, to tackle atherothrombotic vascular disease.
Collapse
Affiliation(s)
- E M Bachmair
- University of Aberdeen, Rowett Institute of Nutrition & Health, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, United Kingdom
| | - L M Ostertag
- University of Aberdeen, Rowett Institute of Nutrition & Health, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, United Kingdom
| | - X Zhang
- University of Aberdeen, Rowett Institute of Nutrition & Health, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, United Kingdom
| | - B de Roos
- University of Aberdeen, Rowett Institute of Nutrition & Health, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, United Kingdom.
| |
Collapse
|
20
|
Wisman PP, Roest M, Asselbergs FW, de Groot PG, Moll FL, van der Graaf Y, de Borst GJ. Platelet-reactivity tests identify patients at risk of secondary cardiovascular events: a systematic review and meta-analysis. J Thromb Haemost 2014; 12:736-47. [PMID: 24612413 DOI: 10.1111/jth.12538] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 02/08/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Antiplatelet therapy is the standard treatment for the prevention of cardiovascular events (CVEs). High on-treatment platelet reactivity (HPR) is a risk factor for secondary CVEs in patients prescribed aspirin and/or clopidogrel. The present review and meta-analysis was aimed at assessing the ability of individual platelet-function tests to reliably identify patients at risk of developing secondary CVEs. METHODS AND RESULTS A systematic literature search was conducted to identify studies on platelet-reactivity measurements and CVEs. The main inclusion criteria were: (i) prospective study design; (ii) study medication, including aspirin and/or clopidogrel; and (iii) a platelet-function test being performed at baseline, before follow-up started. Of 3882 identified studies, 102 (2.6%; reporting on 44 098 patients) were included in the meta-analysis. With regard to high on-aspirin platelet reactivity (HAPR), 22 different tests were discussed in 55 studies (22 441 patients). Pooled analysis showed that HAPR was diagnosed in 22.2% of patients, and was associated with an increased CVE risk (relative risk [RR] 2.09; 95% confidence interval [CI] 1.77-2.47). Eleven HAPR tests independently showed a significantly increased CVE risk in patients with HAPR as compared with those with normal on-aspirin platelet reactivity. As regards high on-clopidogrel platelet reactivity (HCPR), 59 studies (34 776 patients) discussed 15 different tests, and reported that HCPR was present in 40.4% of patients and was associated with an increased CVE risk (RR 2.80; 95% CI 2.40-3.27). Ten tests showed a significantly increased CVE risk. CONCLUSIONS Patients with HPR are suboptimally protected against future cardiovascular complications. Furthermore, not all of the numerous platelet tests proved to be able to identify patients at increased cardiovascular risk.
Collapse
Affiliation(s)
- P P Wisman
- Department of Vascular Surgery, UMC Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
21
|
Postula M, Janicki PK, Rosiak M, Kaplon-Cieslicka A, Trzepla E, Filipiak KJ, Kosior DA, Czlonkowski A, Opolski G. New single nucleotide polymorphisms associated with differences in platelets reactivity in patients with type 2 diabetes treated with acetylsalicylic acid: genome-wide association approach and pooled DNA strategy. J Thromb Thrombolysis 2014; 36:65-73. [PMID: 23054467 DOI: 10.1007/s11239-012-0823-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objective of this study was to use genome-wide association approach and pooled DNA strategy to search for new genomic loci associated with inter-individual differences in platelet reactivity in the diabetic patients during acetylsalicylic acid (ASA) treatment. Study cohort consisted of 297 diabetic patients who had been taking ASA (75 mg daily) for at least 3 months. We tested association of single nucleotide polymorphisms (SNPs) genotyped using high density microarray platform with several platelet reactivity assays, followed by individual genotyping of most significant SNPs identified in the microarray genomic scan. The highest statistical significance (p value of 0.0001-0.008 in individual genotyping) was observed for SNP located within the regulatory G-protein signaling (RGS) 7 gene (rs2502448) using recessive genetic model. The diabetic patients on ASA treatment and homozygotes for its minor allele were characterized by increased odds ratio of at 3.45 (confidence interval: 1.82-6.53) for high on ASA platelet reactivity (i.e. impaired ASA response) when compared with homozygotes for wild-type allele. The genome-wide approach might provide an opportunity to identify novel candidate genes and pathways related to platelet activation in diabetic patients.
Collapse
Affiliation(s)
- Marek Postula
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 26/28 Krakowskie Przedmiescie, 02-927 Warsaw, Poland.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Lee CH, Lin YH, Chang SH, Tai CD, Liu SJ, Chu Y, Wang CJ, Hsu MY, Chang H, Chang GJ, Hung KC, Hsieh MJ, Lin FC, Hsieh IC, Wen MS, Huang Y. Local sustained delivery of acetylsalicylic acid via hybrid stent with biodegradable nanofibers reduces adhesion of blood cells and promotes reendothelialization of the denuded artery. Int J Nanomedicine 2014; 9:311-26. [PMID: 24421640 PMCID: PMC3888352 DOI: 10.2147/ijn.s51258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Incomplete endothelialization, blood cell adhesion to vascular stents, and inflammation of arteries can result in acute stent thromboses. The systemic administration of acetylsalicylic acid decreases endothelial dysfunction, potentially reducing thrombus, enhancing vasodilatation, and inhibiting the progression of atherosclerosis; but, this is weakened by upper gastrointestinal bleeding. This study proposes a hybrid stent with biodegradable nanofibers, for the local, sustained delivery of acetylsalicylic acid to injured artery walls. Biodegradable nanofibers are prepared by first dissolving poly(D,L)-lactide-co-glycolide and acetylsalicylic acid in 1,1,1,3,3,3-hexafluoro-2-propanol. The solution is then electrospun into nanofibrous tubes, which are then mounted onto commercially available bare-metal stents. In vitro release rates of pharmaceuticals from nanofibers are characterized using an elution method, and a highperformance liquid chromatography assay. The experimental results suggest that biodegradable nanofibers release high concentrations of acetylsalicylic acid for three weeks. The in vivo efficacy of local delivery of acetylsalicylic acid in reducing platelet and monocyte adhesion, and the minimum tissue inflammatory reaction caused by the hybrid stents in treating denuded rabbit arteries, are documented. The proposed hybrid stent, with biodegradable acetylsalicylic acid-loaded nanofibers, substantially contributed to local, sustained delivery of drugs to promote re-endothelialization and reduce thrombogenicity in the injured artery. The stents may have potential applications in the local delivery of cardiovascular drugs. Furthermore, the use of hybrid stents with acetylsalicylic acid-loaded nanofibers that have high drug loadings may provide insight into the treatment of patients with high risk of acute stent thromboses.
Collapse
Affiliation(s)
- Cheng-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taiwan ; Department of Mechanical Engineering, Taiwan
| | - Yu-Huang Lin
- Graduate Institute of Medical Mechatronics, Chang Gung University, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taiwan
| | - Chun-Der Tai
- Graduate Institute of Medical Mechatronics, Chang Gung University, Taiwan
| | | | - Yen Chu
- Laboratory of Cardiovascular Physiology, Division of Thoracic and Cardiovascular Surgery, Taiwan
| | - Chao-Jan Wang
- Department of Medical Imaging and Intervention, Taiwan
| | - Ming-Yi Hsu
- Department of Medical Imaging and Intervention, Taiwan
| | - Hung Chang
- Hematology-Oncology Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Gwo-Jyh Chang
- Graduate Institute of Clinical Medicinal Sciences, Chang Gung University College of Medicine, Linkou, Taiwan
| | - Kuo-Chun Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taiwan
| | - Ming-Jer Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taiwan
| | - Fen-Chiung Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taiwan
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taiwan
| | - Yenlin Huang
- Department of Anatomical Pathology, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan
| |
Collapse
|
23
|
Weng Z, Li X, Li Y, Lin J, Peng F, Niu W. The association of four common polymorphisms from four candidate genes (COX-1, COX-2, ITGA2B, ITGA2) with aspirin insensitivity: a meta-analysis. PLoS One 2013; 8:e78093. [PMID: 24244288 PMCID: PMC3828324 DOI: 10.1371/journal.pone.0078093] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 09/09/2013] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Evidence is mounting suggesting that a strong genetic component underlies aspirin insensitivity. To generate more information, we aimed to evaluate the association of four common polymorphisms (rs3842787, rs20417, rs201184269, rs1126643) from four candidate genes (COX-1, COX-2, ITGA2B, ITGA2) with aspirin insensitivity via a meta-analysis. METHODS AND RESULTS In total, there were 4 (353/595), 6 (344/698), 10 (588/878) and 7 (209/676) articles (patients/controls) qualified for rs3842787, rs20417, rs20118426 and rs1126643, respectively. The data were extracted in duplicate and analyzed by STATA software (Version 11.2). The risk estimate was expressed as odds ratio (OR) and 95% confidence interval (95% CI). Analyses of the full data set indicated significant associations of rs20417 (OR; 95% CI; P: 1.86; 1.44-2.41; <0.0005) and rs1126643 (2.37; 1.44-3.89; 0.001) with aspirin insensitivity under allelic model. In subgroup analyses, the risk estimate for rs1126643 was greatly potentiated among patients with aspirin semi-resistance relative to those with aspirin resistance, especially under dominant model (aspirin semi-resistance: 5.44; 1.42-20.83; 0.013 versus aspirin resistance: 1.96; 1.07-3.6; 0.03). Further grouping articles by ethnicity observed a stronger prediction of all, but rs20417, examined polymorphisms for aspirin insensitivity in Chinese than in Caucasians. Finally, meta-regression analyses observed that the differences in percentage of coronary artery disease (P = 0.034) and averaged platelet numbers (P = 0.012) between two groups explained a large part of heterogeneity for rs20417 and rs1126643, respectively. CONCLUSION Our findings provide strong evidence that COX-2 and ITGA2 genetic defects might increase the risk of having aspirin insensitivity, especially for aspirin semi-resistance and in Chinese populations.
Collapse
Affiliation(s)
- Zhiyuan Weng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaobo Li
- State Key Laboratory of Medical Genomics, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Hypertension, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuqiong Li
- State Key Laboratory of Medical Genomics, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Hypertension, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinxiu Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Feng Peng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- * E-mail: (FP); (WN)
| | - Wenquan Niu
- State Key Laboratory of Medical Genomics, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- * E-mail: (FP); (WN)
| |
Collapse
|
24
|
Mijajlovic MD, Shulga O, Bloch S, Covickovic-Sternic N, Aleksic V, Bornstein NM. Clinical consequences of aspirin and clopidogrel resistance: an overview. Acta Neurol Scand 2013; 128:213-9. [PMID: 23432706 DOI: 10.1111/ane.12111] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 12/21/2022]
Abstract
The aim of this review is to introduce the concept of personalized medicine in secondary stroke prevention with antiplatelet medication. In the last years, many studies have been conducted regarding aspirin resistance and genotyping of clopidogrel metabolism. A review of the currently published data on this issue emphasizes the importance of focusing on the individualizing approach in antiplatelet therapy to achieve maximal therapeutic beneficial effect. However, many authors suggest that, before new information from ongoing trials become available, good clinical practice should dictate the use of low dose of aspirin that was shown to be effective in the prevention of stroke and death in patients with ischemic cerebrovascular disease, because higher doses do not have significantly better efficacy than lower doses in secondary stroke prevention, but lower-dose aspirin is associated with less side effects. On the other hand, many factors are associated with clopidogrel resistance, and recent genetic studies showed that the CYP2C19*2 genotype (loss-of-function allele) is related to poor metabolism of clopidogrel, but larger studies are needed to definitively confirm or rule out the clinical significance of this genetic effect. The aim of personalized approach in secondary stroke prevention is to take the most appropriate medicine in the right dose in accordance with the clinical condition of the patient and associated risk factors.
Collapse
Affiliation(s)
- M. D. Mijajlovic
- Neurology Clinic; Clinical Center of Serbia; School of Medicine; University of Belgrade; Belgrade; Serbia
| | - O. Shulga
- Department of Neurology; Volyn Regional Clinical Hospital; Lutsk; Ukraine
| | - S. Bloch
- Department of Neurology; Tel-Aviv Sourasky Medical Center - University; Tel-Aviv; Israel
| | - N. Covickovic-Sternic
- Neurology Clinic; Clinical Center of Serbia; School of Medicine; University of Belgrade; Belgrade; Serbia
| | - V. Aleksic
- Neurology Clinic; Clinical Center of Serbia; School of Medicine; University of Belgrade; Belgrade; Serbia
| | - N. M. Bornstein
- Department of Neurology; Tel-Aviv Sourasky Medical Center - University; Tel-Aviv; Israel
| |
Collapse
|
25
|
The contribution of platelet glycoproteins (GPIa C807T and GPIba C-5T) and cyclooxygenase 2 (COX-2G-765C) polymorphisms to platelet response in patients treated with aspirin. Gene 2013; 526:118-21. [DOI: 10.1016/j.gene.2013.04.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/20/2013] [Accepted: 04/29/2013] [Indexed: 11/20/2022]
|
26
|
Würtz M, Lordkipanidzé M, Grove EL. Pharmacogenomics in cardiovascular disease: focus on aspirin and ADP receptor antagonists. J Thromb Haemost 2013; 11:1627-39. [PMID: 23809178 DOI: 10.1111/jth.12318] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Indexed: 11/27/2022]
Abstract
Antiplatelet agents like aspirin and adenosine diphosphate receptor antagonists are effective in reducing recurrent ischemic events. Considerable inter-individual variability in the platelet inhibition obtained with these drugs has initiated a search for explanatory mechanisms and ways to improve treatment. In recent years, numerous genetic polymorphisms have been linked with reduced platelet inhibition and lack of clinical efficacy of antiplatelet drugs, particularly clopidogrel and aspirin. Consequently, attempts to adjust antiplatelet treatment according to genotype have been made, but the clinical benefit has been modest in studies performed so far. The progress in genome science over the last decade and the declining cost of sequencing technologies hold the promise of enabling genetically tailored antiplatelet therapy. However, more evidence is needed to clarify which polymorphisms may serve as targets to improve treatment. The present review outlines the panel of polymorphisms affecting the benefit of aspirin and adenosine diphosphate receptor antagonists, including novel and ongoing studies evaluating whether genotyping may be beneficial in tailoring antiplatelet therapy.
Collapse
Affiliation(s)
- M Würtz
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | |
Collapse
|
27
|
Gorelick PB, Farooq MU. Advances in our understanding of "resistance" to antiplatelet agents for prevention of ischemic stroke. Stroke Res Treat 2013; 2013:727842. [PMID: 23936730 PMCID: PMC3725785 DOI: 10.1155/2013/727842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/27/2013] [Indexed: 01/10/2023] Open
Abstract
We review the role of aspirin and clopidogrel for prevention of ischemic stroke and explore the concept of antiplatelet therapy resistance both from a laboratory and clinical perspective and genetic polymorphisms that might influence platelet reactivity with clopidogrel administration. Debates have raged over the years about the application of platelet function tests in clinical practice. We conclude that platelet function testing is not indicated in routine clinical practice. This recommendation is supported by clinical guideline statements, a lack of a global platelet function measure, and limitations of current platelet function test methods as applied in practice. We discuss a recently hypothesized hierarchy of patient characteristics in relation to which patients are most likely to benefit from platelet function studies based on acuity (i.e., risk) of cardiovascular disease. A focus of antiplatelet therapy administration should include emphasis on compliance/adherence and in the example of aspirin, use of well-absorbed forms of aspirin and avoidance of drugs that may interact with aspirin to inhibit its mechanism of action (e.g., certain nonsteroidal anti-inflammatory drugs).
Collapse
Affiliation(s)
- Philip B. Gorelick
- Hauenstein Neuroscience Center, 220 Cherry Street SE, Grand Rapids, MI 49503, USA
- Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, 333 Bostwick Avenue NE, Grand Rapids, MI 49503, USA
| | - Muhammad U. Farooq
- Hauenstein Neuroscience Center, 220 Cherry Street SE, Grand Rapids, MI 49503, USA
| |
Collapse
|
28
|
ROSIAK MAREK, POSTULA MAREK, KAPLON-CIESLICKA AGNIESZKA, KONDRACKA AGNIESZKA, TRZEPLA EWA, ZAREMBA MALGORZATA, FILIPIAK KRZYSZTOFJ, KOSIOR DARIUSZA, CZLONKOWSKI ANDRZEJ, OPOLSKI GRZEGORZ, JANICKI PIOTRK. Lack of effect of common single nucleotide polymorphisms in leukotriene pathway genes on platelet reactivity in patients with diabetes. Mol Med Rep 2013; 8:853-60. [DOI: 10.3892/mmr.2013.1567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 06/17/2013] [Indexed: 11/06/2022] Open
|
29
|
Postula M, Janicki PK, Rosiak M, Kaplon-Cieslicka A, Kondracka A, Trzepla E, Filipiak KJ, Kosior DA, Czlonkowski A, Opolski G. Effect of common single-nucleotide polymorphisms in acetylsalicylic acid metabolic pathway genes on platelet reactivity in patients with diabetes. Med Sci Monit 2013; 19:394-408. [PMID: 23715170 PMCID: PMC3670858 DOI: 10.12659/msm.883922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Platelet reactivity in patients on acetylsalicylic acid (ASA) therapy can be influenced by physiological or pathological conditions affecting ASA pharmacokinetics or pharmacodynamics. The mechanism of such variability in the therapeutic response to ASA, particularly in diabetic patients, is poorly understood. The rate of elimination of ASA and its metabolite, salicylic acid (SA), is likely a major factor determining drug efficacy. The objective of this study was to investigate the effect of genetic polymorphisms in the selected candidate genes within the ASA metabolic pathway on the platelet reactivity and concentration of ASA and thromboxane A2 (TxA2) metabolites in a population of patients with type 2 diabetes mellitus (T2DM). Material/Methods The study cohort consisted of 287 Caucasians with T2DM who had been taking ASA tablets at the dose of 75 mg per day for at least 3 months. Platelet reactivity analyses were performed using VerifyNow Aspirin and PFA-100 assays. The measured ASA metabolite included salicylic acid (ASA), and TxA2 metabolites included serum TxB2 and urinary 11-dh-TxB2. Genotyping for the selected 18 single-nucleotide polymorphisms (SNPs) within 5 genes of the ASA metabolic pathway was performed using a Sequenom iPLEX platform. Results No statistically significant association was observed between the investigated SNPs genotypes, platelet reactivity, and measured metabolites in the investigated cohort of patients. Conclusions The results of our study failed to confirm that the selected variants in the genes within the ASA metabolic pathway might contribute to platelet reactivity in a diabetic population treated with ASA.
Collapse
Affiliation(s)
- Marek Postula
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Liu XF, Cao J, Fan L, Liu L, Li J, Hu GL, Hu YX, Li XL. Prevalence of and risk factors for aspirin resistance in elderly patients with coronary artery disease. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2013; 10:21-7. [PMID: 23610570 PMCID: PMC3627718 DOI: 10.3969/j.issn.1671-5411.2013.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 05/28/2012] [Accepted: 06/26/2012] [Indexed: 11/18/2022]
Abstract
Objective To assess the prevalence of and related risk factors for aspirin resistance in elderly patients with coronary artery disease (CAD). Methods Two hundred and forty-six elderly patients (75.9 ± 7.4 years) with CAD who received daily aspirin therapy (≥ 75 mg) over one month were recruited. The effect of aspirin was assessed using light transmission aggregometry (LTA) and thrombelastography platelet mapping assay (TEG). Aspirin resistance was defined as ≥ 20% arachidonic acid (AA)-induced aggregation and ≥ 70% adenosine diphosphate (ADP)-induced aggregation in the LTA assay. An aspirin semi-responder was defined as meeting one (but not both) of the criteria described above. Based on the results of TEG, aspirin resistance was defined as ≥ 50% aggregation induced by AA. Results As determined by LTA, 23 (9.3%) of the elderly CAD patients were resistant to aspirin therapy; 91 (37.0%) were semi-responders. As determined by TEG, 61 patients (24.8%) were aspirin resistant. Of the 61 patients who were aspirin resistant by TEG, 19 were aspirin resistant according to LTA results. Twenty-four of 91 semi-responders by LTA were aspirin resistant by TEG. Multivariate logistic regression analysis revealed that elevated fasting serum glucose level (Odds ratio: 1.517; 95% CI: 1.176–1.957; P = 0.001) was a significant risk factor for aspirin resistance as determined by TEG. Conclusions A significant number of elderly patients with CAD are resistant to aspirin therapy. Fasting blood glucose level is closely associated with aspirin resistance in elderly CAD patients.
Collapse
Affiliation(s)
- Xian-Feng Liu
- First Geriatric Cardiology Division of South Building, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Grinshtein YI, Kosinova AA, Grinshtein IY. ASPIRIN RESISTANCE CANDIDATE GENES AND THEIR ASSOCIATION WITH THE RISK OF CARDIOVASCULAR EVENTS. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2013. [DOI: 10.15829/1728-8800-2013-1-67-72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The review presents the current literature evidence on the most likely genetic polymorphisms of aspirin resistance, such as polymorphisms of cyclooxygenase, glycoproteins GP Ib/IIIa, GP Ibα, GP VI, and adenosine diphosphate receptors P2Y1 and P2Y12. The authors discuss the prevalence of these polymorphisms in laboratory and clinical aspirin resistance, as well as their association with the risk of cardiovascular events during aspirin treatment.
Collapse
Affiliation(s)
- Yu. I. Grinshtein
- Prof. V.F. Voyno-Yasenetskyi Krasnoyarsk State Medical University, Krasnoyarsk
| | - A. A. Kosinova
- Prof. V.F. Voyno-Yasenetskyi Krasnoyarsk State Medical University, Krasnoyarsk
| | - I. Yu. Grinshtein
- Prof. V.F. Voyno-Yasenetskyi Krasnoyarsk State Medical University, Krasnoyarsk
| |
Collapse
|
32
|
García-González MA, Nicolás-Pérez D, Lanas A, Bujanda L, Carrera P, Benito R, Strunk M, Sopeña F, Santolaria S, Piazuelo E, Jiménez P, Campo R, Espinel J, Manzano M, Geijo F, Pellisé M, González-Huix F, Espinós J, Zaballa M, Titó L, Barranco L, Pazo R, Quintero E. Prognostic role of host cyclooxygenase and cytokine genotypes in a Caucasian cohort of patients with gastric adenocarcinoma. PLoS One 2012; 7:e46179. [PMID: 23029430 PMCID: PMC3460851 DOI: 10.1371/journal.pone.0046179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 08/30/2012] [Indexed: 12/14/2022] Open
Abstract
Background Genetic factors influencing the prognosis of gastric adenocarcinoma (GAC) are not well known. Given the relevance of cytokines and other pro-inflammatory mediators in cancer progression and invasiveness, we aimed to assess the prognostic role of several functional cytokine and cyclooxygenase gene polymorphisms in patients with GAC. Methodology Genomic DNA from 380 Spanish Caucasian patients with primary GAC was genotyped for 23 polymorphisms in pro-inflammatory (IL1B, TNFA, LTA, IL6, IL12p40), anti-inflammatory (IL4, IL1RN, IL10, TGFB1) cytokine, and cyclooxygenase (PTGS1 and PTGS2) genes by PCR, RFLP and TaqMan assays. Clinical and histological information was collected prospectively. Survival curves were estimated by the Kaplan-Meier method and compared using the log rank test. Outcome was determined by analysis of Cox proportional hazards, adjusting for confounding factors. Results The median follow-up period and median overall survival (OS) time were 9.9 months (range 0.4–120.3) and 10.9 months (95% CI: 8.9–14.1), respectively. Multivariate analysis identified tumor stages III (HR, 3.23; 95% CI:2–5.22) and IV (HR, 5.5; 95% CI: 3.51–8.63) as independent factors associated with a significantly reduced OS, whereas surgical treatment (HR: 0.44; 95%CI: 0.3–0.6) was related to a better prognosis of the disease. Concerning genetic factors, none of the 23 polymorphisms evaluated in the current study did influence survival. Moreover, no gene-environment interactions on GAC prognosis were observed. Conclusions Our results show that, in our population, the panel of selected pro- and anti-inflammatory cytokine, and cyclooxygenase gene polymorphisms are not relevant in determining the prognosis of gastric adenocarcinoma.
Collapse
|
33
|
Sahin T, Celikyurt U, Geyik B, Oner G, Kilic T, Bildirici U, Kozdag G, Ural D. Relationship between endothelial functions and acetylsalicylic acid resistance in newly diagnosed hypertensive patients. Clin Cardiol 2012; 35:755-63. [PMID: 22847393 DOI: 10.1002/clc.22042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 06/23/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We aimed to investigate the effects and dose dependency of aspirin on endothelial functions and prevalence of aspirin resistance in newly diagnosed hypertensive patients without previous drug therapy and development of cardiac complications. HYPOTHESIS Acetylsalicyclic acid improves endothelial function. METHODS Fifty-eight hypertensive patients and 61 healthy subjects in the control group were included in the study. Endothelial functions of the patient and control groups were evaluated with brachial artery examination. Patient and control groups were divided into 2 groups. A total of 100 mg and 300 mg of aspirin were given to the separate groups for 1 week. After 1 week, endothelial functions were reevaluated and aspirin resistance examined with a platelet function analyzer (PFA-100; Dade Behring, Marbourg, Germany). RESULTS Baseline flow-mediated dilatation (FMD) change percent in hypertensive patients was 9.8%, and it was significantly lower than in the control group (12%) (P < 0.001). Frequency of acetylsalicylic acid (ASA) resistance was 20% and 26% in control and hypertensive patient groups, respectively (P = not significant). ASA resistance was 28% and 24% in 100 mg and 300 mg in hypertensive patients, respectively (P = not significant). FMD change percent increased both in the control and hypertensive groups after ASA treatment from 12.4% to 13.3% and 9.8 % to 11.9 %, respectively. FMD percentage change was significantly increased in hypertensive patients irrespective of ASA resistance (P = 0.02, for ASA resistance [+]; P < 0.012, for ASA resistance [-]). CONCLUSIONS Endothelial functions were impaired more in hypertensive patients compared to the control group. Endothelial functions were improved with all ASA doses in hypertensive patients irrespective of ASA resistance.
Collapse
Affiliation(s)
- Tayfun Sahin
- Department of Cardiology, Medical Faculty of Kocaeli University, Kocaeli, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Xu ZH, Jiao JR, Yang R, Luo BY, Wang XF, Wu F. Aspirin Resistance: Clinical Significance and Genetic Polymorphism. J Int Med Res 2012; 40:282-92. [PMID: 22429367 DOI: 10.1177/147323001204000128] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE: To determine the prevalence, clinical implications and underlying mechanism of aspirin resistance in Chinese patients. METHODS: Platelet aggregation was determined by light transmission aggregometry (LTA) using four different inducers. Patients were divided into aspirin-resistant (AR), aspirin semi responder (ASR) and aspirin-sensitive (AS) groups, according to their LTA results. Aspirin resistance was assessed by thromboelastography (TEG, with arachidonic acid [AA] or adenosine diphosphate as inducers), serum/urinary 11-dehydrothromboxane B2 (11-DH-TXB2) assay, platelet function analyser-100 assay and P-selectin assay. Polymorphisms in the prostaglandin endoperoxide synthase 1 ( PTGS1) gene (A842G, C50T, C22T, G128A, C644A and C714A), the PTGS2 gene (G765C) and the integrin β3 ( ITGB3) gene (C196T) were examined. RESULTS: The study included 360 aspirin-treated patients and 314 healthy controls. AS patients had significantly lower levels of 11-DH-TXB2 than AR and ASR patients, and significantly lower levels of P-selectin than AR patients. TEG-AA was more sensitive, specific and consistent than P-selectin in detecting aspirin resistance. The frequency of the PTGS2 G765C mutation was significantly higher in the AR/ASR groups versus the AS group. CONCLUSIONS: TEG-AA was more sensitive, specific and consistent than the P-selectin assay for detecting aspirin resistance, and the PTGS2 G765C mutation may be related to aspirin resistance.
Collapse
Affiliation(s)
- Z-H Xu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - J-R Jiao
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - R Yang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - B-Y Luo
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - X-F Wang
- Department of Blood Transfusion, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - F Wu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
35
|
Williams PJ, Morgan L. The role of genetics in pre-eclampsia and potential pharmacogenomic interventions. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2012; 5:37-51. [PMID: 23226061 PMCID: PMC3513227 DOI: 10.2147/pgpm.s23141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Indexed: 01/23/2023]
Abstract
The pregnancy-specific condition pre-eclampsia not only affects the health of mother and baby during pregnancy but also has long-term consequences, increasing the chances of cardiovascular disease in later life. It is accepted that pre-eclampsia has a placental origin, but the pathogenic mechanisms leading to the systemic endothelial dysfunction characteristic of the disorder remain to be determined. In this review we discuss some key factors regarded as important in the development of pre-eclampsia, including immune maladaptation, inadequate placentation, oxidative stress, and thrombosis. Genetic factors influence all of these proposed pathophysiological mechanisms. The inherited nature of pre-eclampsia has been known for many years, and extensive genetic studies have been undertaken in this area. Genetic research offers an attractive strategy for studying the pathogenesis of pre-eclampsia as it avoids the ethical and practical difficulties of conducting basic science research during the preclinical phase of pre-eclampsia when the underlying pathological changes occur. Although pharmacogenomic studies have not yet been conducted in pre-eclampsia, a number of studies investigating treatment for essential hypertension are of relevance to therapies used in pre-eclampsia. The pharmacogenomics of antiplatelet agents, alpha and beta blockers, calcium channel blockers, and magnesium sulfate are discussed in relation to the treatment and prevention of pre-eclampsia. Pharmacogenomics offers the prospect of individualized patient treatment, ensuring swift introduction of optimal treatment whilst minimizing the use of inappropriate or ineffective drugs, thereby reducing the risk of harmful effects to both mother and baby.
Collapse
|
36
|
|
37
|
Amici S, Paciaroni M, Agnelli G, Caso V. Gene-drug interaction in stroke. Stroke Res Treat 2011; 2011:212485. [PMID: 22135769 PMCID: PMC3216369 DOI: 10.4061/2011/212485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 07/05/2011] [Accepted: 09/02/2011] [Indexed: 01/09/2023] Open
Abstract
Stroke is the third cause of mortality and one of most frequent causes of long-term neurological disability, as well as a complex disease that results from the interaction of environmental and genetic factors. The focus on genetics has produced a large number of studies with the objective of revealing the genetic basis of cerebrovascular diseases. Furthermore, pharmacogenetic research has investigated the relation between genetic variability and drug effectiveness/toxicity. This review will examine the implications of pharmacogenetics of stroke; data on antihypertensives, statins, antiplatelets, anticoagulants, and recombinant tissue plasminogen activator will be illustrated.
Several polymorphisms have been studied and some have been associated with positive drug-gene interaction on stroke, but the superiority of the genotype-guided approach over the clinical approach has not been proved yet; for this reason, it is not routinely recommended.
Collapse
Affiliation(s)
- Serena Amici
- Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 Perugia, Italy
| | | | | | | |
Collapse
|
38
|
Postula M, Kaplon-Cieslicka A, Rosiak M, Kondracka A, Serafin A, Filipiak KJ, Czlonkowski A, Opolski G, Janicki PK. Genetic determinants of platelet reactivity during acetylsalicylic acid therapy in diabetic patients: evaluation of 27 polymorphisms within candidate genes. J Thromb Haemost 2011; 9:2291-301. [PMID: 21854539 DOI: 10.1111/j.1538-7836.2011.04482.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Decreased platelet responsiveness to acetylsalicylic acid (ASA) reported previously in diabetic patients could be attributed to patient-based, clinical, genetic and cellular factors. The objective of the present study was to investigate the effect of the genomic polymorphism on the platelet reactivity in diabetic patients treated with ASA. METHODS AND RESULTS The study cohort consisted of 295 Caucasians with diabetes type 2 who had been taking ASA tablets at the dose of 75 mg per day for at least 3 months for primary or secondary prevention of myocardial infarction (MI). Platelet reactivity analyzes were performed using VerifyNow ASA and PFA-100 assays. Genotyping for the selected 27 single nucleotide polymorphisms (SNPs) within 19 genes was performed using a Sequenom iPLEX platform. The results indicate that the statistically significant differences in platelet reactivity were observed in the PFA-100 assay for SNPs in following genes: TXBA2R (rs1131882), ADRA2A (rs4311994), PLA2G7 (rs7756935) and 9p21.3 (rs10120688) (P = 0.02, P = 0.03, P = 0.02, P = 0.03, respectively, all significance levels corrected for multiple comparisons). When using the VerifyNow ASA test, a weak nominal statistical significance (i.e. before multiple comparison testing) was observed for two SNPs in the GPVI gene: rs1671152 and rs1613662 [P = 0.025 (0.5) for both SNPs, corrected for multiple comparisons test]. CONCLUSIONS The results from the present study suggest that the four analyzed genes may contribute to platelet reactivity measured with the PFA-100 assay in the diabetic population treated with ASA.
Collapse
Affiliation(s)
- M Postula
- Department of Cardiology, Medical University of Warsaw, Poland.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Ahmad T, Voora D, Becker RC. The pharmacogenetics of antiplatelet agents: towards personalized therapy? Nat Rev Cardiol 2011; 8:560-71. [PMID: 21826075 DOI: 10.1038/nrcardio.2011.111] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
40
|
Hoh CM, Smith SA, McMichael MA, Byron JK. Evaluation of effects of low-dose aspirin administration on urinary thromboxane metabolites in healthy dogs. Am J Vet Res 2011; 72:1038-45. [DOI: 10.2460/ajvr.72.8.1038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
41
|
Lordkipanidzé M, Diodati JG, Palisaitis DA, Schampaert E, Turgeon J, Pharand C. Genetic determinants of response to aspirin: Appraisal of 4 candidate genes. Thromb Res 2011; 128:47-53. [DOI: 10.1016/j.thromres.2011.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 02/08/2011] [Accepted: 02/21/2011] [Indexed: 01/28/2023]
|
42
|
The Cyclooxygenase-1 C50T Polymorphism Is Not Associated with Aspirin Responsiveness Status in Stable Coronary Artery Disease in Tunisian Patients. Genet Test Mol Biomarkers 2011; 15:513-6. [DOI: 10.1089/gtmb.2010.0225] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
43
|
|
44
|
FitzGerald R, Pirmohamed M. Aspirin resistance: Effect of clinical, biochemical and genetic factors. Pharmacol Ther 2011; 130:213-25. [DOI: 10.1016/j.pharmthera.2011.01.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 01/18/2011] [Indexed: 01/08/2023]
|
45
|
Tello-Montoliu A, Ueno M, Angiolillo DJ. Antiplatelet drug therapy: role of pharmacodynamic and genetic testing. Future Cardiol 2011; 7:381-402. [DOI: 10.2217/fca.11.14] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Antiplatelet therapy represents the cornerstone of treatment for the short- and long-term prevention of atherothrombotic disease processes, in particular in high-risk settings such as in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention. Currently, dual antiplatelet therapy with aspirin and clopidogrel represents the most commonly used treatment regimen in these settings. However, a considerable number of patients continue to experience adverse outcomes, including both bleeding and recurrent ischemic events. Numerous investigations have demonstrated that this phenomenon may be, in part, attributed to the broad variability in individual response profiles to this standard antiplatelet treatment regimen, as identified by various assays of platelet function testing. In addition, recent studies have demonstrated that genetic polymorphisms may also have an important role in determining levels of platelet inhibition and may be considered as a tool to identify patients at risk of adverse events. This article provides an overview on antiplatelet drug response variability, an update on definitions, including the role of pharmacodynamic testing, underlying mechanisms – with emphasis on recent understandings on pharmacogenetics and drug–drug interactions – and current and future perspectives on individualized antiplatelet therapy.
Collapse
Affiliation(s)
- Antonio Tello-Montoliu
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Cardiology-Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Masafumi Ueno
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | | |
Collapse
|
46
|
Schrör K, Huber K, Hohlfeld T. Functional testing methods for the antiplatelet effects of aspirin. Biomark Med 2011; 5:31-42. [DOI: 10.2217/bmm.10.122] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
At antiplatelet doses of 75–325 mg/day, aspirin irreversibly inhibits the platelet cyclooxygenase (COX)-1-dependent thromboxane A2 (TXA2) formation. This is the pharmacological mode of action of aspirin, and it can be predicted that if aspirin does not inhibit COX-1 sufficiently, patients will not benefit from its antiplatelet effects. A pharmacodynamic failure of aspirin occurs in 1–2% of patients. The vast majority of atherothrombotic events in patients treated with aspirin result from mechanisms that are dependent on residual (non-COX-1-dependent) platelet reactivity. Global tests of platelet activation in vitro may identify patients with high residual platelet reactivity but are not sufficiently specific to test the pharmacological effect of aspirin. A further problem is the absence of standardized normal ranges for many assays and the fact that different equipment measures different signals, which are also influenced by the agonist and the anticoagulant used. Similar considerations apply for the determination of platelet-derived biomarkers such as circulating P-selectin, soluble CD40 ligand and others. The direct measurement of inhibition of thromboxane-forming capacity is the most specific pharmacological assay for aspirin. However, there is no linear correlation between inhibition of TXA2 formation and inhibition of platelet function. Measurement of urinary levels of the TXB2 metabolite, 11-dehydro-thromboxane B2, represents an index of TXA2 biosynthesis in vivo, but is also sensitive to other cellular sources of TXA2. One general problem of all assays is the relationship with clinical outcome, which is still unclear. Monitoring aspirin treatment by testing platelet function or measuring biomarkers in clinical practice should not be recommended until a clear relationship for the predictive value of these assays for clinical outcome has been established.
Collapse
Affiliation(s)
| | - Kurt Huber
- 3. Medizinische Abteilung (Kardiologie), Wilhelminenspital, Montleartstrasse 37, 1160 Wien, Austria
| | - Thomas Hohlfeld
- Institut für Pharmakologie und Klinische Pharmakologie, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum, Moorenstraße 5, 40225 Düsseldorf, Germany
| |
Collapse
|
47
|
Kojuri J, Mahmoody Y, Zangbar Sabegh B, Jannati M, Mahboodi A, Khalili A. Dose-related effect of aspirin on laboratory-defined platelet aggregation and clinical outcome after coronary stenting. Cardiovasc Ther 2010; 28:147-52. [PMID: 20557313 DOI: 10.1111/j.1755-5922.2010.00170.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Acetylsalicylic acid (aspirin) is widely used in the secondary prevention of coronary artery disease. There is controversy regarding the prevalence of aspirin resistance in patients with coronary artery disease and the effect of dose on resistance. Our primary aims were to determine the degree of platelet responsiveness to aspirin, and to study the influence of dose on platelet inhibition and clinical outcomes after coronary stenting. METHODS AND RESULTS We prospectively studied the effect of aspirin on platelet function in 106 stable outpatients 6 months after successful percutaneous coronary angioplasty. Participants were randomized in a double-blind, double-crossover study (80 or 500 mg per day for 6 months). The platelet response to aspirin was determined by 10 micromol/L adenosine-5-diphosphate-induced aggregation with light transmission aggregometry. The clinical outcome was determined by single photon emission computed tomography with Tc-99m, and major adverse cardiac events were recorded (myocardial infarction, death, unstable angina or need for revascularization). In both groups 30.2% of the participants were resistant to aspirin. There was no significant difference between the dose of 80 mg compared to 500 mg aspirin in the incidence of aspirin resistance (P= 0.3). No correlation was found between aspirin resistance and clinical outcome (P= 0.4). Female sex and smoking were strongly associated with aspirin resistance. CONCLUSION The frequency of aspirin resistance is not dependent on the dose of aspirin. Female sex and smoking were the strongest predictors of aspirin resistance. Aspirin resistance is not a predictor of poor clinical outcome in patients who received double antiplatelet therapy.
Collapse
Affiliation(s)
- Javad Kojuri
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | | | | | | | |
Collapse
|
48
|
Abderrazek F, Chakroun T, Addad F, Dridi Z, Gerotziafas G, Gamra H, Hassine M, Elalamy I. The GPIIIa PlA polymorphism and the platelet hyperactivity in Tunisian patients with stable coronary artery disease treated with aspirin. Thromb Res 2010; 125:e265-8. [PMID: 20138334 DOI: 10.1016/j.thromres.2010.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/17/2009] [Accepted: 01/17/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Various genetic polymorphisms have been proposed to explain the persistent platelet hyperactivity (HPR) under aspirin treatment. PlA polymorphism of platelet GPIIIa receptor has been largely studied. However, its influence on platelet sensitivity to aspirin remains controversial. OBJECTIVES The aim of this prospective study is to investigate whether this PlA polymorphism is associated with a greater prevalence of HPR in stable coronary artery disease patients Material and Methods: 188 stable coronary artery disease patients were included. Platelet aspirin inhibitory effect was determined with PFA-100 using Collagen/Epinephrine closure time (CEPI-CT). A CEPI-CT<160sec was defining the HPR status. GPIIIa PlA polymorphism was established using polymerase chain reaction and classical restriction fragments length polymorphism. RESULTS The observed frequencies of different genotypes were not different from those predicted by the Hardy-Weinberg equilibrium: PlA1/lA1 (55.3%), PlA1/PlA2 (39.4%) and PlA2/PlA2 (5.3%). HPR patients with inadequate aspirin inhibition were significantly more often homozygous PlA1/A1 (65.4% vs. 47.7%, p=0.015). After multivariate analysis, PlA1/A1 genotype was the only independent risk factor for persistent HPR (OR: 2.07; 95% CI [1.14 to 3.76; p=0.016). CONCLUSION In CAD patients receiving daily low dose of aspirin, there is a significant and independent association between the expression of GPIIIa PlA1 allele and the occurrence of persistent HPR detected with PFA-100.
Collapse
Affiliation(s)
- Fatma Abderrazek
- Haematology's Laboratory; Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Old and New Molecular Mechanisms Associated with Platelet Resistance to Antithrombotics. Pharm Res 2010; 27:2365-73. [DOI: 10.1007/s11095-010-0209-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 06/28/2010] [Indexed: 12/22/2022]
|
50
|
Abstract
Platelet responsiveness to conventional antiplatelet therapy underlies a high interindividual variability influenced by various factors. For instance, antiplatelet therapy does not curtail the expected effects in a relevant number of patients as demonstrated by the occurrence of repeated cardiovascular events including stent thrombosis and/or by inadequate platelet inhibition measured by in vitro platelet function assays. Besides non-genetic factors such as age, gender, liver and renal function and co-medication, considerable variation of antiplatelet drug responsiveness can be attributed to genetic factors including polymorphisms and genetic variants of platelet surface proteins and drug metabolizing enzymes. Nowadays, platelet pharmacogenomics has started a new field with the goal to link genetic information of various drug targets to interindividual variability of drug response. Evolving data from large cohort studies suggest a promising role for pharmacogenomics in the context of antiplatelet therapy. Additionally, with the revolution of low cost and high-throughput genotyping techniques, genetic testing has become affordable for clinical application and individualization of therapy. However, a key issue to define the future role of pharmacogenomics will rely on the benefit and the timeliness of implementing the genetic information into therapeutic decision. Hence, it warrants further investigations to document the prognostic effects of therapeutic alterations in distinct genotypes. Concerning the safety profile of emerging antiplatelet and antithrombotic drugs in certain risk groups it would be fatal to individualize treatment barely on behalf of an atherothrombotic genotype. In contrast, individual risk assessment combining non-genetic information and pharmacogenetic analysis represents a reasonable concept. Here, we provide a review on current data describing the role of pharmacogenomics in the field of antiplatelet drug treatment in cardiovascular patients with future directions.
Collapse
Affiliation(s)
- C S Zuern
- Medizinische Klinik, Abteilung Kardiologie und Kreislauferkrankungen, University Hospital Tuebingen, Tuebingen, Germany.
| | | | | | | |
Collapse
|