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Petrucci G, Rizzi A, Bellavia S, Dentali F, Frisullo G, Pitocco D, Ranalli P, Rizzo PA, Scala I, Silingardi M, Zagarrì E, Gussoni G, Rocca B. Stability of the thromboxane B 2 biomarker of low-dose aspirin pharmacodynamics in human whole blood and in long-term stored serum samples. Res Pract Thromb Haemost 2024; 8:102623. [PMID: 39698184 PMCID: PMC11652867 DOI: 10.1016/j.rpth.2024.102623] [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: 09/21/2024] [Revised: 10/24/2024] [Accepted: 10/26/2024] [Indexed: 12/20/2024] Open
Abstract
Background Serum thromboxane B2 (sTXB2) is a validated biomarker of low-dose aspirin pharmacodynamics. In the original method, nonanticoagulated blood samples must be incubated at 37 °C immediately after withdrawal, centrifuged and serum supernatant should be frozen until assayed. Timely completion of all preanalytical steps may affect the feasibility and quality of sTXB2 measurements. The storage duration of frozen serum can also affect sTXB2 stability. Objectives We assessed the stability of sTXB2 in clotted blood samples stored at 4 °C before further processing and in sera stored at -40 °C for over a decade. Methods Venous whole blood withdrawn from individuals on chronic low-dose aspirin was dispensed in different tubes and immediately incubated at 37 °C for 1 hour. The reference tube was promptly processed following the original protocol; the remaining tubes were stored at 4 °C for 12 to 72 hours before further processing. Sera stored at a controlled -40 °C temperature for <1 to 15 years were reassayed. Values within the interassay variation limits (±9%) vs baseline were considered acceptable. Results Baseline sTXB2 values (median, 5.4 ng/mL; IQR, 2.4-13.4 ng/mL; n = 40) were comparable with those in samples at 4 °C up to 48 hours (median, 97% [IQR, 86%-104%] of the reference; n = 26), but at 72 hours, the variability exceeded the interassay variation. Thromboxane B2 levels were stable in frozen sera for up to 10 years (median, 101% [IQR, 87%-108%] of the reference; n = 32) but decreased significantly afterward (median, 87% [IQR, 74%-109%] at 15 years; P = .005; n = 32). Conclusion Thromboxane B2 is stable in clotted blood samples stored at 4 °C for up to 48 hours before further processing and in serum samples stored at -40 °C over 10 years.
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Affiliation(s)
- Giovanna Petrucci
- Department of Healthcare Surveillance and Bioethics, Section of Pharmacology, Catholic University School of Medicine, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Alessandro Rizzi
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Catholic University School of Medicine, Rome, Italy
| | | | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Giovanni Frisullo
- Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Dario Pitocco
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Catholic University School of Medicine, Rome, Italy
| | - Paola Ranalli
- Hematology Unit, Pescara Hospital, Pescara, Italy
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy
| | | | - Irene Scala
- Catholic University School of Medicine, Rome, Italy
- Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | - Elisa Zagarrì
- Department of Clinical Research, Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti Foundation Study Center, Milan, Italy
| | - Gualberto Gussoni
- Department of Clinical Research, Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti Foundation Study Center, Milan, Italy
| | - Bianca Rocca
- Department of Healthcare Surveillance and Bioethics, Section of Pharmacology, Catholic University School of Medicine, Rome, Italy
- Department of Medicine and Surgery, Libera Universtà Mediterranea-LUM University, Casamassima, Bari, Italy
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2
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Gurbel PA, Bliden KP, Kundan P, Kraft D, Parekh R, Singh S, Babu AD, Shah AP, Chaudhary R, Tantry US. Early assessment of the pharmacokinetic and pharmacodynamic effects following acetylsalicylic acid loading: toward a definition for acute therapeutic response. J Thromb Thrombolysis 2024; 57:21-28. [PMID: 38066385 PMCID: PMC10830588 DOI: 10.1007/s11239-023-02914-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 02/01/2024]
Abstract
Despite decades of investigations, the optimal assessment of the "therapeutic response" to early after loading dose of acetylsalicylic acid (ASA) remains unclear. Limited information is available on the relation between pharmacodynamic (PD) and pharmacokinetic (PK) measurements assessed immediately after ASA administration. Serial PD and PK analyses were performed immediately after a single 162 or 650 mg dose of chewed and swallowed ASA in ten healthy adults. ASA response was defined as > 95% inhibition of serum thromboxane (Tx)B2, < 550 aspirin reaction units (ARU) by VerifyNow Aspirin (VN) test, and ≤ 20% arachidonic acid (AA)-induced platelet aggregation (PA). Correlation analyses between PK and PD measurements and receiver operating characteristic (ROC) curve analyses were performed. ASA response measured by VN test and AA-induced PA was achieved within 30 min of ASA administration. A correlation was observed between ARU and AA-induced maximum PA (r = 0.69, p < 0.001), serum TxB2 (r = 0.74 and p < 0.001), and serum TxB2 inhibition (r = 0.79, p < 0.001). In ROC curve analyses, ≤ 558 ARU and ≤ 7% AA-induced PA were associated with > 95% inhibition of TxB2. 686 ng/ml plasma ASA cut-off point was associated with > 95% inhibition of serum TxB2, ≤ 7% 1 mM AA-induced PA, and ≤ 585 ARU. A modest ~ 50% inhibition of TxB2 inhibition was associated with marked inhibition of 1 mM AA-induced platelet aggregation by LTA. Our analyses demonstrated important relationships between pharmacodynamic, and pharmacokinetic parameters measured immediately following oral ASA and cutoff values for ARU and AA-induced PA that is associated with > 95% inhibition of serum TxB2.
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Affiliation(s)
- Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, 21209, USA.
| | - Kevin P Bliden
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, 21209, USA
| | - Parshotam Kundan
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, 21209, USA
| | - Danielle Kraft
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, 21209, USA
| | - Rueshil Parekh
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, 21209, USA
| | - Sahib Singh
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, 21209, USA
| | - Aravind D Babu
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, 21209, USA
| | - Anika P Shah
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, 21209, USA
| | - Rahul Chaudhary
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Artificial Intelligence for Holistic Evaluation and Advancement of Cardiovascular Thrombosis, Pittsburgh, PA, USA
| | - Udaya S Tantry
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, 21209, USA
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3
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Brambilla M, Becchetti A, Rovati GE, Cosentino N, Conti M, Canzano P, Giesen PL, Loffreda A, Bonomi A, Cattaneo M, De Candia E, Podda GM, Trabattoni D, Werba PJ, Campodonico J, Pinna C, Marenzi G, Tremoli E, Camera M. Cell Surface Platelet Tissue Factor Expression: Regulation by P2Y 12 and Link to Residual Platelet Reactivity. Arterioscler Thromb Vasc Biol 2023; 43:2042-2057. [PMID: 37589138 PMCID: PMC10521789 DOI: 10.1161/atvbaha.123.319099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND ADP-induced platelet activation leads to cell surface expression of several proteins, including TF (tissue factor). The role of ADP receptors in platelet TF modulation is still unknown. We aimed to assess the (1) involvement of P2Y1 and P2Y12 receptors in ADP-induced TF exposure; (2) modulation of TFpos-platelets in anti-P2Y12-treated patients with coronary artery disease. Based on the obtained results, we revisited the intracellular localization of TF in platelets. METHODS The effects of P2Y1 or P2Y12 antagonists on ADP-induced TF expression and activity were analyzed in vitro by flow cytometry and thrombin generation assay in blood from healthy subjects, P2Y12-/-, and patients with gray platelet syndrome. Ex vivo, P2Y12 inhibition of TF expression by clopidogrel/prasugrel/ticagrelor, assessed by VASP (vasodilator-stimulated phosphoprotein) platelet reactivity index, was investigated in coronary artery disease (n=238). Inhibition of open canalicular system externalization and electron microscopy (TEM) were used for TF localization. RESULTS In blood from healthy subjects, stimulated in vitro by ADP, the percentage of TFpos-platelets (17.3±5.5%) was significantly reduced in a concentration-dependent manner by P2Y12 inhibition only (-81.7±9.5% with 100 nM AR-C69931MX). In coronary artery disease, inhibition of P2Y12 is paralleled by reduction of ADP-induced platelet TF expression (VASP platelet reactivity index: 17.9±11%, 20.9±11.3%, 40.3±13%; TFpos-platelets: 10.5±4.8%, 9.8±5.9%, 13.6±6.3%, in prasugrel/ticagrelor/clopidogrel-treated patients, respectively). Despite this, 15% of clopidogrel good responders had a level of TFpos-platelets similar to the poor-responder group. Indeed, a stronger P2Y12 inhibition (130-fold) is required to inhibit TF than VASP. Thus, a VASP platelet reactivity index <20% (as in prasugrel/ticagrelor-treated patients) identifies patients with TFpos-platelets <20% (92% sensitivity). Finally, colchicine impaired in vitro ADP-induced TF expression but not α-granule release, suggesting that TF is open canalicular system stored as confirmed by TEM and platelet analysis of patients with gray platelet syndrome. CONCLUSIONS Data show that TF expression is regulated by P2Y12 and not P2Y1; P2Y12 antagonists downregulate the percentage of TFpos-platelets. In clopidogrel good-responder patients, assessment of TFpos-platelets highlights those with residual platelet reactivity. TF is stored in open canalicular system, and its membrane exposure upon activation is prevented by colchicine.
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Affiliation(s)
- Marta Brambilla
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
| | - Alessia Becchetti
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
| | - Gian Enrico Rovati
- Department of Pharmaceutical Sciences (G.E.R., C.P., M. Camera), Università degli Studi di Milano, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
| | - Maria Conti
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
| | - Paola Canzano
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
| | | | - Alessia Loffreda
- Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy (A.L.)
| | - Alice Bonomi
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
| | - Marco Cattaneo
- Unità di Medicina II, ASST Santi Paolo e Carlo, Department of Scienze della Salute (M. Cattaneo, G.M.P.), Università degli Studi di Milano, Italy
| | - Erica De Candia
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy (E.D.C.)
| | - Gian Marco Podda
- Unità di Medicina II, ASST Santi Paolo e Carlo, Department of Scienze della Salute (M. Cattaneo, G.M.P.), Università degli Studi di Milano, Italy
| | - Daniela Trabattoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
| | - Pablo Josè Werba
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
| | - Christian Pinna
- Department of Pharmaceutical Sciences (G.E.R., C.P., M. Camera), Università degli Studi di Milano, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
| | | | - Marina Camera
- Centro Cardiologico Monzino IRCCS, Milan, Italy (M.B., A. Becchetti, N.C., M. Conti, P.C., A. Bonomi, D.T., P.J.W., J.C., G.M., M. Camera)
- Department of Pharmaceutical Sciences (G.E.R., C.P., M. Camera), Università degli Studi di Milano, Italy
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Perier DM, Seret DG, Huang DF, Dillinger DJG, Henry PP, Drouet PL, Benamer DH. [Résistance à l'aspirine : l'ennemi de mon ami est mon ennemi]. Ann Cardiol Angeiol (Paris) 2021; 70:401-409. [PMID: 34732279 DOI: 10.1016/j.ancard.2021.10.009] [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: 09/14/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022]
Abstract
Low dose aspirin is an efficient antiplatelet agent to decrease the risk of occlusive arterial events, however it is not infallible. Aspirin resistance describe its inability to block the formation of thromboxane A2 in platelets and/or to produce an inhibitory effect on platelet aggregation. Detection of aspirin resistance relies on the results of various platelet function tests or on blood and urinary thromboxane metabolites concentrations, but these methods show very low correlation and reproducibility. Moreover, light-transmission aggregometry using arachidonic acid, known as the reference functional assay, requires technical expertise. The incidence rate of aspirin resistance amoung populations suffering from cardiovascular diseases is about 25%, however there is a wide variability depending on the specificity of the used test and the clinical features of the considered population. Aspirin resistance is associated with the recurrence of arterial occlusive events: the odds ratio is about 4 all tests combined, therefore it could be considered as a risk marker. Evidence is lacking regarding the relevance of these tests to resort an intensification of the antithrombotic treatment, and experts recommend to reserve their use for high-risk situations. Nevertheless several studies have explored the effect of dose increases or intake frequency increases, and revealed encouraging results regarding pharmacodynamic endpoints. The reasons for aspirin resistance are numerous, often remain debate, and can accumulate to result in poor response to aspirin.
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Affiliation(s)
- Dr Matthieu Perier
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - Dr Gabriel Seret
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Dr Florent Huang
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Dr Jean-Guillaume Dillinger
- Université de Paris, AP-HP, hôpital Lariboisière, Département de Cardiologie, 2, rue Ambroise Paré, Paris, 75010 France; C.R.E.A.T.I.F. Centre de Référence et d'Éducation aux Antithrombotiques d'Ile de France, hôpital Lariboisière, Département de Cardiologie, 2, rue Ambroise Paré, Paris, 75010 France
| | - Pr Patrick Henry
- Université de Paris, AP-HP, hôpital Lariboisière, Département de Cardiologie, 2, rue Ambroise Paré, Paris, 75010 France
| | - Pr Ludovic Drouet
- Université de Paris, AP-HP, hôpital Lariboisière, Département de Cardiologie, 2, rue Ambroise Paré, Paris, 75010 France; C.R.E.A.T.I.F. Centre de Référence et d'Éducation aux Antithrombotiques d'Ile de France, hôpital Lariboisière, Département de Cardiologie, 2, rue Ambroise Paré, Paris, 75010 France; Service de médecine vasculaire, Hôpital Saint Joseph, 185, rue Raymond Losserand, 75014 Paris, France; Professeur émérite de l'université de Paris
| | - Dr Hakim Benamer
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Institut Jacques Cartier, Institut cardiovasculaire Paris Sud (ICPS) Ramsay Générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Membre du Collège de Médecine des Hôpitaux de Paris, France
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5
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Garcia A, Dunoyer-Geindre S, Nolli S, Reny JL, Fontana P. An Ex Vivo and In Silico Study Providing Insights into the Interplay of Circulating miRNAs Level, Platelet Reactivity and Thrombin Generation: Looking beyond Traditional Pharmacogenetics. J Pers Med 2021; 11:jpm11050323. [PMID: 33919053 PMCID: PMC8143175 DOI: 10.3390/jpm11050323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/18/2022] Open
Abstract
Platelet reactivity (PR), a key pharmacodynamic (PD) component of the action of antiplatelet drugs in cardiovascular disease (CVD) patients, is highly variable. PR is associated with occurrence or recurrence of thrombotic and bleeding events, but this association is modulated by several factors. Conventional pharmacogenetics explains a minor part of this PR variability, and among determinants of PR, circulating microRNAs (miRNAs) have been the focus of attention during these last years as biomarkers to predict PR and clinical outcomes in CVD. This being said, the impact of miRNAs on platelet function and the mechanisms behind it are largely unknown. The level of a set of candidate miRNAs including miR-126-3p, miR-150-5p, miR-204-5p and miR-223-3p was quantified in plasma samples of stable CVD patients and correlated with PR as assessed by light-transmission aggregometry and in vivo thrombin generation markers. Finally, miRNA target networks were built based on genes involved in platelet function. We show that all candidate miRNAs were associated with platelet aggregation, while only miR-126-3p and miR-223-3p were positively correlated with in vivo thrombin generation markers. In silico analysis identified putative miRNA targets involved in platelet function regulation. Circulating miRNAs were associated with different aspects of platelet reactivity, including platelet aggregation and platelet-supported thrombin generation. This paves the way to a personalized antithrombotic treatment according to miRNA profile in CVD patients.
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Affiliation(s)
- Alix Garcia
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (A.G.); (S.D.-G.); (S.N.); (J.-L.R.)
| | - Sylvie Dunoyer-Geindre
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (A.G.); (S.D.-G.); (S.N.); (J.-L.R.)
| | - Séverine Nolli
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (A.G.); (S.D.-G.); (S.N.); (J.-L.R.)
| | - Jean-Luc Reny
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (A.G.); (S.D.-G.); (S.N.); (J.-L.R.)
- Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; (A.G.); (S.D.-G.); (S.N.); (J.-L.R.)
- Division of Angiology and Haemostasis, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-372-97-51
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6
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Terrier J, Daali Y, Fontana P, Csajka C, Reny JL. Towards Personalized Antithrombotic Treatments: Focus on P2Y 12 Inhibitors and Direct Oral Anticoagulants. Clin Pharmacokinet 2020; 58:1517-1532. [PMID: 31250210 DOI: 10.1007/s40262-019-00792-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oral anticoagulants and antiplatelet drugs are commonly prescribed to lower the risk of cardiovascular diseases, such as venous and arterial thrombosis, which represent the leading causes of mortality worldwide. A significant percentage of patients taking antithrombotics will nevertheless experience bleeding or recurrent ischemic events, and this represents a major public health issue. Cardiovascular medicine is now questioning the one-size-fits-all policy, and more personalized approaches are increasingly being considered. However, the available tools are currently limited and they are only moderately able to predict clinical events or have a significant impact on clinical outcomes. Predicting concentrations of antithrombotics in blood could be an effective means of personalization as they have been associated with bleeding and recurrent ischemia. Target concentration interventions could take advantage of physiologically based pharmacokinetic (PBPK) and population-based pharmacokinetic (POPPK) models, which are increasingly used in clinical settings and have attracted the interest of governmental regulatory agencies, to propose dosages adapted to specific population characteristics. These models have the benefit of combining parameters from different sources, such as experimental in vitro data and patients' demographic, genetic, and physiological in vivo data, to characterize the dose-concentration relationships of compounds of interest. As such, they can be used to predict individual drug exposure. In the near future, these models could therefore be a valuable means of predicting personalized antithrombotic blood concentrations and, hopefully, of preventing clinical non-response or bleeding in a given patient. Existing approaches for personalization of antithrombotic prescriptions will be reviewed using practical examples for P2Y12 inhibitors and direct oral anticoagulants. The review will additionally focus on the existing PBPK and POPPK models for these two categories of drugs. Lastly, we address potential scenarios for their implementation in clinics, along with the main limitations and challenges.
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Affiliation(s)
- Jean Terrier
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.,Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Chantal Csajka
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland. .,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Division of Internal Medicine and Rehabilitation, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
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7
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Ilardi F, Gargiulo G, Paolillo R, Ferrone M, Cimino S, Giugliano G, Schiattarella GG, Verde N, Stabile E, Perrino C, Cirillo P, Coscioni E, Morisco C, Esposito G. Impact of chronic kidney disease on platelet aggregation in patients with acute coronary syndrome. J Cardiovasc Med (Hagerstown) 2020; 21:660-666. [PMID: 32520854 DOI: 10.2459/jcm.0000000000000981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS Chronic kidney disease (CKD) is associated with increased thrombotic events and seems to influence platelet reactivity. Conflicting results have been published on platelet response in CKD patients with stable coronary artery disease. The aim of our study was to investigate the impact of CKD on platelet aggregation in acute coronary syndrome (ACS) patients receiving dual antiplatelet therapy, included the more potent P2Y12 inhibitors. METHODS We enrolled 206 patients with ACS, divided in two groups, according to the presence or the absence of moderate/severe CKD. Platelet aggregation was performed with light transmission aggregometry and results are expressed as percentage of maximum platelet aggregation. High residual platelet reactivity (HRPR) was defined as maximum platelet aggregation more than 59%. RESULTS Patients with CKD [estimate glomerular filtration rate (eGFR) < 60 ml/min/1.73 m, n = 28] were prevalent older, diabetic, had previous coronary revascularization. In these patients, platelet aggregation was significantly higher than in those with eGFR ≥ 60 ml/min/1.73 m (ADP 10 μmol/l: 28.46 ± 26.19 vs. 16.64 ± 12.79, P < 0.001; ADP 20 μmol/l: 30.07 ± 25.89 vs. 17.46 ± 12.82, P < 0.001). HRPR was observed in 4.4% of patients, with higher prevalence in those with eGFR less than 60 ml/min/1.73 m [21.4 vs. 1.7%, P < 0.001, odds ratio (OR) [95% confidence interval (CI)] = 15.91 (3.71-68.17), P < 0.001]. At multivariate analysis, after correction for baseline confounders, eGFR [adjusted OR (95% CI) = 0.95 (0.91-0.98), P = 0.007], together with the use of clopidogrel [adjusted OR (95% CI) = 23.59 (4.01-138.82), P < 0.001], emerged as determinants of HRPR. CONCLUSION In patients with ACS receiving dual antiplatelet therapy, CKD is associated with an increasing ADP-induced platelet aggregation and higher prevalence of HRPR, which is mainly correlated to clopidogrel use.
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Affiliation(s)
- Federica Ilardi
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
- Mediterranea Cardiocentro, Naples
| | - Giuseppe Gargiulo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Roberta Paolillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Marco Ferrone
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Sara Cimino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Giugliano
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Gabriele G Schiattarella
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
- Department of Internal Medicine (Cardiology), University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicola Verde
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Cinzia Perrino
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Plinio Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Enrico Coscioni
- Department of Heart Surgery, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno, Italy
| | - Carmine Morisco
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
- Mediterranea Cardiocentro, Naples
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8
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Zapilko V, Fish RJ, Garcia A, Reny JL, Dunoyer-Geindre S, Lecompte T, Neerman-Arbez M, Fontana P. MicroRNA-126 is a regulator of platelet-supported thrombin generation. Platelets 2020; 31:746-755. [DOI: 10.1080/09537104.2020.1775804] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Veronika Zapilko
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Richard J. Fish
- Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
| | - Alix Garcia
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Luc Reny
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Thomas Lecompte
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
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9
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Platelet function/reactivity testing and prediction of risk of recurrent vascular events and outcomes after TIA or ischaemic stroke: systematic review and meta-analysis. J Neurol 2020; 267:3021-3037. [DOI: 10.1007/s00415-020-09932-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022]
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10
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Fontana P, Ibberson M, Stevenson B, Wigger L, Daali Y, Niknejad A, Mach F, Docquier M, Xenarios I, Cuisset T, Alessi MC, Reny JL. Contribution of exome sequencing to the identification of genes involved in the response to clopidogrel in cardiovascular patients. J Thromb Haemost 2020; 18:1425-1434. [PMID: 32077582 DOI: 10.1111/jth.14776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND On-clopidogrel platelet reactivity (PR) is associated with the risk of thrombotic or bleeding event in selected populations of high-risk patients. PR is a highly heritable phenotype and a few variants of cytochrome genes, essentially CYP2C19, are associated with PR but only explain 5% to 12% of the variability. OBJECTIVE The aim of this study is to delineate genetic determinants of on-clopidogrel PR using high-throughput sequencing. METHODS We performed a whole exome sequencing of 96 low- and matched high-PR patients in a discovery cohort. Exomes from genes with variants significantly associated with PR were sequenced in 96 low- and matched high-PR patients from an independent replication cohort. RESULTS We identified 585 variants in 417 genes with an adjusted P value < .05. In the replication cohort, all top variants including CYP2C8, CYP2C18, and CYP2C19 from the discovery population were found again. An original network analysis identified several candidate genes of potential interest such as a regulator of PI3K, a key actor in the downstream signaling pathway of the P2Y12 receptor. CONCLUSION This study emphasizes the role of CYP-related genes as major regulators of clopidogrel response, including the poorly investigated CYP2C8 and CYP2C18.
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Affiliation(s)
- Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Mark Ibberson
- SIB Swiss Institute of Bioinformatics, Vital-IT Group, University of Lausanne, Lausanne, Switzerland
| | - Brian Stevenson
- SIB Swiss Institute of Bioinformatics, Vital-IT Group, University of Lausanne, Lausanne, Switzerland
| | - Leonore Wigger
- SIB Swiss Institute of Bioinformatics, Vital-IT Group, University of Lausanne, Lausanne, Switzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Niknejad
- SIB Swiss Institute of Bioinformatics, Vital-IT Group, University of Lausanne, Lausanne, Switzerland
| | - François Mach
- Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Mylène Docquier
- iGE3 Genomics platform, University of Geneva, Geneva, Switzerland
| | - Ioannis Xenarios
- SIB Swiss Institute of Bioinformatics, Vital-IT Group, University of Lausanne, Lausanne, Switzerland
| | - Thomas Cuisset
- INSERM, INRA, C2VN, APHM, Aix Marseille University, Marseille, France
| | | | - Jean-Luc Reny
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
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11
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Fontana P, Roffi M, Reny JL. Platelet Function Test Use for Patients with Coronary Artery Disease in the Early 2020s. J Clin Med 2020; 9:jcm9010194. [PMID: 31936845 PMCID: PMC7019825 DOI: 10.3390/jcm9010194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 12/14/2022] Open
Abstract
In the field of antithrombotics, precision medicine is of particular interest, as it may lower the incidence of potentially life-threatening side effects. Indeed, antiplatelet drugs such as P2Y12 inhibitors are one of the most common causes of emergency admissions for drug-related adverse events. The last ten years have seen a continuous debate on whether platelet function tests (PFTs) should be used to tailor antiplatelet drugs to cardiovascular patients. Large-scale randomized studies investigating the escalation of antiplatelet therapies according to the results of PFTs were mostly negative. Potent P2Y12 inhibitors are recommended as a first-line treatment in acute coronary syndrome patients, bringing the bleeding risk at the forefront. De-escalation from prasugrel or ticagrelor to clopidogrel is now considered, with or without the use of a PFT. This review covers recent advances in escalation and de-escalation strategies based on PFTs in various clinical settings. It also describes the main features of the most popular platelet function tests as well as the potential added value of genetic testing. Finally, we detail practical suggestions on how PFTs could be used in clinical practice.
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Affiliation(s)
- Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
- Division of Angiology and Haemostasis, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-372-97-51; Fax: +41-22-372-98-91
| | - Marco Roffi
- Division of Cardiology, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Jean-Luc Reny
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
- Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
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12
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Patrono C, Rocca B. Measurement of Thromboxane Biosynthesis in Health and Disease. Front Pharmacol 2019; 10:1244. [PMID: 31736753 PMCID: PMC6832017 DOI: 10.3389/fphar.2019.01244] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/27/2019] [Indexed: 12/17/2022] Open
Abstract
Thromboxane (TX) A2 is a chemically unstable lipid mediator involved in several pathophysiologic processes, including primary hemostasis, atherothrombosis, inflammation, and cancer. In human platelets, TXA2 is the major arachidonic acid derivative via the cyclooxygenase (COX)-1 pathway. Assessment of platelet TXA2 biosynthesis can be performed ex vivo through measurement of serum TXB2, an index of platelet COX-1 activity, as well as in vivo through measurement of urinary enzymatic metabolites, a non-invasive index of platelet activation. This article reviews the main findings of four decades of clinical investigation based on these analytical approaches, focusing on the measurement of TXA2 metabolites to characterize the pathophysiologic role of transiently or persistently enhanced platelet activation and to describe the clinical pharmacology of COX-1 inhibition in health and disease.
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Affiliation(s)
- Carlo Patrono
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Bianca Rocca
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
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13
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Tscharre M, Farhan S, Bruno V, Rohla M, Egger F, Weiss TW, Hübl W, Willheim M, Wojta J, Geppert A, Huber K, Freynhofer MK. Impact of platelet turnover on long-term adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention. Eur J Clin Invest 2019; 49:e13157. [PMID: 31318979 DOI: 10.1111/eci.13157] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 07/05/2019] [Accepted: 07/15/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Increased platelet turnover and high platelet reactivity are associated with short-term major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) or stable coronary artery disease (SCAD). We investigated the impact of platelet turnover on long-term MACE. METHODS Consecutive patients presenting with ACS or SCAD undergoing PCI between 2009 and 2010 were included. All patients received clopidogrel and aspirin as dual antithrombotic therapy regimen. Multivariable Cox proportional hazard models were applied to assess the prognostic impact of platelet turnover (reticulated platelet count [RPC], mean platelet volume [MPV]) and function on long-term MACE, a composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke. RESULTS In total, 477 patients were eligible. Mean age was 64.3 ± 12.7 years, 68.8% were male. Median follow-up was 5.8 (IQR 4.2-6.5) years. Median RPC was 7.6 (IQR 5.6-10.4) g/L and median MPV was 10.7 (IQR 10.1-11.3) fL. In univariable analysis, RPC was associated with MACE, both as continuous (HR 1.064 [95%CI 1.021-1.111]; P = .006) and dichotomized (HR 1.693 [95%CI 1.156-2.481]; P = .006) variable. After adjustment, continuous RPC (HR 1.055 [95%CI 1.012-1.099]; P = .010) and dichotomized RPC (HR 1.716 [95%CI 1.152-2.559]; P = .007) remained significantly associated with MACE. Neither MPV nor platelet function testing was associated with long-term adverse outcome. CONCLUSION Increased platelet turnover is associated with long-term adverse outcome in patients with coronary artery disease undergoing PCI. Platelet turnover represents a new marker of atherothrombotic risk and might help to guide composition or duration of antiplatelet therapy.
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Affiliation(s)
- Maximilian Tscharre
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.,Institute for Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria
| | - Serdar Farhan
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Veronika Bruno
- Department of Obstetrics and Gynaecology, Wilhelminenhospital, Vienna, Austria
| | - Miklos Rohla
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.,Institute for Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria
| | - Florian Egger
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Thomas W Weiss
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.,Institute for Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
| | - Wolfgang Hübl
- Department of Laboratory Medicine, Wilhelminenhospital, Vienna, Austria
| | - Martin Willheim
- Department of Laboratory Medicine, Wilhelminenhospital, Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.,Core Facilities, Medical University of Vienna, Vienna, Austria
| | - Alexander Geppert
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
| | - Matthias K Freynhofer
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
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14
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Clinical outcomes and predictive model of platelet reactivity to clopidogrel after acute ischemic vascular events. Chin Med J (Engl) 2019; 132:1053-1062. [PMID: 30896564 PMCID: PMC6595887 DOI: 10.1097/cm9.0000000000000210] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND High on-treatment platelet reactivity (HTPR) has been suggested as a risk factor for patients with ischemic vascular disease. We explored a predictive model of platelet reactivity to clopidogrel and the relationship with clinical outcomes. METHODS A total of 441 patients were included. Platelet reactivity was measured by light transmittance aggregometry after receiving dual antiplatelet therapy. HTPR was defined by the consensus cutoff of maximal platelet aggregation >46% by light transmittance aggregometry. CYP2C19 loss-of-function polymorphisms were identified by DNA microarray analysis. The data were compared by binary logistic regression to find the risk factors. The primary endpoint was major adverse clinical events (MACEs), and patients were followed for a median time of 29 months. Survival curves were constructed with Kaplan-Meier estimates and compared by log-rank tests between the patients with HTPR and non-HTPR. RESULTS The rate of HTPR was 17.2%. Logistic regression identified the following predictors of HTPR: age, therapy regimen, body mass index, diabetes history, CYP2C192, or CYP2C193 variant. The area under the curve of receiver operating characteristic for the HTPR predictive model was 0.793 (95% confidence interval: 0.738-0.848). Kaplan-Meier analysis showed that patients with HTPR had a higher incidence of MACE than those with non-HTPR (21.1% vs. 9.9%; χ = 7.572, P = 0.010). CONCLUSIONS Our results suggest that advanced age, higher body mass index, treatment with regular dual antiplatelet therapy, diabetes, and CYP2C192 or CYP2C193 carriers are significantly associated with HTPR to clopidogrel. The predictive model of HTPR has useful discrimination and good calibration and may predict long-term MACE.
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15
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The prognostic value of multiple electrode aggregometry and light transmittance aggregometry in stable cardiovascular patients with type 2 diabetes mellitus. Thromb Res 2019; 180:47-54. [PMID: 31202191 DOI: 10.1016/j.thromres.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/15/2019] [Accepted: 06/03/2019] [Indexed: 01/10/2023]
Abstract
AIM Limited data are available regarding the clinical relevance of platelet function measurements in stable patients with coronary artery disease (CAD). Our aim is to evaluate the agreement between multiple electrode aggregometry (MEA) and light transmittance aggregometry (LTA) in detecting clopidogrel low responders and their prognostic value in CAD patients with type 2 diabetes mellitus (T2DM) on dual platelet inhibition. METHODS LTA and MEA were performed in 122 stable cardiovascular patients with T2DM. The upper quartile of patients according to maximum LTA (LTAmax) and MEA measurements were defined as clopidogrel low responders. Agreement between the two methods was evaluated by kappa statistics. We assessed the potential correlation between antiplatelet response and clinical outcome and the optimal cutoff value according to ROC analysis to predict the occurrence of major adverse cardiovascular events (MACE), during 1-year follow-up period. RESULTS Cohen's kappa coefficients (0.214) indicated fair agreement (70.2%) between LTA and MEA. A total of 25 MACE occurred in 108 patients (23.1%). Patients with MACE had higher LTAmax than those without (57.1 ± 16.5 vs 49.3 ± 18.3, respectively, p = 0.023). MEA measurements were similar between patients with and without MACE (30.1 ± 15.4 vs 30.6 ± 20.8, respectively; p = 0.84). Multiple logistic regression showed LTAmax response as an independent predictor of death from cardiovascular causes (Odds Ratio, adjusted:0.2;0.05-0.81). ROC analysis indicated that LTAmax cutoff of 62.5% best predicted death (AUC = 0.67, sensitivity = 78%, specificity = 61.5%). CONCLUSIONS The assessment of platelet responsiveness remains highly test-specific. Our results support the prognostic role of LTA, but not MEA testing, for death risk evaluation in stable cardiovascular T2DM patients.
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16
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Lee SN, Moon D, Sung MK, Moon KW, Yoo KD. Impact of platelet reactivity on long-term prognosis in Korean patients receiving percutaneous coronary intervention. Platelets 2019; 30:1030-1035. [PMID: 30601072 DOI: 10.1080/09537104.2018.1562172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Both high and low platelet responses to clopidogrel are highly associated with mortality. A therapeutic window for platelet reactivity was recently determined to be an important factor for improving clinical outcomes after percutaneous coronary intervention (PCI). We evaluated the impact of the antiplatelet activity of clopidogrel on long-term clinical outcomes in Korean patients receiving PCI. We analyzed the clinical outcomes of 814 Korean patients undergoing PCI for a median of 48 months. Platelet reactivity on clopidogrel was measured with the VerifyNow P2Y12 assay. The primary endpoint was all-cause death at 4 years. Patients were classified into three groups according to the P2Y12 reaction unit (PRU): low platelet reactivity (LPR; PRU < 85), normal platelet reactivity (NPR; 85 ≤ PRU < 208), and high platelet reactivity (HPR; PRU ≥ 208). The incidence of all-cause death was 7.0% in the LPR group, 1.5% in the NPR group, and 6.2% in the HPR group (log-rank p = 0.002). Based on multivariate analyses, all-cause death was significantly higher in both the LPR and HPR groups than in the NPR group (LPR, hazard ratio [HR]: 5.095; 95% confidence interval [95% CI]: 1.360-19.080, p = 0.016; HPR, HR: 3.315; 95% CI: 1.145-9.593, p = 0.027). Both LPR and HPR were significantly associated with long-term mortality in Korean patients receiving PCI, which suggests that the therapeutic concept of PRU may be an important prognostic factor.
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Affiliation(s)
- Su Nam Lee
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea , Suwon , South Korea
| | - Donggyu Moon
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea , Suwon , South Korea
| | - Min Kyung Sung
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea , Suwon , South Korea
| | - Keon-Woong Moon
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea , Suwon , South Korea
| | - Ki-Dong Yoo
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea , Suwon , South Korea
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17
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Somuncu MU, Demir AR, Karakurt ST, Karakurt H, Karabag T. Long Term Cardiovascular Outcome Based on Aspirin and Clopidogrel Responsiveness Status in Young ST-Elevated Myocardial Infarction Patients. Arq Bras Cardiol 2018; 112:138-146. [PMID: 30570067 PMCID: PMC6371821 DOI: 10.5935/abc.20180251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background A subset of patients who take antiplatelet therapy continues to have
recurrent cardiovascular events which may be due to antiplatelet resistance.
The effect of low response to aspirin or clopidogrel on prognosis was
examined in different patient populations. Objective We aimed to investigate the prevalence of poor response to dual antiplatelet
therapy and its relationship with major adverse cardiovascular events (MACE)
in young patients with ST-elevation myocardial infarction (STEMI). Methods In our study, we included 123 patients under the age of 45 with STEMI who
underwent primary percutaneous intervention. A screening procedure to
determine both aspirin and clopidogrel responsiveness was performed on the
fifth day of admission. We followed a 2x2 factorial design and patients were
allocated to one of four groups, according to the presence of aspirin and/or
clopidogrel resistance. Patients were followed for a three-year period. A
p-value less than 0.05 was considered statistically significant. Results We identified 48% of resistance against one or more antiplatelet in young
patients with STEMI. More MACE was observed in patients with poor response
to dual platelet therapy or to clopidogrel compared those with adequate
response to the dual therapy (OR: 1.875, 1.144-3.073, p < 0.001; OR:
1.198, 0.957-1.499, p = 0.036, respectively). After adjustment for potential
confounders, we found that poor responders to dual therapy had 3.3 times
increased odds for three-year MACE than those with adequate response to the
dual therapy. Conclusion Attention should be paid to dual antiplatelet therapy in terms of increased
risk for cardiovascular adverse events especially in young patients with
STEMI.
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Affiliation(s)
- Mustafa Umut Somuncu
- Bulent Ecevit University - Faculty of Medicine -, Department of Cardiology, Zonguldak - Turkey
| | - Ali Riza Demir
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul - Turkey
| | - Seda Tukenmez Karakurt
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul - Turkey
| | - Huseyin Karakurt
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul - Turkey
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18
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Dipyrone (metamizole) markedly interferes with platelet inhibition by aspirin in patients with acute and chronic pain: A case-control study. Eur J Anaesthesiol 2018; 34:288-296. [PMID: 28030443 DOI: 10.1097/eja.0000000000000581] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonopioid analgesic drugs may interfere with platelet inhibition by aspirin. Recent in vitro and clinical studies in patients with cardiovascular disease have suggested that this pharmacodynamic interaction may also occur with dipyrone, a nonopioid analgesic popular in Europe, Asia and South America. OBJECTIVE Dipyrone is used extensively in acute and chronic pain. This study was undertaken to provide clinical data, so far missing, on its interactions in this group of patients. DESIGN A case-control study. SETTING Primary care in one European university hospital centre. PATIENTS In total, 27 patients with stable cardiovascular, cerebrovascular or peripheral arterial disease and acute or chronic pain were identified and given dipyrone for at least 5 days in combination with low-dose aspirin. In total, 10 comparable patients on low-dose aspirin alone served as controls. MAIN OUTCOME MEASURES Platelet-rich plasma was prepared to determine arachidonic acid-induced aggregation (aggregometry) and thromboxane formation (immunoassay). Platelet sensitivity to aspirin was examined in vitro. The presence of dipyrone (metabolites) in plasma was confirmed by HPLC. Additional in vitro measurements examined the aspirin/dipyrone interaction in healthy donors. RESULTS Inhibition of aggregation was observed in only six of 27 patients receiving aspirin with dipyrone, with absence of complete inhibition by antiplatelet therapy showing in 78% of patients. In contrast, aggregation was completely inhibited in nine of 10 control patients (P < 0.001). Platelet thromboxane synthesis was higher in patients receiving dipyrone + aspirin compared with controls (387 ± 89 vs. 7 ± 1 ng ml, P < 0.001). Aspirin added in vitro failed to inhibit aggregation and thromboxane synthesis in platelet-rich plasma from dipyrone-treated patients. In vitro measurements with blood from healthy individuals confirmed that dipyrone dramatically reduces inhibition of platelet thromboxane synthesis by aspirin. CONCLUSIONS Dipyrone given for 5 days or longer blunts platelet inhibition by low-dose aspirin in the majority of recipients. TRIAL REGISTRATION German Clinical Trials Register: DRKS ID DRKS00000204. Universal Trial Number (UTN): U1111-1113-3946.
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The Aspirin Regimens in Essential Thrombocythemia (ARES) phase II randomized trial design: Implementation of the serum thromboxane B 2 assay as an evaluation tool of different aspirin dosing regimens in the clinical setting. Blood Cancer J 2018; 8:49. [PMID: 29880847 PMCID: PMC5992153 DOI: 10.1038/s41408-018-0078-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 12/12/2022] Open
Abstract
Once-daily (od), low-dose aspirin (75–100 mg) is recommended to reduce the thrombotic risk of patients with essential thrombocytemia (ET). This practice is based on data extrapolated from other high-risk patients and an aspirin trial in polycythemia vera, with the assumption of similar aspirin pharmacodynamics in the two settings. However, the pharmacodynamics of low-dose aspirin is impaired in ET, reflecting accelerated renewal of platelet cyclooxygenase (COX)-1. ARES is a parallel-arm, placebo-controlled, randomized, dose-finding, phase II trial enrolling 300 ET patients to address two main questions. First, whether twice or three times 100 mg aspirin daily dosing is superior to the standard od regimen in inhibiting platelet thromboxane (TX)A2 production, without inhibiting vascular prostacyclin biosynthesis. Second, whether long-term persistence of superior biochemical efficacy can be safely maintained with multiple vs. single dosing aspirin regimen. Considering that the primary study end point is serum TXB2, a surrogate biomarker of clinical efficacy, a preliminary exercise of reproducibility and validation of this biomarker across all the 11 participating centers was implemented. The results of this preliminary phase demonstrate the importance of controlling reproducibility of biomarkers in multicenter trials and the feasibility of using serum TXB2 as a reliable end point for dose-finding studies of novel aspirin regimens.
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Tegtmeyer R, Borst O, Gawaz M, Rath D. Individualized antithrombotic therapy in high-risk cardiovascular patients. Per Med 2018; 15:223-236. [PMID: 29798711 DOI: 10.2217/pme-2017-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recent guidelines suggest dual antiplatelet therapy (DAPT) after 'drug-eluting' stent (DES) implantation for 6 months in stable patients and for 12 months in patients after acute coronary syndrome. Serious complications after stent implantation include stent thrombosis, recurrent myocardial infarction, ischemic stroke, cardiovascular death and bleeding. These complications also occur beyond 1 year after coronary intervention. Thus, it is important to consider whether a prolonged DAPT (>12 months after percutaneous coronary intervention) is of benefit to lower thrombo-ischemic events in high-risk patients. This review addresses the results of recent randomized clinical studies (DAPT, ITALIC, OPTIDUAL and PEGASUS) and meta-analyses to support the author's view of which patient collectives might benefit from prolonged DAPT.
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Affiliation(s)
- Roland Tegtmeyer
- Department of Cardiology & Cardiovascular Medicine, University of Tuebingen, Tuebingen, Germany
| | - Oliver Borst
- Department of Cardiology & Cardiovascular Medicine, University of Tuebingen, Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology & Cardiovascular Medicine, University of Tuebingen, Tuebingen, Germany
| | - Dominik Rath
- Department of Cardiology & Cardiovascular Medicine, University of Tuebingen, Tuebingen, Germany
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van Diemen J, Fuijkschot W, Spit K, van Reuler A, Bonten T, Numans M, van der Bom J, Smulders Y, Thijs A. Influence of pre-analytical time and temperature conditions on serum thromboxane B 2 levels. Thromb Res 2018; 163:1-5. [DOI: 10.1016/j.thromres.2018.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/22/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
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22
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Schrör K. Why we should not skip aspirin in cardiovascular prevention. Hamostaseologie 2018; 36:33-43. [DOI: 10.5482/hamo-14-10-0048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/06/2015] [Indexed: 01/05/2023] Open
Abstract
SummarySince more than 20 years, aspirin is an approved and established first-line antiplatelet medication in cardiovascular prevention. This is partially due to ist unique mode of action which is not shared with any other antiplatelet agent as well by the reliability of its pharmacological efficacy: inhibition of platelet COX-1 and subsequent thromboxane formation in almost every patient. Aspirin acts synergistic with ADP-antagonists in dual antiplatelet therapy of acute coronary syndroms (ACS) and percutaneous coronary interventions (PCI) and is also approved for long-term secondary prevention. Patients with atrial fibrillation are an exception and benefit more from anticoagulants. After the introduction of the new oral anticoagulants (NOACs), i.e. direct inhibitors of factor Xa or thrombin formation, there is a renewed discussion about the role of antiplatelet agents, specifically if additional dual antiplatelet treatment is still necessary for an optimum clinical effect or whether one component, such as aspirin might be skipped in favor of other classes of oral antiplatelet agents, such as ADP-antagonists. The available data are insufficient to recommend this because of a low number of studies and a still uncertain benefit/ risk (bleeding) ratio. More research on aspirin as a chemopreventive appears also to be necessary and is going on, in particular in individuals at high-risk for vascular thrombotic diseases (diabetics, preeclampsia, venous thrombembolism).
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23
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Olechowski B, Khanna V, Mariathas M, Ashby A, Dalton RT, Nordon I, Englyst N, Harris S, Nicholas Z, Thayalasamy K, Mahmoudi M, Curzen N. Changes in platelet function with inflammation in patients undergoing vascular surgery. Platelets 2017; 30:190-198. [DOI: 10.1080/09537104.2017.1392498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Bartosz Olechowski
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Vikram Khanna
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Mariathas
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alexander Ashby
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard T Dalton
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ian Nordon
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola Englyst
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Scott Harris
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zoe Nicholas
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kala Thayalasamy
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael Mahmoudi
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nick Curzen
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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24
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Larsen SB, Grove EL, Neergaard-Petersen S, Würtz M, Hvas AM, Kristensen SD. Reduced Antiplatelet Effect of Aspirin Does Not Predict Cardiovascular Events in Patients With Stable Coronary Artery Disease. J Am Heart Assoc 2017; 6:JAHA.117.006050. [PMID: 28780510 PMCID: PMC5586446 DOI: 10.1161/jaha.117.006050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Increased platelet aggregation during antiplatelet therapy may predict cardiovascular events in patients with coronary artery disease. The majority of these patients receive aspirin monotherapy. We aimed to investigate whether high platelet‐aggregation levels predict cardiovascular events in stable coronary artery disease patients treated with aspirin. Methods and Results We included 900 stable coronary artery disease patients with either previous myocardial infarction, type 2 diabetes mellitus, or both. All patients received single antithrombotic therapy with 75 mg aspirin daily. Platelet aggregation was evaluated 1 hour after aspirin intake using the VerifyNow Aspirin Assay (Accriva Diagnostics) and Multiplate Analyzer (Roche; agonists: arachidonic acid and collagen). Adherence to aspirin was confirmed by serum thromboxane B2. The primary end point was the composite of nonfatal myocardial infarction, ischemic stroke, and cardiovascular death. At 3‐year follow‐up, 78 primary end points were registered. The primary end point did not occur more frequently in patients with high platelet‐aggregation levels (first versus fourth quartile) assessed by VerifyNow (hazard ratio: 0.5 [95% CI, 0.3–1.1], P=0.08) or Multiplate using arachidonic acid (hazard ratio: 1.0 [95% CI, 0.5–2.1], P=0.92) or collagen (hazard ratio: 1.4 [95% CI, 0.7–2.8], P=0.38). Similar results were found for the composite secondary end point (nonfatal myocardial infarction, ischemic stroke, stent thrombosis, and all‐cause death) and the single end points. Thromboxane B2 levels did not predict any end points. Renal insufficiency was the only clinical risk factor predicting the primary and secondary end points. Conclusions This study is the largest to investigate platelet aggregation in stable coronary artery disease patients receiving aspirin as single antithrombotic therapy. We found that high platelet‐aggregation levels did not predict cardiovascular events.
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Affiliation(s)
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Faculty of Health, Institute of Clinical Medicine Aarhus University, Aarhus, Denmark
| | | | - Morten Würtz
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Faculty of Health, Institute of Clinical Medicine Aarhus University, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark .,Faculty of Health, Institute of Clinical Medicine Aarhus University, Aarhus, Denmark
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25
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Sommakia S, Baker OJ. Regulation of inflammation by lipid mediators in oral diseases. Oral Dis 2017; 23:576-597. [PMID: 27426637 PMCID: PMC5243936 DOI: 10.1111/odi.12544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/08/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023]
Abstract
Lipid mediators (LM) of inflammation are a class of compounds derived from ω-3 and ω-6 fatty acids that play a wide role in modulating inflammatory responses. Some LM possess pro-inflammatory properties, while others possess proresolving characteristics, and the class switch from pro-inflammatory to proresolving is crucial for tissue homeostasis. In this article, we review the major classes of LM, focusing on their biosynthesis and signaling pathways, and their role in systemic and, especially, oral health and disease. We discuss the detection of these LM in various body fluids, focusing on diagnostic and therapeutic applications. We also present data showing gender-related differences in salivary LM levels in healthy controls, leading to a hypothesis on the etiology of inflammatory diseases, particularly Sjögren's syndrome. We conclude by enumerating open areas of research where further investigation of LM is likely to result in therapeutic and diagnostic advances.
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Affiliation(s)
- Salah Sommakia
- School of Dentistry, The University of Utah, Salt Lake City, UT, USA
| | - Olga J. Baker
- School of Dentistry, The University of Utah, Salt Lake City, UT, USA
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26
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Mavrakanas TA, Alam A, Reny JL, Fontana P. Platelet reactivity in stable cardiovascular patients with chronic kidney disease. Platelets 2017; 29:455-462. [PMID: 28580812 DOI: 10.1080/09537104.2017.1316485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The study aimed to evaluate antiplatelet drug responsiveness in stable outpatients with cardiovascular disease and chronic kidney disease (CKD) and examine whether impaired antiplatelet drug responsiveness is associated with worse clinical outcomes in this population. Stable cardiovascular patients (n = 771) were enrolled at least one month after an acute ischemic atherothrombotic event. Antiplatelet drug responsiveness was assessed with specific assays (serum TxA2 for aspirin, the VASP assay for clopidogrel) and other aggregation-based assays using different agonists. All patients were followed until the first occurrence of a major adverse cardiovascular event. The 133 CKD patients were found to have higher activity of von Willebrand factor and higher fibrinogen levels. After a median follow-up of 33 months, 88 events occurred in patients without CKD and 31 events in patients with CKD (5.0 events and 8.7 events per 100 patient years, respectively, HR = 1.75 (95% CI 1.16-2.63; p = 0.008). The prevalence of poor aspirin and clopidogrel responsiveness and high platelet reactivity as assessed with different aggregation-based assays was similar in patients with estimated GFR ≥ 60 ml/min, 45-59 ml/min, and < 45 ml/min. No significant interaction for CKD vs. non-CKD was observed for events occurrence in patients with or without high platelet reactivity on several assays, with the exception of collagen-induced aggregation. In stable cardiovascular patients, CKD is not associated with higher platelet reactivity. Decreased antiplatelet drug responsiveness is not associated with worse clinical outcomes in CKD patients.
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Affiliation(s)
- Thomas A Mavrakanas
- a Nephrology Division , McGill University Health Center , Montreal , Canada.,b Division of General Internal Medicine , Geneva University Hospitals , Geneva , Switzerland
| | - Ahsan Alam
- a Nephrology Division , McGill University Health Center , Montreal , Canada
| | - Jean-Luc Reny
- c Division of Internal Medicine and Rehabilitation , Trois-Chêne, Geneva University Hospitals , Geneva , Switzerland.,d Geneva Platelet Group , Faculty of Medicine , Geneva , Switzerland
| | - Pierre Fontana
- d Geneva Platelet Group , Faculty of Medicine , Geneva , Switzerland.,e Division of Angiology and Hemostasis , Geneva University Hospitals , Geneva , Switzerland
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27
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Stierlin FB, Molica F, Reny JL, Kwak BR, Fontana P. Pannexin1 Single Nucleotide Polymorphism and Platelet Reactivity in a Cohort of Cardiovascular Patients. ACTA ACUST UNITED AC 2017; 23:11-15. [PMID: 28142297 DOI: 10.1080/15419061.2017.1282469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pannexin1 (Panx1), a membrane channel-forming protein permitting the passage of small-sized molecules, such as ATP, is expressed in human platelets. Recently, we showed that inhibiting Panx1 affects collagen-induced platelet aggregation but not aggregation triggered by other agonists. We also found that a single nucleotide polymorphism (SNP; rs1138800) in the Panx1 gene encoded for a gain-of-function channel (Panx1-400C) and was associated with enhanced collagen-induced platelet reactivity. Here, we assessed the association of this SNP with platelet reactivity in a cohort of 758 stable cardiovascular patients from the ADRIE study treated with aspirin and/or clopidogrel. We found that presence of the Panx1-400C allele was not associated with platelet reactivity in stable cardiovascular patients, irrespective of the platelet aggregation agonist used (collagen, ADP or arachidonic acid) or the anti-platelet drug regimen. Moreover, the Panx1-400A > C SNP did also not affect the re-occurrence of cardiac ischemic events in the same stable cardiovascular patient cohort.
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Affiliation(s)
- Florian B Stierlin
- a Department of Pathology and Immunology , University of Geneva , Geneva , Switzerland.,b Department of Medical Specializations - Cardiology , University of Geneva , Geneva , Switzerland.,c Geneva Platelet Group , University of Geneva , Geneva , Switzerland
| | - Filippo Molica
- a Department of Pathology and Immunology , University of Geneva , Geneva , Switzerland.,b Department of Medical Specializations - Cardiology , University of Geneva , Geneva , Switzerland
| | - Jean-Luc Reny
- c Geneva Platelet Group , University of Geneva , Geneva , Switzerland.,d Department of Medical Specializations, Division of Internal Medicine and Rehabilitation , Trois-Chêne Hospital, Geneva University Hospitals , Geneva , Switzerland
| | - Brenda R Kwak
- a Department of Pathology and Immunology , University of Geneva , Geneva , Switzerland.,b Department of Medical Specializations - Cardiology , University of Geneva , Geneva , Switzerland
| | - Pierre Fontana
- c Geneva Platelet Group , University of Geneva , Geneva , Switzerland.,e Department of Medical Specializations, Division of Angiology and Haemostasis , Geneva University Hospitals , Geneva , Switzerland
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28
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Molica F, Stierlin FB, Fontana P, Kwak BR. Pannexin- and Connexin-Mediated Intercellular Communication in Platelet Function. Int J Mol Sci 2017; 18:E850. [PMID: 28420171 PMCID: PMC5412434 DOI: 10.3390/ijms18040850] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 12/11/2022] Open
Abstract
The three major blood cell types, i.e., platelets, erythrocytes and leukocytes, are all produced in the bone marrow. While red blood cells are the most numerous and white cells are the largest, platelets are small fragments and account for a minor part of blood volume. However, platelets display a crucial function by preventing bleeding. Upon vessel wall injury, platelets adhere to exposed extracellular matrix, become activated, and form a platelet plug preventing hemorrhagic events. However, when platelet activation is exacerbated, as in rupture of an atherosclerotic plaque, the same mechanism may lead to acute thrombosis causing major ischemic events such as myocardial infarction or stroke. In the past few years, major progress has been made in understanding of platelet function modulation. In this respect, membrane channels formed by connexins and/or pannexins are of particular interest. While it is still not completely understood whether connexins function as hemichannels or gap junction channels to inhibit platelet aggregation, there is clear-cut evidence for a specific implication of pannexin1 channels in collagen-induced aggregation. The focus of this review is to summarize current knowledge of the role of connexins and pannexins in platelet aggregation and to discuss possible pharmacological approaches along with their limitations and future perspectives for new potential therapies.
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Affiliation(s)
- Filippo Molica
- Department of Pathology and Immunology, University of Geneva, 1211 Geneva, Switzerland.
- Department of Medical Specializations, Cardiology, University of Geneva, 1211 Geneva, Switzerland.
| | - Florian B Stierlin
- Department of Pathology and Immunology, University of Geneva, 1211 Geneva, Switzerland.
- Department of Medical Specializations, Cardiology, University of Geneva, 1211 Geneva, Switzerland.
- Geneva Platelet Group, University of Geneva, 1211 Geneva, Switzerland.
| | - Pierre Fontana
- Geneva Platelet Group, University of Geneva, 1211 Geneva, Switzerland.
- Division of Angiology and Haemostasis, Geneva University Hospitals, 1211 Geneva, Switzerland.
| | - Brenda R Kwak
- Department of Pathology and Immunology, University of Geneva, 1211 Geneva, Switzerland.
- Department of Medical Specializations, Cardiology, University of Geneva, 1211 Geneva, Switzerland.
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29
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Kukula K, Klopotowski M, Kunicki PK, Jamiolkowski J, Debski A, Bekta P, Polanska-Skrzypczyk M, Chmielak Z, Witkowski A. Platelet aggregation and risk of stent thrombosis or bleeding in interventionally treated diabetic patients with acute coronary syndrome. BMC Cardiovasc Disord 2016; 16:252. [PMID: 27931181 PMCID: PMC5146852 DOI: 10.1186/s12872-016-0433-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/03/2016] [Indexed: 12/13/2022] Open
Abstract
Background Platelet aggregation monitoring in diabetic patients treated with coronary interventions (PCI) for an acute coronary syndrome (ACS) is a promising way of optimizing treatment and outcomes in this high risk group. The aim of the study was to verify whether clopidogrel response measured by Multiplate analyzer (ADPtest) in diabetic ACS patients treated with PCI predicts the risk of stent thrombosis or cardiovascular mortality and bleeding. Methods Into this prospective, observational study 206 elective PCI patients were enrolled. Two cutoff points of ADPtest were used in analysis to divide patients into groups. One (345 AU x min) was calculated based on ROC curve analysis; this cutoff provided the best ROC curve fit, although it did not reach statistical significance. The other (468 AU x min) was accepted based on the consensus of the Working Group on On-Treatment Platelet Reactivity. The risk of stent thrombosis and mortality was assessed using Cox regression analysis and Kaplan-Meier curves. Results The risk of stent thrombosis was higher in the group of patients with impaired clopidogrel response for either cutoff value (for >354 AU x min - HR 12.33; 95% CI 2.49–61.1; P = 0.002). Cardiovascular mortality was also higher in the impaired clopidogrel response group (for >354 AU x min - HR 10.58; 95% CI 2.05–54.58; P = 0.005). We did not find a clear relation of increased clopidogrel response to the risk of bleeding. Conclusions The results of this study show that in diabetic ACS patient group treated with PCI an impaired platelet response to clopidogrel measured by the Multiplate analyzer results in increased risk of stent thrombosis and cardiac death.
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Affiliation(s)
- K Kukula
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - M Klopotowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - P K Kunicki
- Clinical Pharmacology Unit, Department of Clinical Biochemistry, Institute of Cardiology, Warsaw, Poland
| | - J Jamiolkowski
- Department of Public Health, Medical University of Bialystok, Bialystok, Poland
| | - A Debski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - P Bekta
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - M Polanska-Skrzypczyk
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - Z Chmielak
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - A Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
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30
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Santos MT, Moscardó A, Latorre A, Cortina B, Vallés J. The time between venepuncture and blood incubation is critical for serum thromboxane B2 synthesis. Platelets 2016; 28:310-311. [PMID: 27897081 DOI: 10.1080/09537104.2016.1246719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- María Teresa Santos
- a Unit of Hemostasia, Thrombosis, Atherosclerosis and Vascular Biology , Health Research Institute La Fe , Valencia , Spain
| | - Antonio Moscardó
- a Unit of Hemostasia, Thrombosis, Atherosclerosis and Vascular Biology , Health Research Institute La Fe , Valencia , Spain
| | - Ana Latorre
- a Unit of Hemostasia, Thrombosis, Atherosclerosis and Vascular Biology , Health Research Institute La Fe , Valencia , Spain
| | - Belén Cortina
- a Unit of Hemostasia, Thrombosis, Atherosclerosis and Vascular Biology , Health Research Institute La Fe , Valencia , Spain
| | - Juana Vallés
- a Unit of Hemostasia, Thrombosis, Atherosclerosis and Vascular Biology , Health Research Institute La Fe , Valencia , Spain
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31
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Li XG, Ma N, Wang B, Li XQ, Mei SH, Zhao K, Wang YJ, Li W, Zhao ZG, Sun SS, Miao ZR. The impact of P2Y12 promoter DNA methylation on the recurrence of ischemic events in Chinese patients with ischemic cerebrovascular disease. Sci Rep 2016; 6:34570. [PMID: 27686864 PMCID: PMC5043343 DOI: 10.1038/srep34570] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/15/2016] [Indexed: 01/21/2023] Open
Abstract
The primary mechanism of clopidogrel resistance is still unclear. We aimed to investigate whether the methylation status of the P2Y12 promoter has effects on platelet function and clinical ischemic events. Patients with ischemic cerebrovascular disease were enrolled into our study. Venous blood samples were drawn for thrombelastograpy (TEG) and active metabolite assay. Patients were divided into a case- or control-group based on the occurrence of ischemic events during a one year follow-up. Two TEG parameters between the case and control groups were statistically significant [ADP inhibition rate (ADP%): P = 0.018; ADP-induced platelet-fibrin clot strength (MAADP): P = 0.030]. The concentrations of clopidogrel active metabolite had no significant difference (P = 0.281). Sixteen CpG dinucleotides on P2Y12 promoter were tested. Three CpG sites (CpG11 and CpG12 + 13) showed lower methylation status, which correlated with a strong association with increased risk of clinical events. Changes of MAADP and ADP% were also associated with methylation levels of CpG 11 and CpG 12 + 13. Hypomethylation of the P2Y12 promoter is associated with a higher platelet reactivity and increased risk of ischemic events in our patients. Methylation analysis of peripheral blood samples might be a novel molecular marker to help early identification of patients at high risk for clinical ischemic events.
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Affiliation(s)
- Xin-Gang Li
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Precision Medicine Research Center for Neurological Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Qing Li
- Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Sheng-Hui Mei
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kun Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- Precision Medicine Research Center for Neurological Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Precision Medicine Research Center for Neurological Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhi-Gang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Precision Medicine Research Center for Neurological Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu-Sen Sun
- College of Pharmacy, Western New England University, Springfield, Massachusetts, United States of America
| | - Zhong-Rong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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32
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Forni Ogna V, Menetrey I, Muller O, Tousset E, Guihard L, Fontana P, Eeckhout E, Eap CB, Vrijens B, Burnier M, Wuerzner G. Effect of long-term adherence to clopidogrel on the VASP-PRI after elective coronary stent implantation: a randomized controlled study. Br J Clin Pharmacol 2016; 82:1486-1497. [PMID: 27447737 DOI: 10.1111/bcp.13071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/02/2016] [Accepted: 07/17/2016] [Indexed: 11/27/2022] Open
Abstract
AIMS The biological response to clopidogrel is highly variable and a poor responsiveness is associated with major adverse cardiac events. Adherence to therapy is a major cause of poor responsiveness but its impact on long-term platelet inhibition is unknown. The objective of the present study was to evaluate the effect of different programmes monitoring adherence to clopidogrel on platelet reactivity. METHODS The study took the form of a monocentric, parallel group, randomized controlled trial. Adults treated with clopidogrel 75 mg after elective coronary stenting were randomized into one of three groups: (i) a standard of care group; (ii) a standard of care + adherence electronic monitoring group, in which drug intake was recorded but kept blinded until the study end; or (iii) an integrated care group, with regular feedback on recorded adherence. Clopidogrel response was assessed with the vasodilator-stimulated phosphoprotein-platelet reactivity index (VASP-PRI) at randomization, 3 months and 6 months. RESULTS A total of 123 adults were enrolled and randomized. Baseline VASP-PRI was highly variable, with a mean of 48 ± 18.8%. No difference between groups in VASP-PRI was found at 6 months (P = 0.761), despite better adherence to clopidogrel in the integrated care group. However, adherence (P = 0.035) and baseline VASP-PRI (P = 0.015) were associated with VASP-PRI at 3 months and 6 months. The association between adherence and VASP-PRI was lost in patients with baseline VASP-PRI > 50%. Diabetes, CYP2C19*2 carrier status and body mass index were significant predictors of VASP-PRI. CONCLUSIONS The platelet response to clopidogrel during chronic therapy remained highly variable, despite high adherence. Different adherence monitoring programmes did not affect VASP-PRI at 6 months. Poor adherence is associated with lower VASP-PRI only in initial good responders to clopidogrel.
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Affiliation(s)
- Valentina Forni Ogna
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Menetrey
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Linda Guihard
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Chin B Eap
- Unit of Biochemistry and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Michel Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Grégoire Wuerzner
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Petrucci G, Rizzi A, Cavalca V, Habib A, Pitocco D, Veglia F, Ranalli P, Zaccardi F, Pagliaccia F, Tremoli E, Patrono C, Rocca B. Patient-independent variables affecting the assessment of aspirin responsiveness by serum thromboxane measurement. Thromb Haemost 2016; 116:891-896. [PMID: 27440714 DOI: 10.1160/th16-05-0349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/15/2016] [Indexed: 12/12/2022]
Abstract
The serum TXB2 (sTXB2) assay reflects the pharmacodynamics of platelet inhibition by low-dose aspirin. However, different studies reported variable sTXB2 values. sTXB2 assay requires whole blood incubation at 37 °C as a condition for optimal thrombin generation, arachidonic acid release and its metabolism by platelet cyclooxygenase-1 to form TXA2. Access to 37 °C incubation may be variably delayed, and different methods to quantitate sTXB2 may contribute to variable results between different Centers. We investigated whether delaying 37 °C incubation and/or analytical issues affect sTXB2 concentrations, biasing the assessment of aspirin responsiveness. Sixty-eight samples from 54 volunteers, on- and off-aspirin, were incubated at 37 °C immediately after sampling (reference sample) or after 5, 10, 15, 20, 30 or 60 minutes at room temperature (RT); 8 samples remained at RT 60 minutes, without subsequent incubation; 314 sera were measured by enzyme immunoassay (EIA) and liquid chromatography-tandem mass-spectrometry (LC/MS-MS) methods. sTXB2 concentrations decreased exponentially as a function of the delay before 37 °C incubation, ranging from 94 ± 11 % at 5 minutes to 23 ± 22 % of the reference sample after 60 minutes at RT. There was high agreement between EIA and LC/MS-MS. Moreover, we simulated the influence of a 15- or 30-minute delayed incubation on 300 sTXB2 measurements from previously-studied, aspirin-treated patients. Delayed incubation reduced the percentage of aspirin 'non-responders' by 22 % to 52 %, depending on the response threshold. In conclusion, a variable delay in the 37 °C incubation of blood samples may affect the assessment of platelet cyclooxygenase-1 inhibition by aspirin and confound the characterization of the determinants of aspirin responsiveness.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Bianca Rocca
- Bianca Rocca, MD, PhD, Istituto di Farmacologia, Università Cattolica, Largo F. Vito 1, 00168 Rome, Italy, Tel.: +39 06 30154253, E-mail: ;
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Gillet B, Ianotto JC, Mingant F, Didier R, Gilard M, Ugo V, Lippert E, Galinat H. Multiple Electrode Aggregometry is an adequate method for aspirin response testing in myeloproliferative neoplasms and differentiates the mechanisms of aspirin resistance. Thromb Res 2016; 142:26-32. [DOI: 10.1016/j.thromres.2016.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/07/2016] [Accepted: 04/09/2016] [Indexed: 01/08/2023]
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Uchiyama S, Ishizuka N, Shimada K, Teramoto T, Yamazaki T, Oikawa S, Sugawara M, Ando K, Murata M, Yokoyama K, Minematsu K, Matsumoto M, Ikeda Y. Aspirin for Stroke Prevention in Elderly Patients With Vascular Risk Factors: Japanese Primary Prevention Project. Stroke 2016; 47:1605-11. [PMID: 27165949 DOI: 10.1161/strokeaha.115.012461] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The effect of aspirin in primary prevention of stroke is controversial among clinical trials conducted in Western countries, and no data are available for Asian populations with a high risk of intracranial hemorrhage. The objective of this study was to evaluate the effect of aspirin on the risk of stroke and intracranial hemorrhage in the Japanese Primary Prevention Project (JPPP). METHODS A total of 14 464 patients (age, 60-85 years) with hypertension, dyslipidemia, and diabetes mellitus participated and were randomized into 2 treatment groups: 100 mg of aspirin or no aspirin. The median follow-up period was 5.02 years. RESULTS The cumulative rate of fatal or nonfatal stroke was similar for the aspirin (2.068%; 95% confidence interval [CI], 1.750-2.443) and no aspirin (2.299%; 95% CI, 1.963-2.692) groups at 5 years; the estimated hazard ratio was 0.927 (95% CI, 0.741-1.160; P=0.509). Aspirin nonsignificantly reduced the risk of ischemic stroke or transient ischemic attack (hazard ratio, 0.783; 95% CI, 0.606-1.012; P=0.061) and nonsignificantly increased the risk of intracranial hemorrhage (hazard ratio, 1.463; 95% CI; 0.956-2.237; P=0.078). A Cox regression adjusted by the risk factors for all stroke, which were age >70 years, smoking, and diabetes mellitus, supported the above result. CONCLUSIONS Aspirin did not show any net benefit for the primary prevention of stroke in elderly Japanese patients with risk factors for stroke, whereas age >70 years, smoking, and diabetes mellitus were risk factors for stroke regardless of aspirin treatment. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00225849.
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Affiliation(s)
- Shinichiro Uchiyama
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.).
| | - Naoki Ishizuka
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Kazuyuki Shimada
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Tamio Teramoto
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Tsutomu Yamazaki
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Shinichi Oikawa
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Masahiro Sugawara
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Katsuyuki Ando
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Mitsuru Murata
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Kenji Yokoyama
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Kazuo Minematsu
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Masayasu Matsumoto
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
| | - Yasuo Ikeda
- From the Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); Clinical Trial Department, Cancer Institute Hospital, Tokyo, Japan (N.I.); Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan (K.S.); Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (T.T.); Clinical Research Support Center, Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan (T.Y.); Diabetes and Life Style Disease Center, Fukujyuji Hospital, Tokyo, Japan (S.O.); Japan Physician's Association, Tokyo, Japan (M.S.); Department of Internal Medicine, Kitamura Memorial Clinic, Tokyo, Japan (K.A.); Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan (M. Murata); Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan (K.Y.); National Cerebral and Cardiovascular Center, Osaka, Japan (K.M.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan (M. Matsumoto); and Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan (Y.I.)
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Gurbel PA, Jeong YH, Navarese EP, Tantry US. Platelet-Mediated Thrombosis. Circ Res 2016; 118:1380-91. [DOI: 10.1161/circresaha.115.307016] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/17/2016] [Indexed: 11/16/2022]
Abstract
The pivotal role that platelets play in thrombosis and resultant ischemic event occurrences in patients with high-risk coronary artery disease is well established. This role provides the fundamental basis for the current wide implementation of dual antiplatelet therapy with aspirin and a P2Y
12
receptor inhibitor. The development of user friendly point-of-care methods to assess platelet reactivity to adenosine diphosphate has increased the frequency of platelet function testing in clinical practice. Recent large observational studies have established an independent relation between the results of point-of-care platelet function testing and clinical event occurrence in patients undergoing coronary artery stenting. However, prospective, randomized trials have failed to demonstrate that personalized antiplatelet therapy based on point-of-care assessment of platelet function is effective in reducing ischemic event occurrences. Important limitations were associated with these trials. In addition, the concept of a therapeutic window of P2Y
12
receptor reactivity with an upper threshold associated with ischemic event occurrence and a lower threshold associated with bleeding has also been proposed. In the absence of strong prospective evidence to support personalized antiplatelet therapy, clinical decision making about antiplatelet therapy rests on the large body of observational data and the fundamental importance of platelet physiology in catastrophic event occurrence in patients with high-risk coronary artery disease.
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Affiliation(s)
- Paul A. Gurbel
- From the Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA (P.A.G., E.P.N., U.S.T.); and Clinical Trial Center, Gyeongsang National University Hospital, Gyeongsangnam-do, Korea (Y.-H.J.)
| | - Young-Hoon Jeong
- From the Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA (P.A.G., E.P.N., U.S.T.); and Clinical Trial Center, Gyeongsang National University Hospital, Gyeongsangnam-do, Korea (Y.-H.J.)
| | - Eliano P. Navarese
- From the Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA (P.A.G., E.P.N., U.S.T.); and Clinical Trial Center, Gyeongsang National University Hospital, Gyeongsangnam-do, Korea (Y.-H.J.)
| | - Udaya S. Tantry
- From the Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA (P.A.G., E.P.N., U.S.T.); and Clinical Trial Center, Gyeongsang National University Hospital, Gyeongsangnam-do, Korea (Y.-H.J.)
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Nagatsuka K, Miyata S, Kada A, Kawamura A, Nakagawara J, Furui E, Takiuchi S, Taomoto K, Kario K, Uchiyama S, Saito K, Nagao T, Kitagawa K, Hosomi N, Tanaka K, Kaikita K, Katayama Y, Abumiya T, Nakane H, Wada H, Hattori A, Kimura K, Isshiki T, Nishikawa M, Yamawaki T, Yonemoto N, Okada H, Ogawa H, Minematsu K, Miyata T. Cardiovascular events occur independently of high on-aspirin platelet reactivity and residual COX-1 activity in stable cardiovascular patients. Thromb Haemost 2016; 116:356-68. [PMID: 27098431 DOI: 10.1160/th15-11-0864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/05/2016] [Indexed: 11/05/2022]
Abstract
Several studies have indicated that approximately 25 % of patients treated with aspirin exhibit high on-treatment platelet reactivity (HTPR), which is potentially associated with cardiovascular events (CVEs). However, this association is still controversial, since the mechanisms by which HTPR contributes to CVEs remain unclear and a no standardised definition of HTPR has been established. To determine whether HTPR is associated with CVE recurrence and what type of assay would best predict CVE recurrence, we conducted a multicentre prospective cohort study of 592 stable cardiovascular outpatients treated with aspirin monotherapy for secondary prevention. Their HTPR was determined by arachidonic acid- or collagen-induced aggregation assays using two different agonist concentrations. Residual cyclooxygenase (COX)-1 activity was assessed by measuring serum thromboxane (TX)B2 or urinary 11-dehydro TXB2. Shear-induced platelet thrombus formation was also examined. We followed all patients for two years to evaluate how these seven indexes were related to the recurrence of CVEs (cerebral infarction, transient ischaemic attack, myocardial infarction, unstable angina, revascularisation, other arterial thrombosis, or cardiovascular death). Of 583 patients eligible for the analysis, CVEs occurred in 69 (11.8 %). A Cox regression model identified several classical risk factors associated with CVEs. However, neither HTPR nor high residual COX-1 activity was significantly associated with CVEs, even by applying cut-off values suggested in previous reports or a receiver-operating characteristic analysis. In conclusion, recurrence of CVEs occurred independently of HTPR and residual COX-1 activity. Thus, our findings do not support the use of platelet or COX-1 functional testing for predicting clinical outcomes in stable cardiovascular patients.
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Affiliation(s)
| | - Shigeki Miyata
- Dr. Shigeki Miyata, Division of Transfusion Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan, Tel.: +81 6 6833 5012 ext. 2294, Fax: +81 6 6872 8175, E-mail:
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Dretzke J, Riley RD, Lordkipanidzé M, Jowett S, O'Donnell J, Ensor J, Moloney E, Price M, Raichand S, Hodgkinson J, Bayliss S, Fitzmaurice D, Moore D. The prognostic utility of tests of platelet function for the detection of 'aspirin resistance' in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-366. [PMID: 25984731 DOI: 10.3310/hta19370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The use of aspirin is well established for secondary prevention of cardiovascular disease. However, a proportion of patients suffer repeat cardiovascular events despite being prescribed aspirin treatment. It is uncertain whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity. This report aims to investigate whether or not insufficient platelet function inhibition by aspirin ('aspirin resistance'), as defined using platelet function tests (PFTs), is linked to the occurrence of adverse clinical outcomes, and further, whether or not patients at risk of future adverse clinical events can be identified through PFTs. OBJECTIVES To review systematically the clinical effectiveness and cost-effectiveness evidence regarding the association between PFT designation of 'aspirin resistance' and the risk of adverse clinical outcome(s) in patients prescribed aspirin therapy. To undertake exploratory model-based cost-effectiveness analysis on the use of PFTs. DATA SOURCES Bibliographic databases (e.g. MEDLINE from inception and EMBASE from 1980), conference proceedings and ongoing trial registries up to April 2012. METHODS Standard systematic review methods were used for identifying clinical and cost studies. A risk-of-bias assessment tool was adapted from checklists for prognostic and diagnostic studies. (Un)adjusted odds and hazard ratios for the association between 'aspirin resistance', for different PFTs, and clinical outcomes are presented; however, heterogeneity between studies precluded pooling of results. A speculative economic model of a PFT and change of therapy strategy was developed. RESULTS One hundred and eight relevant studies using a variety of PFTs, 58 in patients on aspirin monotherapy, were analysed in detail. Results indicated that some PFTs may have some prognostic utility, i.e. a trend for more clinical events to be associated with groups classified as 'aspirin resistant'. Methodological and clinical heterogeneity prevented a quantitative summary of prognostic effect. Study-level effect sizes were generally small and absolute outcome risk was not substantially different between 'aspirin resistant' and 'aspirin sensitive' designations. No studies on the cost-effectiveness of PFTs for 'aspirin resistance' were identified. Based on assumptions of PFTs being able to accurately identify patients at high risk of clinical events and such patients benefiting from treatment modification, the economic model found that a test-treat strategy was likely to be cost-effective. However, neither assumption is currently evidence based. LIMITATIONS Poor or incomplete reporting of studies suggests a potentially large volume of inaccessible data. Analyses were confined to studies on patients prescribed aspirin as sole antiplatelet therapy at the time of PFT. Clinical and methodological heterogeneity across studies precluded meta-analysis. Given the lack of robust data the economic modelling was speculative. CONCLUSIONS Although evidence indicates that some PFTs may have some prognostic value, methodological and clinical heterogeneity between studies and different approaches to analyses create confusion and inconsistency in prognostic results, and prevented a quantitative summary of their prognostic effect. Protocol-driven and adequately powered primary studies are needed, using standardised methods of measurements to evaluate the prognostic ability of each test in the same population(s), and ideally presenting individual patient data. For any PFT to inform individual risk prediction, it will likely need to be considered in combination with other prognostic factors, within a prognostic model. STUDY REGISTRATION This study is registered as PROSPERO 2012:CRD42012002151. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Janine Dretzke
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | | | - Susan Jowett
- Health Economics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer O'Donnell
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Joie Ensor
- Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Eoin Moloney
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Malcolm Price
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Smriti Raichand
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - James Hodgkinson
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Susan Bayliss
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - David Fitzmaurice
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - David Moore
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
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Abstract
Antiplatelet agents represent a cornerstone in the management of patients at increased cardiovascular risk. Essential hypertension is considered a major public health problem leading to increased cardiovascular morbidity and mortality. The majority of patients with essential hypertension exhibit also additional cardiovascular risk factors and present with increased platelet activation. Despite recent innovations in the field of antiplatelet treatment and the introduction of novel agents, the role of antiplatelet treatment in patients with essential hypertension remains understudied. This review aims to shed light on novel experimental and clinical data in the evolving field of antiplatelet treatment in essential hypertension. In particular, recent data regarding aspirin, clopidogrel, novel P2Y12 inhibitors, and other agents with potential antiplatelet effects are critically reviewed.
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Reny JL, Fontana P, Hochholzer W, Neumann FJ, Ten Berg J, Janssen PW, Geisler T, Gawaz M, Marcucci R, Gori AM, Cuisset T, Alessi MC, Berdagué P, Gurbel PA, Yong G, Angiolillo DJ, Aradi D, Beigel R, Campo G, Combescure C. Vascular risk levels affect the predictive value of platelet reactivity for the occurrence of MACE in patients on clopidogrel. Systematic review and meta-analysis of individual patient data. Thromb Haemost 2015; 115:844-55. [PMID: 26607655 DOI: 10.1160/th15-09-0742] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 10/22/2015] [Indexed: 01/16/2023]
Abstract
Prior studies have shown an association between high on-clopidogrel platelet reactivity (PR) and the risk of major adverse cardiovascular events (MACE). However, large intervention trials on PR-tailored treatments have been neutral. The role and usefulness of PR with regard to levels of cardiovascular risk are unclear. We undertook a systematic review and meta-analysis of individual patient data on MACE outcomes (acute coronary syndromes (ACS), ischaemic strokes, and vascular deaths) in relation to PR and its interaction with cardiovascular risk levels. PR was determined using ADP-induced light transmission aggregometry with a primary concentration of 20 µM ADP. Thirteen prospective studies totaled 6,478 clopidogrel-treated patients who experienced 421 MACE (6.5 %) during a median follow-up of 12 months. The strength of the association between the risk of MACE and PR increased significantly (p=0.04) with the number of risk factors present (age> 75 years, ACS at inclusion, diabetes, and hypertension). No association was detected in patients with no risk factor (p=0.48). In patients presenting one risk factor, only high-PR was associated with an increased risk of MACE (HR 3.2, p=0.001). In patients presenting ≥ 2 risk factors, the increase of risk started from medium-PR (medium-PR: HR=2.9, p=0.0004; high-PR: HR=3.7, p=0.0003). PR allowed the reclassification of 44 % of the total population to a different risk level for the outcome of MACE, mostly in intermediate or high risk patients. In conclusion, the magnitude of the association between PR and MACE risk is strongly dependent on the level of cardiovascular risk faced by patients on clopidogrel.
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Affiliation(s)
- Jean-Luc Reny
- Jean-Luc Reny, Division of Internal Medicine and Rehabilitation, Trois-Chêne Hospital, Geneva University Hospitals, Ch. du Pont-Bochet 3, CH-1226 Thônex-Geneva, Switzerland, Tel.: +41 22 305 65 37, Fax: +41 22 305 61 15, E-mail:
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Gallego-Fabrega C, Krupinski J, Fernandez-Cadenas I. La resistencia en el tratamiento secundario del ictus isquémico, el componente genético en la respuesta a ácido acetilsalicílico y clopidogrel. Neurologia 2015; 30:566-73. [DOI: 10.1016/j.nrl.2013.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/20/2013] [Accepted: 11/28/2013] [Indexed: 02/08/2023] Open
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Drug resistance and secondary treatment of ischaemic stroke: The genetic component of the response to acetylsalicylic acid and clopidogrel. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2013.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Brun C, Daali Y, Combescure C, Zufferey A, Michelson AD, Fontana P, Reny JL, Frelinger AL. Aspirin response: Differences in serum thromboxane B2 levels between clinical studies. Platelets 2015; 27:196-202. [PMID: 26270593 DOI: 10.3109/09537104.2015.1072147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Serum thromboxane B2 (TxB2) is a specific marker of platelet inhibition by aspirin. Yet, TxB2 levels differ by up to 10-fold between some aspirin-treated patient cohorts. This study aimed to identify factors responsible for differences in serum TxB2 between cohorts in the ADRIE study (n = 657) and the BOSTON study (n = 678) of aspirin-treated cardiovascular patients originally tested with different ELISA assays. TxB2 levels were assessed in representative subgroups of the two cohorts (34 samples in BOSTON and 39 in ADRIE) by both ELISAs, as well as liquid chromatography and tandem mass spectroscopy (MS). A multivariate analysis was performed on the whole cohort database to identify determinants of the difference of TxB2 levels between cohorts. There was no systematic bias between the original ELISA TxB2 values and the MS values and the median difference was small, 0.12 ng/ml, thus not explaining the difference between median TxB2 levels in the two study populations (7 and 0.6 ng/ml in the ADRIE and BOSTON studies, respectively). In the combined dataset of the ADRIE and BOSTON cohorts (n = 1342), body mass index, age, gender, aspirin dose, time from aspirin intake to blood draw, NSAID intake, platelet count and C-reactive protein were significantly associated with TxB2 levels. After adjustment for patient characteristics, the difference between cohorts did not decrease. Unexplained differences in serum TxB2 levels in different populations of aspirin-treated cardiovascular patients suggest that further studies are needed to confirm the role of serum TxB2 level as a prognostic factor or rather as a marker of therapeutic observance.
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Affiliation(s)
- Charlotte Brun
- a Division of General Internal Medicine , Geneva University Hospitals , Geneva , Switzerland .,b Geneva Platelet Group, University of Geneva School of Medicine , Geneva , Switzerland
| | - Youssef Daali
- b Geneva Platelet Group, University of Geneva School of Medicine , Geneva , Switzerland .,c Division of Clinical Pharmacology , Geneva University Hospitals , Geneva , Switzerland
| | - Christophe Combescure
- d Division of Clinical Epidemiology , Geneva University Hospitals , Geneva , Switzerland
| | - Anne Zufferey
- b Geneva Platelet Group, University of Geneva School of Medicine , Geneva , Switzerland
| | - Alan D Michelson
- e Center for Platelet Research Studies, Division of Hematology/Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard Medical School , Boston , MA , USA
| | - Pierre Fontana
- b Geneva Platelet Group, University of Geneva School of Medicine , Geneva , Switzerland .,f Division of Angiology and Haemostasis , Geneva University Hospitals , Geneva , Switzerland , and
| | - Jean-Luc Reny
- b Geneva Platelet Group, University of Geneva School of Medicine , Geneva , Switzerland .,g Division of Internal Medicine and Rehabilitation, Trois-Chêne, Department of Internal Medicine, Rehabilitation and Geriatrics , Geneva University Hospitals , Geneva , Switzerland
| | - Andrew L Frelinger
- e Center for Platelet Research Studies, Division of Hematology/Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard Medical School , Boston , MA , USA
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Pettersen AA, Arnesen H, Seljeflot I. A brief review on high on-aspirin residual platelet reactivity. Vascul Pharmacol 2015; 67-69:6-9. [PMID: 25869498 DOI: 10.1016/j.vph.2015.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/17/2015] [Accepted: 03/26/2015] [Indexed: 02/02/2023]
Abstract
Although aspirin is effective in secondary prevention in coronary heart disease, new thromboembolic events in patients on aspirin are frequently seen. In trials on aspirin-treated patients, platelet function tests have revealed large variability in platelet aggregation. This phenomenon has been named aspirin resistance, aspirin non-responsiveness or high-on-aspirin residual platelet reactivity. The mechanism of aspirin antiplatelet effect is due to the inhibition of cyclooxygenase-1 enzyme in platelets. In some trials, almost all patients on aspirin have a very low level of serum thromboxane B2, indicating that the measured platelet reactivity in aspirin-treated patients might be due to platelet activation via other pathways, such as ADP or thrombin. The prevalence of real aspirin resistance seems to be very low, and probably the term "high-on-aspirin residual platelet reactivity" should be preferred to describe this phenomenon.
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Affiliation(s)
- A A Pettersen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway; Department of Medicine, Vestre Viken HF, Ringerike Hospital, Hønefoss, Norway.
| | - H Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - I Seljeflot
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Ullevaal, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
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Chinese Society of Cardiology of Chinese Med, Yong H, Ya-Ling H, Run-Lin G, Da-Yi H, Yun Z, Jun-Bo G, Yong-Qiang Z, Xu-Bo S, Yi-Da T, Zhen-Yu L, Jing-Bo H, Feng B, Ji-Yan C, Shao-Liang C, Yun-Dai C, Hong-Liang C, Zhi-Min D, Wei-Yi F, Guo-Sheng F, Xiang-Hua F, Chuan-Yu G, Run-Lin G, Wei G, Jun-Bo G, Lei G, Li-Jun G, Ya-Ling H, Ben H, Jing-Bo H, Da-Yi H, Yong H, Fu-Sui J, Da-Lin J, Guo-Liang J, Shao-Bin J, Xue-Jun J, Quan-Min J, Bao L, Chun-Jian L, Guo-Qing L, Hong-Wei L, Jian-Ping L, Lang L, Xiao-Ying L, Xiao-Dong L, Yi L, Yong-Jun L, Chun L, Bin L, Jun-Ming L, Qi-Ming L, Zhen-Yu L, Shu-Zheng L, Gen-Shan M, Li-Kun M, Yi-Tong M, Shao-Ping N, Jian-Jun P, Shu-Bin Q, Chun-Guang Q, Wei-Feng S, Zhu-Jun S, Xu-Bo S, Fu-Cheng S, Yi-Hong S, Yi-Da T, Ye T, Chun-Xue W, Hai-Chang W, Jian-An W, Le-Feng W, Wei-Min W, Chang-Qian W, Meng W, Shang-Yu W, Yong-Jian W, Ya-Wei X, Hong-Bing Y, Li-Xia Y, Tian-He Y, Yue-Jin Y, Bo Y, Jin-Qing Y, Zu-Yi Y, Qi Z, Rui-Yan Z, Shu-Yang Z, Yun Z, Zheng Z, Xue-Zhong Z, Yong-Qiang Z, Xu-Chen Z, Yu-Jie Z, Jian-Hua Z, Jun Z. Chinese experts recommendation on the monitoring and management of variability in responsiveness to antiplatelet therapy. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Droppa M, Tschernow D, Müller KAL, Tavlaki E, Karathanos A, Stimpfle F, Schaeffeler E, Schwab M, Tolios A, Siller-Matula JM, Gawaz M, Geisler T. Evaluation of clinical risk factors to predict high on-treatment platelet reactivity and outcome in patients with stable coronary artery disease (PREDICT-STABLE). PLoS One 2015; 10:e0121620. [PMID: 25799149 PMCID: PMC4370634 DOI: 10.1371/journal.pone.0121620] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/02/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES This study was designed to identify the multivariate effect of clinical risk factors on high on-treatment platelet reactivity (HPR) and 12 months major adverse events (MACE) under treatment with aspirin and clopidogrel in patients undergoing non-urgent percutaneous coronary intervention (PCI). METHODS 739 consecutive patients with stable coronary artery disease (CAD) undergoing PCI were recruited. On-treatment platelet aggregation was tested by light transmittance aggregometry. Clinical risk factors and MACE during one-year follow-up were recorded. An independent population of 591 patients served as validation cohort. RESULTS Degree of on-treatment platelet aggregation was influenced by different clinical risk factors. In multivariate regression analysis older age, diabetes mellitus, elevated BMI, renal function and left ventricular ejection fraction were independent predictors of HPR. After weighing these variables according to their estimates in multivariate regression model, we developed a score to predict HPR in stable CAD patients undergoing elective PCI (PREDICT-STABLE Score, ranging 0-9). Patients with a high score were significantly more likely to develop MACE within one year of follow-up, 3.4% (score 0-3), 6.3% (score 4-6) and 10.3% (score 7-9); odds ratio 3.23, P=0.02 for score 7-9 vs. 0-3. This association was confirmed in the validation cohort. CONCLUSIONS Variability of on-treatment platelet function and associated outcome is mainly influenced by clinical risk variables. Identification of high risk patients (e.g. with high PREDICT-STABLE score) might help to identify risk groups that benefit from more intensified antiplatelet regimen. Additional clinical risk factor assessment rather than isolated platelet function-guided approaches should be investigated in future to evaluate personalized antiplatelet therapy in stable CAD-patients.
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Affiliation(s)
- Michal Droppa
- Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Dimitri Tschernow
- Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Karin A. L. Müller
- Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Elli Tavlaki
- Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Athanasios Karathanos
- Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Fabian Stimpfle
- Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Elke Schaeffeler
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- Department of Clinical Pharmacology, University Hospital of Tübingen, Tübingen, Germany
| | - Alexander Tolios
- Laboratory Medicine Institute, Medical Center of the University of Munich, Munich, Germany
| | | | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Tobias Geisler
- Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany
- * E-mail:
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Zhang L, Yang J, Zhu X, Wang X, Peng L, Li X, Cheng P, Yin T. Effect of high-dose clopidogrel according to CYP2C19*2 genotype in patients undergoing percutaneous coronary intervention– a systematic review and meta-analysis. Thromb Res 2015; 135:449-58. [DOI: 10.1016/j.thromres.2014.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/02/2014] [Accepted: 12/03/2014] [Indexed: 11/29/2022]
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Vrijens B, Claeys MJ, Legrand V, Vandendriessche E, Van de Werf F. Projected inhibition of platelet aggregation with ticagrelor twice daily vs. clopidogrel once daily based on patient adherence data (the TWICE project). Br J Clin Pharmacol 2015; 77:746-55. [PMID: 24868573 DOI: 10.1111/bcp.12275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIM Twice daily dosing is often perceived as inferior to once daily dosing due to a higher likelihood of missing a dose. However, more important is the extent to which drug action is maintained when doses are delayed or missed. We compared the estimated inhibition of platelet aggregation (eIPA) for ticagrelor twice daily and clopidogrel once daily, based on their pharmacokinetic/ pharmacodynamic relationships and patient dosing history data. METHODS Drug dosing histories of 5014 patients prescribed cardiovascular medications (primarily antihypertensive medicines) were extracted from an electronically compiled dosing history database. eIPA levels were simulated for 677 twice daily and 677 once daily dosing histories over a 30 day period, based on published onset/offset models for ticagrelor and clopidogrel IPA characteristics. RESULTS While many patients treated twice daily missed at least one dose in 30 days, only 25.7% missed two consecutive doses. By comparison, 46.8% of patients treated once daily missed at least one dose. Simulations based on patient adherence over time showed that the average mean eIPA for ticagrelor twice daily remained significantly higher than for clopidogrel once daily (81.1% vs. 55.0%, P < 0.001). Ticagrelor twice daily patients had an eIPA below 10% for 0.20% of the 30 day period compared with 2.05% for clopidogrel once daily (P = 0.0001). CONCLUSIONS The projected level of platelet inhibition remained higher for ticagrelor twice daily than clopidogrel once daily, mainly due to the higher eIPA level achieved with ticagrelor and the relatively low likelihood of missing two consecutive twice daily doses. This modelling and simulation study suggests a therapeutic benefit of ticagrelor over clopidogrel when taking into account the most common dosing omissions.
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Basili S, Raparelli V, Proietti M, Tanzilli G, Franconi F. Impact of Sex and Gender on the Efficacy of Antiplatelet Therapy: The Female Perspective. J Atheroscler Thromb 2015; 22:109-25. [DOI: 10.5551/jat.24935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Stefania Basili
- Research Center on gender and Evaluation and Promotion of Quality in Medicine (CEQUAM), Sapienza University Of Rome
- I Clinica Medica, Sapienza University of Rome
| | | | | | - Gaetano Tanzilli
- Department of the Heart and Great Vessels “Attilio Reale,” Sapienza University of Rome
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Reny JL, Fontana P. Antiplatelet drugs and platelet reactivity: is it time to halt clinical research on tailored strategies? Expert Opin Pharmacother 2014; 16:449-52. [PMID: 25495963 DOI: 10.1517/14656566.2015.993608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Personalized medicine of antiplatelet drugs in cardiovascular patients has led to a significant enthusiasm. Indeed, numerous longitudinal studies showed an association between high platelet reactivity and the recurrence of ischemic events. The first small randomized trials of P2Y12 blockers tailored to each patient's platelet reactivity yielded encouraging reductions of coronary stent thrombosis in high-risk populations. The discovery of genetic variants contributing to the pharmacodynamic effect of clopidogrel has then paved the way toward a personalized antiplatelet therapy based on reliable and stable genetic tests. This enthusiasm was soon tempered by large interventional trials demonstrating that a platelet function testing-based strategy did not improve clinical outcome and that genetic variants discovered up to now only explained a small part of the pharmacodynamic effect of clopidogrel, thus limiting its clinical use. Looking back to the most recent trials, their target populations and the type of clinical setting, it seems that the one-size-fits all policy regarding antiplatelet drugs may be well acceptable for low-risk patients. On the contrary, integration of the clinical setting as well as other risk factors may help to identify subgroups of patients who could derive a benefit from a truly personalized management of antiplatelet therapy.
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Affiliation(s)
- Jean-Luc Reny
- University of Geneva, Geneva Platelet Group, Faculty of Medicine , Geneva , Switzerland
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