1/1
2 files

Changes in platelet function independent of pharmacotherapy following coronary intervention in non-ST-elevation myocardial infarction patients

journal contribution
posted on 28.03.2022, 15:27 by Phillip M. Freeman, Konstantinos E. Moschonas, Christine Hinz, Valerie B. O’Donnell, Tim D. Kinnaird, Philip James, Richard A. Anderson
Background High on treatment platelet reactivity (HTPR) is common in patients receiving clopidogrel following an acute coronary syndrome (ACS); it's also associated with increased morbidity and mortality. More potent and predictable antiplatelet drugs have addressed this issue at the expense of increased bleeding. Identification of HTPR and the targeted use of more potent antiplatelet drugs has, so far, broadly failed. We investigate this approach in terms of the timing of platelet function testing and how this can impact on the ability of these bedside tests to predict HTPR around the time of coronary intervention. Methods High risk ACS patients treated with 5 days of clopidogrel had platelet function assessed using the multiple electrode aggregometry system (MEA) pre, post and 24 h following percutaneous coronary intervention (PCI). Simultaneous detailed analysis of platelet status was undertaken with quantification of platelet bound and soluble p-selectin and mass spectrometry quantification of the eicosanoid 12-HETE. Results As assessed by MEA 40.5% of patients had HTPR pre-PCI; mean aggregation units (AU) in response to ADP were 499.1 ± 46.3 pre-PCI, 407.6 ± 37.7 post-PCI and 269.1 ± 24.6 AU 24 h post-PCI (pre to post PCI p > 0.05, pre to 24 h post-PCI p = 0.0002). This highly significant drop in platelet reactivity was contrasted with on-going expression of platelet bound p-selectin, increased soluble p-selectin and rising 12-HETE concentrations. Conclusions This study outlines significant changes in ex-vivo platelet aggregation that occur within 24 h of PCI in high risk NSTEMI patients using bedside PFT. Whilst there were no changes in antiplatelet therapy during the study period its clear that timing is crucial when assessing high on treatment residual platelet activity.

History

Published in

Atherosclerosis

Publisher

Elsevier

Version

AM (Accepted Manuscript)

Citation

Freeman, P.M., Moschonas, K.E., Hinz, C., O'Donnell, V.B., Kinnaird, T.D., James, P.E. and Anderson, R.A. (2015) 'Changes in platelet function independent of pharmacotherapy following coronary intervention in non-ST-elevation myocardial infarction patients', Atherosclerosis, 243(1), pp.320-327

Print ISSN

0021-9150

Cardiff Met Affiliation

  • Cardiff School of Sport and Health Sciences

Cardiff Met Authors

Philip James

Cardiff Met Research Centre/Group

  • Cardiovascular Metabolism and Inflammation

Copyright Holder

© The Publisher

Language

en