Association between Mean Platelet Volume and Resistance to Aspirin and P2Y12 Receptor Inhibitors in Elderly Patients with Acute Coronary Syndrome

  1. Chirino Navarta, Daniel Agustín; Servicio de Cardiología de la Unidad Asistencial Por Más Salud Dr. César Milstein, Ciudad Autónoma de Buenos Aires; Servicio de Cardiología del Sanatorio Franchín, Ciudad Autónoma de Buenos Aires;
  2. Trejo, Graciela 1
  3. Leonardi, Mariela 1
  4. Crudo, Claudia 2
  5. Arias, Mirta 2
  6. Tellechea, Francisco 3
  7. Rodriguez Vazquez, María Luisa 4
  8. Dizeo, Claudio 4
  1. 1 Servicio de Cardiología
  2. 2 Servicio de Laboratorio de Hematología
  3. 3 Servicio de Cardiología Opta para miembro titular SAC
  4. 4 Servicio de Cardiología MTSAC
Revista:
Revista Argentina de Cardiología (RAC)

Ano de publicación: 2019

Volume: 87

Número: 4

Páxinas: 266-272

Tipo: Artigo

DOI: 10.7775/AJC.87.4.14678 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

Resumo

Background: Antiplatelet resistance and mean platelet volume (MPV) are event predictors in acute coronary syndrome (ACS), buttheir association has been poorly studied.Objective: The aim of this study was to evaluate the association between MPV and resistance to aspirin (ASA) and P2Y12 receptorinhibitors (P2Y12i) in elderly patients with ACS.Methods: Patients over 65 years old diagnosed with ACS were included in the study. They were divided into group 1 (resistance toboth antiplatelet agents), group 2 (resistance to one antiplatelet agent) and group 3 (no resistance to antiplatelet agents). Plateletaggregation was measured between 12 and 24 hours postloading (by light transmission aggregometry). Resistance to P2Y12i wasconsidered as maximum percentage of aggregation (MPA) with adenosine diphosphate (ADP) >60% and resistance to ASA as MPAwith arachidonic acid (ARA) >20%. The composite endpoint of global death and cardiovascular re-hospitalization was consideredduring follow-up.Results: One hundred and ninety five patients included in the study received ASA and P2Y12i (120 received clopidogrel and 75ticagrelor). Nineteen percent of patients belonged to group 1, 34.4% to group 2 and 46.6% to group 3. Mean platelet volume wasassociated with resistance to both antiplatelet agents [OR 1.02 (95% CI 1.01-1.05), p=0.03], while MPV and the GRACE score wereindependent predictors of the composite endpoint [HR 1.03 (95% CI 1.01-1.07), p=0.04, and HR 1.02 (95% CI 1.01-1.04), p=0.02,respectively].Conclusions: Mean platelet volume was associated with the presence of resistance to both antiplatelet agents. During follow-up,MPV and the GRACE score were predictors of the composite endpoint.

Referencias bibliográficas

  • Vilariño JO, Esper R, Badimón JJ. Fisiopatología de los síndromes coronarios agudos. Tres paradigmas para un nuevo dogma. Rev Esp Cardiol 2004;4:13G-24G.
  • Davi PG. Platelet activation and atherothrombosis. Engl J Med. 2007;357:2482-94. http://doi.org/b5vkv3
  • Navarro Estrada JL, Constantin I, González N, Bazzino O, Charask A, Duronto E y cols. Consenso para el manejo de pacientes con Síndrome Coronario Agudo sin Supradesnivel del Segmento ST (Angina Inestable e Infarto de Miocardio sin elevación del ST) Consenso de la Sociedad Argentina de Cardiología. Rev Argent Cardiol 2014;81(Supl.1):1-44.
  • Sociedad Argentina de Cardiología. Consenso de infarto agudo de miocardio con elevación del segmento ST. Rev Argent Cardiol 2015;83(Supl.4):1-47.
  • Siller-Matula JM, Trenk D, Schrör K, Gawaz M, Kristensen SD, Storey RF, et al. Response Variability to P2Y12 Receptor Inhibitors: Expectations and Reality. JACC Cardiovasc Interv 2013;6:1111-28. http://doi.org/f5kq2n
  • Zhou Y, Wang Y, Wu Y, Huang C, Yan H, Zhu W, et al. Individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2017;17:1-13. http://doi.org/gbjvhn
  • Verdoia M, Sartori C, Pergolini P, Nardin M, Rolla R, Barbieri L, et al. Prevalence and predictors of high-on treatment platelet reactivity with ticagrelor in ACS patients undergoing stent implantation. Vascul Pharmacol 2016;77:48–53. http://doi.org/f79rnd
  • Bonello L, Pansieri M, Mancini J, Bonello R, Maillard L, Barnay P, et al. High on-treatment platelet reactivity after prasugrel loading dose and cardiovascular events after percutaneous coronary intervention in acute coronary syndromes. J Am Coll Cardiol 2011;58:467-73. http://doi.org/bp7tw7
  • Parodi G, Marcucci R, Valenti R, Gori AM, Migliorini A, Giusti B, et al. High residual platelet reactivity after clopidogrel loading and long-term cardiovascular events among patients with acute coronary syndromes undergoing PCI. JAMA 2011;306:1215-23. http://doi.org/cmr33k
  • Gurbel PA, Tantry US. Aspirin and clopidogrel resistance: consideration and management. J Interv Cardiol 2006;19:439-48. http://doi.org/fbdww3
  • Senaran H, Ileri M, Altinbaş A, Koşar A, Yetkin E, Oztürk M, et al. Thrombopoietin and Mean Platelet Volume in Coronary Artery Disease. Clin Cardiol 2001;24:405-8. http://doi.org/cpbn5b
  • Huczek Z, Kochman J, Filipiak KJ, Horszczaruk GJ, Grabowski M, Piatkowski R, et al. Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol 2005;46:284-90. http://doi.org/cn5hbt
  • Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost 2010;8:148-56. http://doi.org/cptq5b
  • Chirino Navarta D, Monteros A, Baglioni F, Murua A, Leonardi M, Trejo G, et al. Volumen plaquetario medio como marcador pronóstico en pacientes con síndrome Coronario Agudo. Rev Argent Cardiol 2015;83:293-9. http://doi.org/c5xp
  • Verdoia M, Schaffer A, Barbieri L, Bellomo G, Marino P, Sinigaglia F, et al. Novara Atherosclerosis Study (NAS) group. Impact of age on mean platelet volume and its relationship with coronary artery disease: a single-centre cohort study. Exp Gerontol 2015;62:32-6. http://doi.org/f6zwf5
  • Uzel H, Ozpelit E, Badak O, Akdeniz B, Barış N, Aytemiz F, et al. Diagnostic accuracy of mean platelet volume in prediction of clopidogrel resistance in patients with acute coronary syndrome. Anadolu Kardiyol Derg 2014;14:134-9. http://doi.org/f6zwf5
  • Jakl R, Sevcik R, Ceral J, Fatorova I, Horacek M, Vojacek J. Mean platelet volume and platelet count: overlooked markers of high on treatment platelet reactivity and worse outcome in patients with acute coronary syndrome. Anatol J Cardiol 2014;14:85-6. http://doi.org/c5xr
  • Huczek Z, Filipiak KJ, Kochman J, Michalak M, Roik M, Piatkowski R. Baseline platelet size is increased in patients with acute coronary syndromes developing early stent thrombosis and predicts future residual platelet reactivity. A case-control study. Thromb Res 2010;125:406-12. http://doi.org/bn4k8f
  • Choi S, Choi D, Kim H, Ku Y, He Y, Park G. Clinical outcome prediction from mean platelet volume in patients undergoing percutaneous coronary intervention in Korean cohort: Implications of more simple and useful test than platelet function testing. Platelets 2014;25:322-7. http://doi.org/c5xt
  • Kim YG, Suh JW, Yoon CH, Oh IY, Cho YS, Youn TJ, et al. Platelet volume indices are associated with high residual platelet reactivity after antiplatelet therapy in patients undergoing percutaneous coronary intervention. J. Atheroscler Thromb 2014;21:445-53. http://doi.org/f6hr27
  • Verdoia M, Pergolini P, Rolla R, Nardin M, Barbieri L, Schaffer A, et al. Mean platelet volume and high-residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor. Expert Opin Pharmacother 2015;16:1739-47. http://doi.org/c5xv
  • Price MJ, Berger PB, Teirstein PS, Tanguay JF, Angiolillo DJ, Spriggs D, et al. GRAVITAS Investigators. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA 2011;305:1097-105. http://doi.org/dsp9t8
  • Candiello A, Cura F, Trivi M, Padilla L, Albertal M, Nau G, et al. Tratamiento antiagregante guiado por pruebas de función plaquetaria en pacientes sometidos a angioplastia coronaria exitosa. Rev Argent Cardiol 2012;80:354-9. http://doi.org/c5xw
  • Bonello L, Tantry US, Marcucci R, Blindt R, Angiolillo DJ, Becker R, et al. Consensus and Future Directions on the Definition of High On-Treatment Platelet Reactivity to Adenosine Diphosphate. J Am Coll Cardiol 2010;56:919-33. http://doi.org/crhtms
  • Cañivano Petreñas L, García Yubero C. Resistencia a la aspirina: prevalencia, mecanismos de acción y asociación con eventos tromboembólicos. Revisión narrativa. Farm Hosp 2010;34:32-43. http://doi.org/bd2gs7
  • Alexopoulos D, Xanthopoulou I, Storey RF, Bliden KP, Tantry US, Angiolillo DJ, et al. Platelet reactivity during ticagrelor maintenance therapy: a patient-level data meta-analysis. Am Heart J 2014;168:530-6. http://doi.org/f6k2f7
  • D’Ascenzo F, Barbero U, Bisi M, Moretti C, Omedè P, Cerrato E, et al. The prognostic impact of high on-treatment platelet reactivity with aspirin or ADP receptor antagonists: Systematic review and metaanalysis. Biomed Res Int 2014;2014:610296. http://doi.org/gb848j
  • Collet JP, Cuisset T, Range G, Cayla G, Elhadad S, Pouillot C, et al. Bedside monitoring to adjust antiplatelet therapy for coronary stenting. N Engl J Med 2012;367:2100-9. http://doi.org/c5xx
  • López-Cuenca A, Tello-Montoliu A, Roldán V, Pérez-Berbel P, Valdés M, Marín F. Prognostic value of mean platelet volume in patients with non-ST-elevation acute coronary syndrome. Angiology 2012;63:241-4. http://doi.org/fgqh7h
  • Guthikonda S, Alviar CL, Vaduganathan M, Arikan M, Tellez A, DeLao T, et al. Role of reticulated platelets and platelet size heterogeneity on platelet activity after dual antiplatelet therapy with aspirin and clopidogrel in patients with stable coronary artery disease. JACC 2008;52:743-9. http://doi.org/cjqgg5