Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
The Effect of Anti-platelet Resistance on Development of Left Ventricular Thrombus Formation After Myocardial Infarction: Prospective, Observational Case-control Research
Antiplatelet Direncinin Miyokard İnfarktüsü Sonrası Sol Ventrikül Trombüsü Gelişimine Etkisi: Prospektif, Gözlemsel, Vaka-kontrol Çalışması
Mehmet Vedat ÇALDIRa, Yeşim AKINa
aClinic of Cardiology, Türkiye Yüksek İhtisas Hospital, Ankara, TURKEY
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(2):91-8
doi: 10.5336/cardiosci.2020-80505
Article Language: EN
Full Text
ABSTRACT
 Objective: Left ventricular (LV) thrombus is a serious complication of acute myocardial infarction (MI). In this study, the effect of biochemical resistance to antiplatelet agents used after ST elevation MI on LV thrombus development was investigated. Material and Methods: Patients who were diagnosed with anterior MI and undergone primary percutaneous coronary intervention were included in this study. The patients were divided into two groups: Patients with thrombus (Group 1) and the patients without thrombus (Group 2). PFA-100 platelet analyzer was used to measure platelet reactivity. Clopidogrel resistance was defined as collagen adenosine 5-diphosphate closure time (COLL/ADP CT) <120 seconds and acetylsalicylic acid (ASA) resistance was defined as collagen epinephrine closure time (COLL/EPI CT) <180 seconds. Group 1 and Group 2 were compared with ASA and clopidogrel resistance. Results: The mean CT for COLL/EPI was similar in two groups (Group 1: 221.4±64.8 sec, Group 2: 217.7±70.2 sec; p=0.81). ASA resistance was detected in 24 (26.7%) patients in the whole patient group. There was no difference between the two groups in terms of ASA resistance [8 patients (26.7%) in Group 1, 16 patients (26.7%) in Group 2; p=1.0]. The mean closure times for COLL/ADP were similar in two groups (Group 1: 145.9±63.9 sec, Group 2: 155.9±63.9 sec; p=0.48). Clopidogrel resistance was detected in 27 (30%) patients in the whole patient group. There was no difference between two groups in terms of clopidogrel resistance [9 (30%) patients in Group 1, 18 (30%) patients in Group 2; p=1.0]. There was no difference between two groups in patients with both clopidogrel and aspirin resistance. Conclusion: In vivo resistance to dual antiplatelet therapy does not appear to be an effective mechanism in the development of LV thrombus after MI.

Keywords: Clopidogrel; thrombosis; aspirin; platelet resistance
ÖZET
 Amaç: Sol ventrikül [left ventricular (LV)] trombüsü, akut miyokard infarktüsünün ciddi bir komplikasyonudur. Bu çalışmada, ST elevasyonlu miyokard infarktüsü sonrası kullanılan antitrombosit ajanlara karşı biyokimyasal direnç varlığının LV mural trombüs gelişimi üzerine etkisi incelenmiştir. Gereç ve Yöntemler: Bu çalışmaya, anteriyor miyokard infarktüsü tanısı konulan ve primer perkütan koroner girişim yapılmış hastalar dâhil edildi. Hastalar 2 gruba ayrıldı. LV'de trombüs saptanan hastalar (Grup 1) ve trombüs saptanmayan hastalar (Grup 2). Trombosit reaktivitesini ölçmek için PFA-100 platelet analizörü kullanıldı. Klopidogrel direnci, kollajen adenozin 5-difosfat kapanma süresi [collagen adenosine 5-diphosphate closure time (COLL/ADP CT)] <120 sn olarak tanımlandı ve asetilsalisilik asit (ASA) direnci, kollajen epinefrin kapanma süresi [collagen epinephrine closure time (COLL/EPI CT)] <180 sn olarak tanımlandı. Grup 1 ve Grup 2 ASA ve klopidogrel direnci açısından karşılaştırıldı. Bulgular: COLL/EPI için ortalama kapanma süresi 2 grupta benzerdi (Grup 1: 221,4±64,8 sn, Grup 2: 217,7±70,2 sn; p=0,81). Tüm hasta grubunda 24 (%26,7) hastada ASA direnci saptandı. ASA direnci açısından 2 grup arasında fark yoktu [Grup 1'de 8 hasta (%26,7), Grup 2'de 16 hasta (%26,7); p=1,0]. COLL/ADP için ortalama kapanma süreleri 2 grupta benzerdi (Grup 1: 145,9±63,9 sn, Grup 2: 155,9±63,9 sn; p=0,48). Tüm hasta grubunda 27 (%30) hastada, klopidogrel direnci saptandı. Klopidogrel direnci varlığı açısından 2 grup arasında fark yoktu [Grup 1'de 9 (%30) hasta, Grup 2'de 18 (%30) hasta; p=1,0]. Ayrıca 2 grup arasında klopidogrel ve aspirin direncinin birlikte olduğu hastalar arasında da fark saptanmadı. Sonuç: İkili antitrombosit tedaviye in vivo direnç, miyokard infarktüsü sonrası LV trombüsü gelişiminde etkili bir mekanizma gibi görünmemektedir.

Anahtar Kelimeler: Klopidogrel; tromboz; aspirin; trombosit direnci
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