.: ORİJİNAL ARAŞTIRMA
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
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(2):91-8
doi: 10.5336/cardiosci.2020-80505
Makale Dili: EN
Tam Metin
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
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
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
REFERANSLAR:
- Keeley EC, Hillis LD. Left ventricular mural thrombus after acute myocardial infarction. Clin Cardiol. 1996;19(2):83-6. [Crossref] [PubMed]
- Weinreich DJ, Burke JF, Pauletto FJ. Left ventricular mural thrombi complicating acute myocardial infarction. Long-term follow-up with serial echocardiography. Ann Intern Med. 1984;100(6):789-94. [Crossref] [PubMed]
- Schwalm JD, Ahmad M, Eikelboom JW, Natarajan MK. A national survey of Canadian practice patterns of warfarin after anterior wall myocardial infarction in the current era of dual antiplatelet therapy. Am J Cardiol. 2010; 105(12): 1844. [Crossref] [PubMed]
- Vaitkus PT, Barnathan ES. Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: a meta-analysis. J Am Coll Cardiol. 1993; 22(4): 1004-9. [Crossref] [PubMed]
- Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest. 2005;115(12):3378-84. [Crossref] [PubMed] [PMC]
- Silva MV, Dusse LM, Vieira LM, Carvalho MD. Platelet antiaggregants in primary and secondary prevention of atherothrombotic events. Arq Bras Cardiol. 2013;100(6):e78-84. English, Portuguese. [PubMed]
- Ray S. Clopidogrel resistance: the way forward. Indian Heart J. 2014;66(5):530-4. [Crossref] [PubMed] [PMC]
- Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. J Am Coll Cardiol. 2007;50(22):2173-95. [PubMed]
- Visser CA, Kan G, David GK, Lie KI, Durrer D. Two dimensional echocardiography in the diagnosis of left ventricular thrombus. A prospective study of 67 patients with anatomic validation. Chest. 1983;83(2):228-32. [Crossref] [PubMed]
- Stratton JR, Lighty GW Jr, Pearlman AS, Ritchie JL. Detection of left ventricular thrombus by two-dimensional echocardiography: sensitivity, specificity, and causes of uncertainty. Circulation. 1982;66(1):156-66. [Crossref] [PubMed]
- Favaloro EJ. Clinical utility of the PFA-100. Semin Thromb Hemost. 2008;34(8):709-33. [Crossref] [PubMed]
- Lippi G, Manzato F, Franchini M, Brocco G, Florenziani G, Guidi G. Establishment of reference values for the PFA-100 platelet function analyzer in pediatrics. Clin Exp Med. 2001;1(1):69-70. [Crossref] [PubMed]
- Mammen EF, Alshameeri RS, Comp PC. Preliminary data from a field trial of the PFA-100 system. Semin Thromb Hemost. 1995;21 Suppl 2:113-21. [Crossref] [PubMed]
- Talle MA, Buba F, Anjorin CO. Prevalence and aetiology of left ventricular thrombus in patients undergoing transthoracic echocardiography at the University of Maiduguri Teaching Hospital. Adv Med. 2014;2014:731936. [Crossref] [PubMed] [PMC]
- Freeman WD, Aguilar MI. Prevention of cardioembolic stroke. Neurotherapeutics. 2011; 8(3):488-502. [Crossref] [PubMed] [PMC]
- von Beckerath N, Taubert D, Pogatsa-Murray G, Schömig E, Kastrati A, Schömig A. Absorption, metabolization, and antiplatelet effects of 300, 600-, and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) Trial. Circulation. 2005; 112(19):2946-50. [Crossref] [PubMed]
- Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7329):71-86. Erratum in: BMJ 2002;324(7330):141. [Crossref] [PubMed] [PMC]
- Berger JS, Lala A, Krantz MJ, Baker GS, Hiatt WR. Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials. Am Heart J. 2011;162(1): 115-24.e2. [Crossref] [PubMed]
- CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996; 348(9038):1329-39. [Crossref] [PubMed]
- Helgason CM, Bolin KM, Hoff JA, Winkler SR, Mangat A, Tortorice KL, et al. Development of aspirin resistance in persons with previous ischemic stroke. Stroke. 1994;25(12):2331-6. [Crossref] [PubMed]
- Vejar M, Fragasso G, Hackett D, Lipkin DP, Maseri A, Born GV, et al. Dissociation of platelet activation and spontaneous myocardial ischemia in unstable angina. Thromb Haemost. 1990;63(2):163-8. [Crossref] [PubMed]
- Gum PA, Kottke-Marchant K, Poggio ED, Gurm H, Welsh PA, Brooks L, et al. Profile and prevalence of aspirin resistance in patients with cardiovascular disease. Am J Cardiol. 2001;88(3): 230-5. [Crossref] [PubMed]
- Gajda SN, Kołtowski Ł, Tomaniak M. Most Recent Evidence Behind Aggregometry and Genotyping Methods as Platelet Function Testing for Tailored Anti-Platelet Treatment Among PCI Patients. Adv Clin Exp Med. 2015;24(4):687-93. [Crossref] [PubMed]
- Gum PA, Kottke-Marchant K, Welsh PA, White J, Topol EJ. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol. 2003;41(6):961-5. Erratum in: J Am Coll Cardiol. 2006;48(9):1918. [Crossref] [PubMed]
- Eikelboom JW, Hirsh J, Weitz JI, Johnston M, Yi Q, Yusuf S. Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events. Circulation. 2002;105(14):1650-5. [Crossref] [PubMed]
- Wenaweser P, Hess O. Stent thrombosis is associated with an impaired response to antiplatelet therapy. J Am Coll Cardiol. 2005; 46(5):CS5-6. [PubMed]
- Matetzky S, Shenkman B, Guetta V, Shechter M, Beinart R, Goldenberg I, et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation. 2004;109(25):3171-5. Erratum in: Circulation. 2011;124(17):e459. Bienart, Roy [corrected to Beinart, Roy]. [Crossref] [PubMed]
- Cattaneo M. Resistance to anti-platelet agents. Thromb Res. 2011;127 Suppl 3:S61-3. [Crossref] [PubMed]
- Altıntaş B, Altındağ R, Bilge Ö, Baysal E, Öztürk Ö, Yaylak B, et al. The effect of ticagrelor based dual antiplatelet therapy on development of late left ventricular thrombus after acute anterior ST elevation myocardial infarction. Int J Cardiol. 2019;287:19-26. [Crossref] [PubMed]
- Thatai D, Ahooja V, Pullicino PM. Pharmacological prevention of thromboembolism in patients with left ventricular dysfunction. Am J Cardiovasc Drugs. 2006;6(1):41-9. [Crossref] [PubMed]
- Massie BM, Krol WF, Ammon SE, Armstrong PW, Cleland JG, Collins JF, et al. The Warfarin and Antiplatelet Therapy in Heart Failure trial (WATCH): rationale, design, and baseline patient characteristics. J Card Fail. 2004;10(2):101-12. [Crossref] [PubMed]
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