Effect of platelet turnover on whole blood platelet aggregation in patients with coronary artery disease

被引:131
作者
Grove, E. L. [1 ]
Hvas, A. M. [2 ]
Mortensen, S. B. [1 ]
Larsen, S. B. [1 ]
Kristensen, S. D. [1 ]
机构
[1] Aarhus Univ Hosp, Dept Cardiol, DK-8200 Aarhus, Denmark
[2] Aarhus Univ Hosp, Dept Clin Biochem, DK-8200 Aarhus, Denmark
关键词
aspirin; coronary artery disease; diabetes mellitus; platelet aggregation; platelet turnover; point-of-care testing; DUAL ANTIPLATELET THERAPY; RETICULATED PLATELETS; ASPIRIN RESISTANCE; DIABETES-MELLITUS; MYOCARDIAL-INFARCTION; BLEEDING-TIME; VOLUME; RISK; AGGREGOMETRY; METAANALYSIS;
D O I
10.1111/j.1538-7836.2010.04115.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Previous studies have demonstrated considerable variation in the antiplatelet effect of aspirin. Objectives: To investigate the impact of platelet turnover on the antiplatelet effect of aspirin in patients with stable coronary artery disease (CAD) and to identify determinants of platelet turnover. Methods: Platelet turnover was evaluated by measurements of immature platelets and thrombopoietin in 177 stable CAD patients on aspirin monotherapy, including 85 type 2 diabetics and 92 non-diabetics. Whole blood platelet aggregation was determined using the VerifyNow (R) Aspirin test and multiple electrode aggregometry (MEA, Multiplate (R)) induced by arachidonic acid (AA) (1.0 mm), adenosine diphosphate (ADP) (10 mu m) and collagen (1.0 mu g mL-1). Results: Immature platelet levels significantly correlated with MEA (r = 0.31-0.36, P-values < 0.0001) and the platelet activation marker sP-selectin (r = 0.19, P = 0.014). Contrary to the VerifyNow (R) test, MEA significantly correlated with variations in platelet count (r = 0.45-0.68, P-values < 0.0001). Among patients with residual platelet reactivity according to AA, there were significantly more diabetics (61% vs. 41%, P = 0.027) and higher levels of sP-selectin (77.7 +/- 29 vs. 70.2 +/- 25 ng mL-1, P = 0.070) and serum thromboxane B(2) (0.81 [0.46; 1.70] vs. 0.56 [0.31; 1.12] ng mL-1, P = 0.034). In a multivariate regression analysis, immature platelet levels were determined by thrombopoietin levels (P < 0.001), smoking (P = 0.020) and type 2 diabetes (P = 0.042). Conclusions: The antiplatelet effect of aspirin was reduced in CAD patients with an increased platelet turnover. Once-daily dosing of aspirin might not suffice to adequately inhibit platelet aggregation in patients with an increased platelet turnover.
引用
收藏
页码:185 / 191
页数:7
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