Effect of Platelet Reactivity, Endothelial Function, and Inflammatory Status on Outcomes in Patients With Stable Angina Pectoris on Clopidogrel Therapy

Woo, Jong Shin; Kim, Weon; Jang, Hyun Hee; Kim, Jin Bae; Kim, Woo-Shik; Kim, Kwon Sam

doi:10.1016/j.amjcard.2013.11.025

Cited by 18 publications

(10 citation statements)

References 29 publications

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“…In a recent study, high platelet reactivity (PR) measured by ADP induced light transmission aggregometry (LTA) was associated with hs-CRP levels, soluble CD62P and CD40L (79).…”

Section: Correlation Between Platelet Aggregation and Inflammatory Mamentioning

confidence: 99%

Platelets, inflammation and anti-inflammatory effects of antiplatelet drugs in ACS and CAD

Müller¹,

Chatterjee²,

Rath³

et al. 2015

Thromb Haemost

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SummaryPlatelets play a pivotal role in chronic inflammation leading to progression of atherosclerosis and acute coronary events. Recent discoveries on novel mechanisms and platelet-dependent inflammatory targets underpin the role of platelets to maintain a chronic inflammatory condition in cardiovascular disease. There is strong and clinically relevant crosslink between chronic inflammation and platelet activation. Antiplatelet therapy is a cornerstone in the prevention and treatment of acute cardiovascular events. The benefit of antiplatelet agents has mainly been attributed to their direct anti-aggregatory impact. Some anti-inflammatory off-target effects have also been described. However, it is unclear whether these effects are secondary due to inhibition of platelet activation or are caused by direct distinct mechanisms interfering with inflammatory pathways. This article will highlight novel platelet associated targets that contribute to inflammation in cardiovascular disease and elucidate mechanisms by which currently available antiplatelet agents evolve anti-inflammatory capacities, in particular by carving out the differential mechanisms directly or indirectly affecting platelet mediated inflammation. It will further illustrate the prognostic impact of antiplatelet therapies by reducing inflammatory marker release in recent cardiovascular trials.

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“…In a recent study, high platelet reactivity (PR) measured by ADP induced light transmission aggregometry (LTA) was associated with hs-CRP levels, soluble CD62P and CD40L (79).…”

Section: Correlation Between Platelet Aggregation and Inflammatory Mamentioning

confidence: 99%

Platelets, inflammation and anti-inflammatory effects of antiplatelet drugs in ACS and CAD

Müller¹,

Chatterjee²,

Rath³

et al. 2015

Thromb Haemost

View full text Add to dashboard Cite

show abstract

“…Such clinical factors include ACS, diabetes mellitus, age, obesity, inflammation and renal and heart failure [7]. Understandably, the link between PCI outcomes, platelet activity and bleeding is better explored logistically, as it may be suggestive of some clinically adverse association(s) [8,9,10]. However, how such an adverse association will translate to clinical practice is unclear.…”

Section: Introductionmentioning

confidence: 99%

Independent Predictors of Major Adverse Events following Coronary Stenting over 28 Months of Follow-Up

et al. 2015

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Background: Despite recent advances in stent design and constantly improving protective pharmacological strategies, complications and adverse events following percutaneous coronary interventions (PCI) are still major factors influencing morbidity and mortality. Therefore, predicting secondary vascular occlusions represents an unmet medical need. Objective: The aim of our study was to triage clinical and laboratory predictors of major adverse clinical events (MACE) following coronary stenting. Methods: This was a prospective, case-controlled, single-center study, which included 94 consecutive patients with documented coronary disease who underwent PCI with drug-eluting stent (DES) implantation. All patients received dual antiplatelet therapy with aspirin and clopidogrel. Numerous clinical characteristics and laboratory biomarkers were assessed before stenting and were correlated with poststenting MACE over the mean follow-up of 28 months. MACE included death, nonfatal myocardial infarction, target vessel revascularisation, stroke, stent thrombosis, angina recurrence and instent restenosis. Results: Twenty-three patients experienced MACE. Independent MACE predictors after PCI with DES implantation were antecedent diabetes mellitus (RR = 0.45; 95% CI 0.20-0.97; p = 0.045), prior thrombolytic therapy (RR = 0.42; 95% CI 0.27-0.83; p = 0.039), baseline plasminogen activator inhibitor -1 (PAI-1; p = 0.008) and plasma von Willebrand factor (vWF) activity (p = 0.007). Other clinical characteristics and laboratory indices showed no correlation with MACE. Conclusions: Background diabetes mellitus, prior thrombolytic therapy, PAI-1 and vWF prestenting activity may be useful for MACE prediction over 28 months of follow-up.

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“…In another small study of 20 participants with coronary artery disease, postclopidogrel endothelial function was measured based on a significantly different pulse wave amplitude system (no measure of blood flow), and it showed a favorable response . Last, in a study of 91 participants with established coronary artery disease and effect of clopidogrel, high platelet aggregability was associated with decreased endothelial function; however, the study did not have pre‐ and postclopidogrel measures . Limited reports note that P2Y12 receptors reside on the vascular cells but show no evidence that P2Y12 receptors are located on endothelial cells.…”

Section: Discussionmentioning

confidence: 99%

Clopidogrel Improves Skin Microcirculatory Endothelial Function in Persons With Heightened Platelet Aggregation

Salimi

Lewis

Yerges‐Armstrong

et al. 2016

JAHA

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BackgroundPlatelet activation can lead to enhanced oxidative stress, inflammatory response, and endothelial dysfunction. To quantify the effects of platelet inhibition on endothelial function, we assessed platelet activity of healthy persons before and after clopidogrel administration and evaluated its effects on endothelial function. We hypothesized that clopidogrel, by attenuating platelet activity, would result in enhanced endothelial function.Methods and ResultsMicrocirculatory endothelial function was quantified by laser Doppler flowmetry (LDF) mediated by thermal hyperemia (TH) and postocclusive reactive hyperemia, respectively, in 287 and 241 relatively healthy and homogenous Old Order Amish persons. LDF and platelet aggregation measures were obtained at baseline and after 7 days of clopidogrel administration. Our primary outcome was percentage change in post‐ versus preclopidogrel LDF measures. Preclopidogrel TH‐LDF and platelet aggregation were higher in women than in men (P<0.001). Clopidogrel administration was associated with ≈2‐fold higher percentage change in TH‐LDF in participants with high versus low baseline platelet aggregation (39.4±10.1% versus 17.4±5.6%, P=0.03). Clopidogrel also increased absolute TH‐LDF measures in persons with high platelet aggregation (1757±766 to 2154±1055, P=0.03), with a more prominent effect in women (1909±846 to 2518±1048, P=0.001). There was no evidence that clopidogrel influenced postocclusive reactive hyperemia LDF measures.ConclusionsThe administration of clopidogrel in healthy persons with high baseline platelet aggregation results in improved TH‐induced microcirculatory endothelial function. These data suggest that clopidogrel may have a beneficial effect on microcirculatory endothelial function, presumably through antiplatelet activity, and may confer additional vascular benefits.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00799396.

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Effect of Platelet Reactivity, Endothelial Function, and Inflammatory Status on Outcomes in Patients With Stable Angina Pectoris on Clopidogrel Therapy

Cited by 18 publications

References 29 publications

Platelets, inflammation and anti-inflammatory effects of antiplatelet drugs in ACS and CAD

Platelets, inflammation and anti-inflammatory effects of antiplatelet drugs in ACS and CAD

Independent Predictors of Major Adverse Events following Coronary Stenting over 28 Months of Follow-Up

Clopidogrel Improves Skin Microcirculatory Endothelial Function in Persons With Heightened Platelet Aggregation

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