Homocysteine levels and platelet reactivity in coronary artery disease patients treated with ticagrelor

Verdoia, Monica; Rolla, Roberta; Negro, Federica; Tonon, Francesco; Pergolini, Patrizia; Nardin, Matteo; Marcolongo, Marco; Luca, Giuseppe De

doi:10.1016/j.numecd.2019.09.018

“…In fact, homocysteine concentrations above the 90th percentile are associated with increased risk of degenerative and atherosclerotic processes [9] in the coronary, cerebral and peripheral circulatory system. In this regard, determining homocysteine together with other cardiovascular risk markers (Apo B, Lp(a), LDL, fibrinogen, PAI-1) now belongs to the clinical practice [10]; moreover, recent evidence suggests the role of homocysteine as a risk factor for thromboembolism, given its influence on platelet reactivity [11][12][13].…”

mentioning

confidence: 99%

Homocysteine as a potential predictor of cardiovascular risk in patients with COVID-19

Ponti¹,

Ruini

²

,

Tomasi³

2020

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Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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“…These con icting results may be due to differences in the test methods of platelet reactivity or the inclusion criteria. The underlying mechanism of platelet hyperactivity in patients with impaired renal function might be related to chronic low-grade in ammation, vascular injury [20] and the accumulation of uremic toxins, such as indoxyl sulfate [21] and homocysteine [22]. Furthermore, preactivation of platelets and platelet turnover [23] also play roles in the pathogenesis of insu cient platelet inhibition by aspirin in patients with impaired renal function.…”

Section: Discussionmentioning

confidence: 99%

“…eGFR was an independent factor of HTPR. The further mechanism of platelet hyperactivity in patients with impaired renal function might be relevant to the accumulation of uremic toxins, such as indoxyl sulfate [25] and homocysteine [26]. Furthermore, pre-activation of platelets in CKD [27] may play a role in the pathogenesis of insu cient platelet inhibition by aspirin in patients with impaired kidney function.…”

Section: Discussionmentioning

confidence: 99%

Association between renal function and platelet reactivity during aspirin therapy in elderly patients with atherosclerotic cardiovascular disease

Liang

¹

,

Zhang

²

,

Liu³

2021

Preprint

0

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Background: Aspirin is the key treatment in the secondary prevention of atherosclerotic cardiovascular disease. High on-treatment platelet reactivity (HTPR) to aspirin has been reported to partially account for the enhanced risk of thrombotic events. In particular, HTPR has been described more frequently among elderly patients. The aim of this study was to identify the clinical and biological factors associated with HTPR in a real-life elderly population.Methods: In this retrospective study, elderly patients with atherosclerotic cardiovascular disease on regular aspirin treatment were enrolled. Cardiovascular risk factors, routine biological parameters, comorbidities, and concomitant medications were recorded. The upper quartile of the platelet aggregation rate, determined by light transmission aggregometry with arachidonic acid, was defined as the HTPR group.Results: A total of 304 patients were included (mean age 77 ± 8 years, 76% men). Patients in the HTPR group were older than the patients in the non-HTPR group (mean age: 79 ± 7 vs. 76 ± 8 years, p = 0.008). Patients with moderately decreased estimated glomerular filtration rate (eGFR) had a higher frequency of HTPR than patients with slightly decreased eGFR or normal eGFR (35.8%, 22.5%, 12.2%, respectively, p < 0.05). In multivariate analysis, an independent risk factor for HTPR was the eGFR (OR: 0.984, 95% CI: 0.980-0.988, p < 0.001).Conclusions: Advanced age and decreased eGFR are correlated with poor pharmacodynamic response to aspirin.

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“…These con icting results may be due to differences in the test methods of platelet reactivity or the inclusion criteria. The underlying mechanism of platelet hyperactivity in patients with impaired renal function might be related to chronic low-grade in ammation, vascular injury [20] and the accumulation of uremic toxins, such as indoxyl sulfate [21] and homocysteine [22]. Furthermore, preactivation of platelets and platelet turnover [19,23] also play roles in the pathogenesis of insu cient platelet inhibition by aspirin in patients with impaired renal function.…”

Section: Discussionmentioning

confidence: 99%

Association between renal function and platelet reactivity during aspirin therapy in elderly patients with atherosclerotic cardiovascular disease

Liang

¹

,

Zhang

²

,

Liu

³

2020

Preprint

View full text Add to dashboard Cite

Background: Aspirin is the key treatment in the secondary prevention of atherosclerotic cardiovascular disease. High on-treatment platelet reactivity (HTPR) to aspirin has been reported to partially account for the enhanced risk of thrombotic events. In particular, HTPR has been described more frequently among elderly patients. The aim of this study was to identify the clinical and biological factors associated with HTPR in a real-life elderly population.Methods: In this retrospective study, elderly patients with atherosclerotic cardiovascular disease on regular aspirin treatment were enrolled. Cardiovascular risk factors, routine biological parameters, comorbidities, and concomitant medications were recorded. The upper quartile of the platelet aggregation rate, determined by light transmission aggregometry with arachidonic acid, was defined as the HTPR group.Results: A total of 304 patients were included (mean age 77 ± 8 years, 76% men). Patients in the HTPR group were older than the patients in the non-HTPR group (mean age: 79 ± 7 vs. 76 ± 8 years, p = 0.008). Patients with moderately decreased estimated glomerular filtration rate (eGFR) had a higher frequency of HTPR than patients with slightly decreased eGFR or normal eGFR (35.8%, 22.5%, 12.2%, respectively, p < 0.05). In multivariate analysis, an independent risk factor for HTPR was the eGFR (OR: 0.984, 95% CI: 0.980-0.988, p < 0.001).Conclusions: Advanced age and decreased eGFR are correlated with poor pharmacodynamic response to aspirin. Antiplatelet strategy in elderly patients with atherosclerotic cardiovascular disease should be driven by an individualized approach, especially in patients with impaired renal function.

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Homocysteine levels and platelet reactivity in coronary artery disease patients treated with ticagrelor

Cited by 16 publications

References 41 publications

Homocysteine as a potential predictor of cardiovascular risk in patients with COVID-19

Homocysteine as a potential predictor of cardiovascular risk in patients with COVID-19

Association between renal function and platelet reactivity during aspirin therapy in elderly patients with atherosclerotic cardiovascular disease

Association between renal function and platelet reactivity during aspirin therapy in elderly patients with atherosclerotic cardiovascular disease

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