Is There a Rationale for Antiplatelet Therapy in Acute Heart Failure?

Mentz, Robert J.; Lazzarini, Valentina; Fiuzat, Mona; Metra, Marco; O’Connor, Christopher M.; Felker, G. Michael

doi:10.1161/circheartfailure.112.000381

Cited by 5 publications

(5 citation statements)

References 64 publications

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“…Given that ischemic heart disease is a leading cause of HF, we hypothesized that the 17% relative reduction in MI risk among vorapaxar‐treated trial participants would translate to a lower risk of subsequent HHF 11,22 . Moreover, heightened platelet activity leading to chronic coronary microthrombosis has been implicated as a mechanism of HF progression 23 . The observation that vorapaxar did not reduce HHF risk suggests either that follow‐up duration was insufficient or that the majority of HHF events were precipitated by events other than intercurrent MI.…”

Section: Discussionmentioning

confidence: 99%

“…11,22 Moreover, heightened platelet activity leading to chronic coronary microthrombosis has been implicated as a mechanism of HF progression. 23 The observation that vorapaxar did not reduce HHF risk suggests either that follow-up duration was insufficient or that the majority of HHF events were precipitated by events other than intercurrent MI. not exclude a possible benefit, particularly in higher-risk patients followed for a longer period of time.…”

Section: Effect Of Antiplatelet Therapy On Risk Of Hospitalization Fo...mentioning

confidence: 99%

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Epidemiology of heart failure hospitalization in patients with stable atherothrombotic disease: Insights from the TRA 2°P‐TIMI 50 trial

Freedman

Berg

Scirica

et al. 2022

Clinical Cardiology

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Background Heart failure (HF) is a growing public health problem and ischemic heart disease is an important risk factor. Understanding the epidemiology of HF in patients with atherosclerosis may help identify subgroups at greater risk who have the potential to derive greater benefit from preventive strategies. Methods and Results The TRA 2°P‐TIMI 50 trial randomized 26,449 patients with stable atherosclerosis to the antiplatelet agent vorapaxar versus placebo. Hospitalization for HF (HHF) endpoints were adjudicated from serious adverse events by blinded structured review using established definitions. HHF incidence was estimated using Kaplan–Meier analysis. Independent predictors of HHF risk were identified using multivariable logistic regression. The effect of vorapaxar on HHF risk was explored using Cox regression. The estimated incidence of HHF at 3 years was 1.6%. Independent predictors of HHF included prior HF (adjusted odds ratio [adj‐OR]: 8.31; 95% confidence interval [CI]: 6.56–10.54), age (adj‐OR [per 10 years]: 1.67; 95% CI: 1.47–1.89), type 2 diabetes mellitus (T2DM; adj‐OR: 2.55; 95% CI: 2.01–3.24), polyvascular disease (two‐territory disease, adj‐OR: 1.89; 95% CI: 1.46–2.44; three‐territory disease, adj‐OR: 2.68; 95% CI: 1.94–3.70), chronic kidney disease (CKD; adj‐OR: 1.65; 95% CI: 1.30–2.11), body mass index (BMI; adj‐OR [per 5 kg/m2]: 1.15; 95% CI: 1.03–1.27), prior myocardial infarction (MI) (adj‐OR: 1.35; 95% CI: 1.03–1.78), and hypertension (adj‐OR: 1.44; 95% CI: 1.02–2.04). Patients who experienced HHF during follow‐up had higher rates of subsequent rehospitalization and death. Vorapaxar did not modify the risk of HHF. Conclusions In patients with stable atherosclerosis, prior HF, age, T2DM, polyvascular disease, CKD, BMI, prior MI, and hypertension are important predictors of HHF risk.

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Section: Discussionmentioning

confidence: 99%

Section: Effect Of Antiplatelet Therapy On Risk Of Hospitalization Fo...mentioning

confidence: 99%

Epidemiology of heart failure hospitalization in patients with stable atherothrombotic disease: Insights from the TRA 2°P‐TIMI 50 trial

Freedman

Berg

Scirica

et al. 2022

Clinical Cardiology

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“…Results from basic and clinical studies have demonstrated that acute heart failure would lead to increase angiotensin II levels, sympathetic overdrive, reduce nitric oxide bioavailability, and elevate inflammation cytokines. 33 All these alterations, via yet-to-be established mechanisms, contribute to platelet activation in acute heart failure. 33 In our study, in HPR patients defined by PAG levels, an increased incidence of anterior MI, as well as a decrease in LVEF ( P = .056; Table 1), was observed.…”

Section: Discussionmentioning

confidence: 99%

“…33 All these alterations, via yet-to-be established mechanisms, contribute to platelet activation in acute heart failure. 33 In our study, in HPR patients defined by PAG levels, an increased incidence of anterior MI, as well as a decrease in LVEF ( P = .056; Table 1), was observed. These characteristics are in agreement with the findings that patients with acute heart failure are more likely to present with activated state of platelets.…”

Section: Discussionmentioning

confidence: 99%

Discordance Between VASP Phosphorylation and Platelet Aggregation in Defining High On-Clopidogrel Platelet Reactivity After ST-Segment Elevation Myocardial Infarction

Sun

Gao

Liu

et al. 2017

Clin Appl Thromb Hemost

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To investigate potential clinical characteristics associated with discordance between platelet vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) flow cytometry (FCM) assay and light transmission aggregometry (LTA) in defining high on-clopidogrel platelet reactivity (HPR) after ST-segment elevation myocardial infarction (STEMI). In this study, platelet responsiveness was measured by the above 2 methods simultaneously on day 1 and on day 6 of STEMI onset in 90 consecutive patients who underwent primary percutaneous coronary intervention. The FCM-derived platelet reactivity index and LTA-derived platelet aggregation rate were both significantly reduced after dual antiplatelet therapy on day 6. Multiple variable-adjusted logistic regression analysis revealed that smoking (odds ratio [OR]: 4.507, 95% confidence interval [CI]: 1.123-18.09, P = .034) and onset-to-admission time (per 1 hour increase, OR: 1.196, 95% CI: 1.023-1.398, P = .025) both were independent predictors for the discordance between the 2 methods. Additionally, improved correlation and concordance was observed in nonsmokers compared with smokers. Our data show that smoking and prolonged onset-to-admission time are associated with discordance between platelet VASP-P and LTA in defining HPR after STEMI, which should be considered when planning personalized antiplatelet therapy.

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“…The activation of neurohormonal, inflammatory, and thrombotic pathways ( 20 - 22 ) has been found to be associated with enhanced platelet reactivity in patients with AHF ( 14 , 23 - 26 ). MPV has emerged as a relatively reliable marker of inflammation in patients with various diseases ( 27 , 28 ), with high MPV associated with low-grade inflammation.…”

Section: Discussionmentioning

confidence: 99%

Correlation between mean platelet volume and B-type natriuretic peptide concentration in emergency patients with heart failure

2015

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BackgroundIn heart failure patients, mean platelet volume (MPV) may reflect increased platelet activation or increased numbers of large, hyper-aggregable platelets. B-type natriuretic peptide (BNP) concentration in blood is a sensitive and specific marker of heart failure, correlating with the severity and prognosis of illness, in patients presenting with acute dyspnea to the emergency department. This study evaluated the correlation between BNP concentration and MPV.Material and methodsData were collected from 319 patients admitted to the emergency department of a cardiology hospital from January–July 2014. EDTA blood samples drawn at admission were analyzed using automated hematology system, and BNP concentration was measured using a fluorescence immunoassay.ResultsThe study included 190 patients with and 129 without acute heart failure (AHF). These groups had BNP concentration of 200-5000 ng/L and 5-98 ng/L, respectively. MPV levels were significantly higher in the AHF group (P < 0.001). BNP concentrations were positively correlated with MPV (r = 0.41, P < 0.001) and neutrophil / lymphocyte ratio (r = 0.38, P < 0.001).ConclusionIncreased MPV values correlate with BNP concentration, an indicator of HF severity and clinical status, in patients with AHF admitted to the emergency department.

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Is There a Rationale for Antiplatelet Therapy in Acute Heart Failure?

Cited by 5 publications

References 64 publications

Epidemiology of heart failure hospitalization in patients with stable atherothrombotic disease: Insights from the TRA 2°P‐TIMI 50 trial

Epidemiology of heart failure hospitalization in patients with stable atherothrombotic disease: Insights from the TRA 2°P‐TIMI 50 trial

Discordance Between VASP Phosphorylation and Platelet Aggregation in Defining High On-Clopidogrel Platelet Reactivity After ST-Segment Elevation Myocardial Infarction

Correlation between mean platelet volume and B-type natriuretic peptide concentration in emergency patients with heart failure

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