Platelet aspirin resistance in ED patients with suspected acute coronary syndrome

Glauser, Jonathan; Emerman, Charles L.; Bhatt, Deepak L.; Peacock, W. Frank

doi:10.1016/j.ajem.2009.01.004

Cited by 4 publications

(1 citation statement)

References 29 publications

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“…This incidence of AR agrees with the reported incidence (6.5%) in 200 patients presenting with apparent ACS at the Cleveland Clinic emergency room (Glauser et al, 2010). The clinical characteristics of the 3 groups of aspirin-sensitive, high normal, and aspirin-insensitive subjects, are shown in Table 1.…”

Section: Resultssupporting

confidence: 91%

Aspirin insensitive thrombophilia: Transcript profiling of blood identifies platelet abnormalities and HLA restriction

Fallahi

Katz

Toma

et al. 2013

Gene

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Aspirin is the most widely used antiplatelet agent because it is safe, efficient, and inexpensive. However, a significant subset of patients does not exhibit a full inhibition of platelet aggregation, termed ‘aspirin resistance’ (AR). Several major studies have observed that AR patients have a 4-fold increased risk of myocardial infarction (MI), stroke, and other thrombotic events. Arachidonic acid-stimulated whole blood aggregation was tested in 132 adults at risk for ischemic events, and identified an inadequate response to aspirin therapy in 9 patients (6.8%). Expression profiling of blood RNA by microarray was used to generate new hypotheses about the etiology of AR. Among the differentially expressed genes, there were decreases in several known platelet transcripts, including clusterin (CLU), glycoproteins IIb/IIIa (ITGA2B/3), lipocalin (LCN2), lactoferrin (LTF), and the thrombopoetin receptor (MPL), but with increased mRNA for the T-cell Th1 chemokine CXCL10. There was a strong association of AR with expression of HLA-DRB4 and HLA-DQA1. Similar HLA changes have been linked to autoimmune disorders, particularly antiphospholipid syndrome (APS), in which autoantibodies to phospholipid/protein complexes can trigger platelet activation. Consistent with APS, AR patients exhibited a 30% reduction in platelet counts. Follow-up testing for autoimmune antibodies observed only borderline titers in AR patients. Overall, these results suggest that AR may be related to changes in platelet gene expression creating a hyperreactive platelet, despite antiplatelet therapy. Future studies will focus on determining the protein levels of these differential transcripts in platelets, and the possible involvement of HLA restriction as a contributing factor.

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Section: Resultssupporting

confidence: 91%

Aspirin insensitive thrombophilia: Transcript profiling of blood identifies platelet abnormalities and HLA restriction

Fallahi

Katz

Toma

et al. 2013

Gene

View full text Add to dashboard Cite

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The Future of Aspirin Therapy in Cardiovascular Disease

Bhatt

Pollack

2021

The American Journal of Cardiology

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Antiplatelet Therapy in Acute Coronary Syndrome and Atrial Fibrillation: Aspirin

Tanguay

2012

Antiplatelet Therapy in ACS and a-Fib

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Platelets play a critical role in the pathophysiology of acute coronary syndrome and thromboembolic complications associated with atrial fibrillation. Despite the development of newer and more potent antiplatelet agents, aspirin remains the cornerstone of antithrombotic therapy. Clinical trials conducted over the past decades have clearly established the safety and efficacy of aspirin therapy for the acute treatment and secondary prevention of acute myocardial infarction, ischemic stroke, and vascular death among patients at high risk for cardiovascular events. Although the absolute benefit of aspirin for primary prevention is lower than seen in secondary prevention trials, it is nevertheless an accepted preventive. This chapter provides a comprehensive overview of the clinical utility of aspirin in the setting of acute coronary syndrome and atrial fibrillation.

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Platelet aspirin resistance in ED patients with suspected acute coronary syndrome

Cited by 4 publications

References 29 publications

Aspirin insensitive thrombophilia: Transcript profiling of blood identifies platelet abnormalities and HLA restriction

Aspirin insensitive thrombophilia: Transcript profiling of blood identifies platelet abnormalities and HLA restriction

The Future of Aspirin Therapy in Cardiovascular Disease

Antiplatelet Therapy in Acute Coronary Syndrome and Atrial Fibrillation: Aspirin

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