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Persistent high on-treatment platelet reactivity in acute coronary syndrome

Donald R Lynch1, Farooq H Khan, Dhananjay Vaidya

  • 1Department of Medicine, Johns Hopkins Medical Institute, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, 301 Building, Division of Cardiology, Baltimore, MD 21224, USA.

Journal of Thrombosis and Thrombolysis
|February 25, 2012
PubMed

Insights

Patients with acute coronary syndrome (ACS) on aspirin therapy show persistent high platelet reactivity three months after treatment. This sustained platelet activity may increase the risk of future cardiovascular events.

Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Persistent high on-treatment platelet reactivity is linked to adverse cardiovascular outcomes in acute coronary syndrome (ACS) patients.
  • The temporal changes in platelet function following ACS and antiplatelet therapy are not well understood.

Purpose of the Study:

  • To investigate platelet activity at a three-month follow-up in patients initially presenting with ACS.
  • To assess the evolution of platelet reactivity under aspirin therapy in ACS patients.

Main Methods:

  • 124 patients (65 ACS, 59 controls) were enrolled. 25 ACS patients underwent repeat platelet function testing at three months.
  • Platelet aggregation induced by epinephrine (EPI) and adenosine diphosphate (ADP) was measured at baseline and follow-up.
  • P-selectin and PAC-1 expression were monitored at both time points in ACS patients on aspirin therapy.

Main Results:

  • ACS patients on aspirin showed no significant percentage change in EPI- and ADP-stimulated platelet aggregation at three months.
  • No significant changes in PAC-1 or P-selectin expression were observed at the three-month follow-up.
  • Platelet reactivity remained persistently high in ACS patients at three months post-presentation.

Conclusions:

  • This study demonstrates persistent high on-treatment platelet reactivity in ACS patients at three months.
  • Sustained high platelet reactivity may indicate an increased risk for recurrent cardiovascular events in these patients.
  • Further research is needed to explore strategies to mitigate persistent platelet reactivity in ACS management.

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