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On-treatment platelet reactivity in peripheral and coronary blood in patients undergoing primary PCI for ST-segment

Luca Spiezia1, Ahmed Al Mamary2, Elena Campello1

  • 1a Department of Medicine, Thrombotic and Haemorrhagic Diseases Unit , University of Padua , Padua , Italy.

Scandinavian Journal of Clinical and Laboratory Investigation
|March 27, 2018
PubMed

Insights

Platelet reactivity in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI) is similar in coronary and peripheral blood. This finding holds true regardless of the antiplatelet drug used, including aspirin and thienopyridines.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Dual antiplatelet therapy is standard for ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (p-PCI).
  • Pre-analytical factors can impact platelet function test results, necessitating careful sample collection and analysis.
  • Understanding on-treatment platelet reactivity is crucial for optimizing antiplatelet therapy efficacy and safety.

Purpose of the Study:

  • To compare on-treatment platelet reactivity in peripheral arterial blood versus coronary arterial blood in STEMI patients.
  • To evaluate if platelet reactivity differs based on the specific thienopyridine (clopidogrel, prasugrel, or ticagrelor) used in combination with aspirin.
  • To assess the consistency of platelet function measurements between peripheral and coronary circulation.

Main Methods:

  • One hundred and nine STEMI patients undergoing p-PCI were enrolled.
  • Patients received intravenous aspirin and one of three thienopyridines (clopidogrel, prasugrel, or ticagrelor) before the procedure.
  • Platelet reactivity was assessed using ASPI-test and ADP-test with multiple electrode aggregometry (MEA) on blood samples from both peripheral and coronary arteries.
  • Low responders were defined based on pre-established normal ranges for ASPI-test and ADP-test values.

Main Results:

  • No significant differences in ASPI-test or ADP-test values were observed between peripheral and coronary blood samples.
  • The prevalence of low aspirin responders was 14% and low thienopyridine responders was 38% in peripheral blood, with similar rates in coronary blood.
  • The prevalence of low clopidogrel responders (45%) was higher than prasugrel (36%) and ticagrelor (33%), consistent across both blood sources.

Conclusions:

  • Platelet function measured by MEA in coronary arteries is consistent with peripheral arterial blood in STEMI patients on dual antiplatelet therapy.
  • The choice of thienopyridine (clopidogrel, prasugrel, ticagrelor) influences the prevalence of low responders, irrespective of the sampling site.
  • Further research is needed to clarify the clinical significance of peripheral versus coronary platelet reactivity in this patient population.

Keywords:
Cardioactive drugscardiologycoagulation and atherothrombosisdiagnostics in primary carepoint-of-care testingthrombocytes and primary haemostasis

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