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Published on: February 28, 2012
Thrombin Generation in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention
Chen Gurevitz1,2, Alon Eisen3,4, Eli Lev5,6
1Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel, chenmor69@gmail.com.
Insights
Thrombin generation is high after percutaneous coronary intervention (PCI) but decreases with triple therapy. Dual therapy may offer similar antithrombotic effects after one month.
Area of Science:
- Cardiology
- Pharmacology
- Hematology
Background:
- Optimal antithrombotic treatment for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) remains debated.
- Dual therapy (clopidogrel and direct oral anticoagulant [DOAC]) is safer than triple therapy, but its efficacy is uncertain.
- This study evaluates thrombin generation (TG) to compare dual and triple antithrombotic strategies.
Purpose of the Study:
- To assess thrombin generation (TG) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).
- To compare TG levels under dual therapy (clopidogrel and DOAC) versus triple therapy (warfarin, aspirin, and clopidogrel).
Main Methods:
- A prospective, noninterventional trial involving patients with AF undergoing PCI.
- Patients initially received 4 weeks of triple therapy, followed by aspirin withdrawal.
- Thrombin generation was measured in platelet-rich and platelet-poor plasma at baseline, 4 weeks, and 2 weeks post-aspirin withdrawal.
Main Results:
- Thrombin generation (measured as endogenous thrombin potential [ETP]) was significantly higher immediately after PCI compared to 4 weeks later.
- These findings were consistent in both platelet-rich and platelet-poor plasma.
- ETP levels remained similar before and after aspirin withdrawal, indicating sustained TG in most patients on dual therapy.
Conclusions:
- Thrombin generation is elevated post-PCI and diminishes after 4 weeks of triple therapy.
- Aspirin withdrawal did not significantly alter TG in most patients, suggesting dual therapy may provide comparable antithrombotic effects to triple therapy after one month.
- Further research is needed to clarify the long-term efficacy of dual therapy in this patient population.
Background:
The optimal antithrombotic treatment for patients with atrial fibrillation (AF) that undergo percutaneous coronary intervention (PCI) is controversial. Dual therapy (clopidogrel and a direct oral anticoagulant [DOAC]) is safer than triple therapy (warfarin, aspirin, and clopidogrel), while efficacy is unclear. We aimed to evaluate thrombin generation (TG) under dual and triple therapy.
Methods:
A noninterventional prospective trial in patients with AF undergoing PCI. Patients received 4 weeks of triple therapy with aspirin, clopidogrel, and a DOAC followed by aspirin withdrawal. TG was measured in platelet-rich plasma (PRP) and platelet-poor plasma (PPP) at 3 five to 21 points, day 1 after PCI (TIME 0), 4 weeks after PCI (TIME 1), and 2 weeks after aspirin withdrawal (TIME 2).
Results:
Twenty-three patients (18 men, median age 78 years, 83% with acute coronary syndrome) were included. Endogenous thrombin potential (ETP) in PPP was high at TIME 0 compared with TIME 1 (ETP 3,178 ± 248 nM vs. 2,378 ± 222 nM, p = 0.005). These results remained consistent when measured in PRP. No significant difference in ETP was found before (TIME 1) and after aspirin withdrawal (TIME 2) although few patients had high ETP levels after stopping aspirin.
Conclusions:
TG potential is high immediately after PCI and decreases 4 weeks after PCI in patients receiving triple therapy. TG remains constant after aspirin withdrawal in most patients, suggesting that after 1 month the antithrombotic effect of dual therapy may be similar to triple therapy.
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