Related Experiment Videos
Ticlopidine and aspirin pretreatment reduces coagulation and platelet activation during coronary dilation procedures
L Gregorini1, J Marco, J Fajadet
1Clinica Medica Generale, IRCCS Ospedale Maggiore, Università di Milano, Italy.
Insights
Combining aspirin (ASA) and ticlopidine with heparin effectively reduces coagulation activation during coronary dilation procedures. This combination therapy is crucial for managing patients undergoing percutaneous transluminal coronary angioplasty (PTCA) and stent implantation.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Pharmacology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA), rotational atherectomy, and stent implantation can activate hemostasis by damaging endothelium and plaque.
- Understanding hemostasis activation is critical for managing patients undergoing these interventional cardiology procedures.
Purpose of the Study:
- To investigate the efficacy of a therapeutic combination of aspirin (ASA) and ticlopidine in decreasing hemostasis activation.
- To evaluate the impact of pre-procedural ticlopidine treatment duration on coagulation and platelet activation markers.
Main Methods:
- 85 patients undergoing PTCA were assessed for markers of coagulation and platelet activation, including thrombin-antithrombin complexes (TAT) and prothrombin fragment 1 + 2 (F1 + 2), and serotonin levels.
- Patients received aspirin (ASA) 250 mg/day and heparin (150 U/kg). Seventy patients also received ticlopidine (250 mg twice daily) for < or = 1 day or > or = 3 days.
- Blood samples were collected from peripheral and coronary ostium sites before, during, and after the procedures.
Main Results:
- Patients not taking ticlopidine or taking it for <= 24 hours exhibited significantly greater thrombin generation (higher TAT and F1 + 2 levels) compared to those on ticlopidine for >= 3 days (p < 0.05).
- Platelet activation and plasma serotonin levels were also significantly higher in patients with shorter ticlopidine treatment durations.
- These findings indicate a dose-dependent effect of ticlopidine on inhibiting hemostasis activation.
Conclusions:
- The combined use of ticlopidine, aspirin (ASA), and heparin effectively controls coagulation activation in patients undergoing coronary dilation.
- This combination therapy is beneficial for patients with stable or unstable angina undergoing procedures like PTCA and stent implantation.
- Pre-treatment with ticlopidine for at least 3 days enhances its anti-hemostatic effects during interventional cardiology procedures.
Objectives:
It is unknown whether a therapeutic combination of aspirin (ASA) and ticlopidine might effectively decrease activation of hemostasis.
Background:
Percutaneous transluminal coronary angioplasty (PTCA), rotational atherectomy and stent implantation are procedures that fracture or ablate endothelium and plaque, a situation that activates hemostasis.
Methods:
In 85 patients undergoing PTCA for a 77.8 +/- 1% stenosis, we measured markers of coagulation and platelet activation (thrombin-antithrombin complexes [TAT], prothrombin fragment 1 + 2 [F1 + 2] serotonin and the presence of circulating activated platelets reacting with monoclonal antibodies against glycoproteins exposed on platelet membranes). Blood samples were drawn from a peripheral vein and from the coronary ostium before the procedures. Both immediately and 10 min after angioplasty, and 10 min afterward, samples were collected from a probing catheter (0.018 in, [0.46 cm]) positioned beyond the stenosis. All patients were being treated with antianginal drugs and ASA, 250 mg/day. Seventy of them had taken ticlopidine, 250 mg, twice daily for < or = 1 day (< or = 24 h) (n = 28) or for > or = 3 days (> or = 72 h) (n = 42). Heparin (150 U/kg) was administered before angioplasty. Thirty patients underwent PTCA; 15 of them were not treated with ticlopidine and 15 were given ticlopidine (> or = 72 h). Thirty-five patients had stent implantation, 20 rotational atherectomy.
Results:
Before and during the procedures, there was greater thrombin generation (expressed by higher TAT and F1 + 2 plasma levels) in patients not taking ticlopidine or taking it for < or = 24 h (p < 0.05). Platelet activation and plasma serotonin levels were also significantly higher in the no ticlopidine or < or = 24-h ticlopidine groups.
Conclusions:
The combined use of ticlopidine, ASA and heparin effectively controls activation of coagulation in patients with stable or unstable angina undergoing coronary dilation.