Preliminary Experience of Preoperative Modification of Platelet Aggregation
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Abstract:
Objective: Antiplatelet drugs are frequently used to prevent ischemic complications of endovascular therapy, but patients who showed poor responses to these drugs have been reported. We have adjusted antiplatelet drugs based on platelet aggregation activity before endovascular therapy. The objective of this study was to investigate the association between platelet aggregation test-based modification of antiplatelet drugs and perioperative complications.Keywords:
Antiplatelet drug
Background: Antiplatelet agents are the mainstay treatment for patients with cardiovascular diseases. However, a substantial proportion of these patients still develop new cardiovascular events while receiving such antiplatelet therapy. Antiplatelet drugs resistance may contribute to the failure of treatment. Objective: We determine the prevalence and clinical significance of antiplatelet drug resistance among patients presenting with acute coronary syndrome (ACS) while receiving aspirin alone or in combination with clopidogrel. The study further investigated possible factors prediction antiplatelet resistance. Materials and Methods: A total of 49 ACS patients who had been taking aspirin or with clopidogrel for at least 7 days were enrolled in this study. The light-transmittance aggregometry (LTA) was used to determine antiplatelet drug responsiveness. The antiplatelet drug resistance was defined as the maximum aggregation > 60% when stimulated by 10 μ mol/L of adenosine diphosphate (ADP). Results: Antiplatelet drug resistance was observed in 3 of patients (6.7%). The level of cardiac markers, both CKMB (p = 0.045) and Troponin-T (p = 0.030), of these 3 patients were significantly higher than in those with antiplatelet responsiveness. Severe angina ( > 2 episodes within 24 hour) and high risk by Thrombolysis in myocardial infarction (TIMI) risk score had a tendency to be associated with antiplatelet resistance. However, there was no significant difference in cumulative occurrence of recurrent ACS and death in 28 days between patients who responded to or resisted antiplatelet drugs. Conclusions: Antiplatelet resistance, assessed by the LTA, is a predictor for the severity of ACS in term of higher cardiac injury but not associated with short-term cardiovascular outcomes both in recurrence and mortality.
Antiplatelet drug
TIMI
Unstable angina
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Aspirin and clopidogrel are widely used in the prevention and treatment of cardiocerebrovascular diseases. Although some patients have received antiplatelet therapy, they still experience ischemic events. This phenomenon is called antiplatelet drug resistance. This article reviews the coping strategies for antiplatelet drug resistance in the prevention of ischemic stroke.
Key words:
Stroke; Brain Ischemia; Platelet Aggregation Inhibitors; Aspirin; Ticlopidine; Clopidogrel; Drug Resistance
Antiplatelet drug
Ticlopidine
Stroke
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Platelet aggregation was studied at 37 degrees C in citrated whole human blood, using the Ultra Flo 100 Whole Blood Platelet Counter. Aggregation was measured as a fall in the number of single platelets following addition of an aggregating agent. At peak aggregation, the fall in the number of platelets induced by ADP (10 microM), collagen (1 microgram/ml) or thrombin (0.2 U/ml) was about 90%. When blood was incubated with the prostacyclin-analogue ZK36374, the aggregation responses to ADP, collagen and thrombin were reduced with IC50's = 0.5, 1.5 and 3 nM respectively and the corresponding IC100's were: 1, 3 and 12 nM. When ZK36374 was added at peak aggregation, the number of single platelets increased significantly due to disaggregation of preformed platelet aggregates. It is concluded that the present technique represents a rapid, sensitive and more physiological approach for investigating the effects of pharmacological agents on platelet aggregation.
Human blood
Agrégation
Adenosine diphosphate
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A series of 4-substituted phenyl-(A, B) and 5-substituted 2-thienyl-(C) acetic acid derivatives were synthesized. Inhibitory activity of collagen-induced rabbit platelet aggregation of 29 compounds including A, B, C and the intermediate compounds of them was studied. Compounds (A-18, B-21 and -27) were inhibitory against platelet aggregation and the most potent compound (B-21) was more effective than aspirin.
Alpha (finance)
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Platelet inhibition
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This report describes the anti-platelet aggregation activity of 48 pyrazines. Among alkyl- and arylpyrazines tested, 2, 3-diphenylpyrazines showed the strongest anti-platelet aggregation activity. Then, various substituents were introduced into the phenyl groups, and the 2, 3-bis(p-methoxyphenyl)pyrazine derivatives were consequently found to possess considerably strong inhibitory activity.
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Antiplatelet drug
Coronary stent
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Newly introduced antiplatelet drugs such as ticlopidine or cilostazol are often administered to preoperative patients. However, how to evaluate the effect of these drugs on anesthetic management remains unsettled. The platelet aggregation test was performed on 20 operative patients, and the aggregation patterns are classified into five categories. The platelet aggregation is almost unchanged in some patients, and slightly depressed in others. The new classification of platelet aggregation patterns that we introduced for preoperative evaluation seems to be a good indicator of platelet function in patients medicated with antiplatelet drugs.
Cilostazol
Ticlopidine
Antiplatelet drug
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Coronary disease
Secondary Prevention
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