Analysis of markers of high residual platelet reactivity when taking acetylsalicylic acid in patients with myocardial infarction during the scarring period
Abstract
Objective. To analyze markers that determine high residual platelet reactivity (HRPR) when taking acetylsalicylic acid (ASA) as part of dual antiplatelet therapy in patients with myocardial infarction (MI) during the scarring period.
Materials and methods. 405 patients with MI underwent the following studies: multielectrode aggregometry, blood test with platelet indices, enzyme-linked immunosorbent determination of soluble CD40 ligand, sP-selectin, von Willebrand factor and endothelin-1. All studies were performed on days 28—30 of MI. Based on the results of aggregometry, patients were divided into 3 groups: group 1 —14 people with low residual platelet reactivity to ASA; group 2 —288 people with optimal platelet reactivity; group 3 —103 people with HRPR to ASA.
Results. When conducting a univariate linear regression analysis, the following factors were identified that independently influenced the ASPI-test value: waist circumference (β = 0.18, 95 % CI (0.027—0.33); p = 0.02); erythrocyte sedimentation rate (β = 0.3, 95 % CI (0.11—0.49); p = 0.0016); leukocyte count (β = 2.1, 95 % CI (1.2—3.0); p = 0.000007); platelet count (β = 0.045, 95 % CI (0.019—0.07); p = 0.00062); thrombocrit (β = 43.0, 95 % CI (16.2—69.8); p = 0.0017); C-reactive protein (β = 0.23, 95 % CI (0.069—0.39); p = 0,0052); TRAP-test (β = 0.19, 95 % CI (0.13—0.26); p < 0.000001); endothelin-1 (β = 1.5, 95 % CI (0.59—2.43); p = 0.0014). To determine the probability of developing HRPR to ASA, a binary regression equation with a logit link function was constructed, which included the following indicators: body mass index (BMI), TRAP-test values, endothelin-1 level (sensitivity — 75.61 %, specificity — 75.73 %, classification accuracy — 75.69 % for this model).
Conclusion. On days 28—30 of MI, 3.5 % of patients with an excessive response to ASA and 25.4 % with an insufficient response to ASA were identified. Markers of HRPR to ASA during the period of MI scarring are BMI, TRAP-test values, endothelin-1 level.
About the Authors
T. Pronko
Гродненский государственный медицинский университет
Belarus
Belarus
V. Snezhitski
Гродненский государственный медицинский университет
Belarus
Belarus
A. Kapytski
Гродненский государственный медицинский университет
Belarus
Belarus
References
1. Fontana, P. Platelet function test use for patients with coronary artery disease in the early 2020s / P. Fontana, M. Roffi, J. L. Reny // J. Clin. Med. — 2020. — Vol. 9, № 1. — Р. 194.
2. Platelet aggregation and the risk of stent thrombosis or bleeding in elective percutaneous coronary intervention patients / K. Kukula [et al.] // Blood Coagul. Fibrinolysis. — 2017. — Vol. 28, № 5. — Р. 383—388.
3. Low on-treatment platelet reactivity predicts long-term risk of bleeding after elective PCI / M. D. Colic [et al.] // J. Interv. Cardiol. — 2015. — Vol. 28. — Р. 531—543.
4. Braunwald’s heart disease: a textbook of cardiovascular medicine / P. Libby [et al.]. — 12th ed. — Philadelphia : Elsevier, 2022. — 1902 p.
5. Calatzis, A. Multiplate platelet function analysis — application and interpretation / A. Calatzis, R. Loreth, M. Spannagl. — Verum Diagnostica GmbH, 2007. — 35 р.
6. Monitoring ASA and P2Y12-specific platelet inhibition — comparison of conventional (single) and multiple electrode aggregometry / J. C. Kruger [et al.] // Scand. J. Clin. Lab. Invest. — 2014. — Vol. 74, № 7. — Р. 568—574.
7. Исследование вазомоторной функции эндотелия плечевой артерии с использованием импедансной технологии у больных атеросклерозом / Л. З. Полонецкий [и др.] // Медицинская панорама. — 2005. — № 7. — С. 40—43.
8. High platelet reactivity on aspirin in patients with acute ST elevation myocardial infarction / J. G. Dillinger [et al.] // Thromb. Res. — 2016. — Vol. 144. — Р. 56—61.
9. High residual platelet reactivity during aspirin therapy in patients with non-ST segment elevation acute coronary syndrome: comparison between initial and late phases / M. D. A. Dracoulakis [et al.] // Arq. Bras. Cardiol. — 2019. — Vol. 113, № 3. — Р. 357—363.
10. Grinstein, J. Aspirin resistance: current status and, role of tailored therapy / J. Grinstein, // Clin. Cardiol. — 2012. — Vol. 35, № 11. — Р. 673—681.
11. Лукьянец, К. Ю. Резистентность к терапии препаратами ацетилсалициловой кислоты: факторы риска, механизмы, методы диагностики / К. Ю. Лукьянец, И. Ю. Пчелин // Juvenis. Scientia. — 2020. — Т. 6, № 2. — С. 16—34.
12. Antithrombotic therapy and body mass: an expert position paper of the ESC Working Group on Thrombosis / B. Rocca [et al.] // Eur. Heart J. — 2018. — Vol. 39, № 19. — Р. 1672—1686.
13. Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials / P. M. Rothwell [et al.] // Lancet. — 2018. — Vol. 392, № 10145. — Р. 387—399.
14. Obesity is associated with impaired responsiveness to once daily low-dose aspirin and in vivo platelet activation / G. Petrucci [et al.] // J. Thromb. Haemost. — 2019. — Vol. 17, № 6. — Р. 885—895.
15. Body mass index and platelet reactivity during dual antiplatelet therapy with clopidogrel or ticagrelor / M. Nardin [et al.] // J. Cardiovasc. Pharmacol. — 2015. — Vol. 66, № 4. — Р. 364—370.
16. The ratio of ADPto TRAP-induced platelet aggregation quantifies P2Y12-dependent platelet inhibition independently of the platelet count / C. B. Olivier [et al.] // PLoS One. — 2016. — Vol. 11, № 2. — Р. e0149053.
17. Platelet reactivity and intramyocardial hemorrhage in patients with ST-segment elevation myocardial infarction / L. A. Malek [et al.] // Clin. Appl. Thromb. Hemost. — 2014. — Vol. 20, № 5. — Р. 553—558.
18. No-reflow and platelet reactivity in diabetic patients with ST-segment elevation myocardial infarction: is there a link / W. Kuliczkowski [et al.] // Postepy Kardiol. Interwencyjnej. — 2017. — Vol. 13, № 4. — Р. 326—330.
19. Platelet reactivity and cardiovascular mortality risk in the LURIC study / M. Berger [et al.] // J. Clin. Med. — 2023. — Vol. 12, № 5. — Р. 1913.
20. Plasma big endothelin-1 and stent thrombosis: an observational study in patients undergoing percutaneous coronary intervention in China / Y. Chen [et al.] // Thromb. Res. — 2017. — Vol. 159. — Р. 5—12.
21. Самодова, А. В. Соотношение содержания внеклеточного пула сигнальных молекул и активности межклеточных контактов крови в норме и патологии / А. В. Самодова, Л. К. Добродеева // Клиническая медицина. — 2022. — Т. 100, № 9—10. — С. 456—463.
Review
For citations:
Pronko T., Snezhitski V., Kapytski A. Analysis of markers of high residual platelet reactivity when taking acetylsalicylic acid in patients with myocardial infarction during the scarring period. Healthcare. 2025;1(1):15—21. (In Russ.)
Views:
17
Email this article 