Evidence of increased platelet reactivity in the first six months after acute ST segment elevation myocardial infarction

Scalone, Giancarla; Coviello, Ilaria; Barone, Lucy; Battipaglia, Irma; Aurigemma, Cristina; Careri, Giulia; Pinnacchio, Gaetano; Tarzia, Pierpaolo; Lanza, Gaetano Antonio; Crea, Filippo

doi:10.1016/j.thromres.2011.03.018

Cited by 18 publications

(9 citation statements)

References 29 publications

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“…PAR1 activation could thus be a key element for the pathogenesis of thrombosis in MPNs. The results of our experiment are also similar to those observed in patients with pre‐infarct angina, where a reduced expression of PAC‐1 is described (Scalone et al , ), and to what occurs months after an acute ST segment elevation myocardial infarction, with a progressive increase in the expression of the platelet fibrinogen receptor despite dual antiplatelet therapy (Scalone et al , ). Indeed, in acute cardiovascular diseases the role of plasma procoagulants such as tissue factor was considered fundamental (Steffel et al , ).…”

Section: Discussionsupporting

confidence: 90%

Unexpected low expression of platelet fibrinogen receptor in patients with chronic myeloproliferative neoplasms: how does it change with aspirin?

et al. 2019

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This study was conducted to evaluate the expression of fibrinogen receptors on platelets of Philadelphia-negative chronic myeloproliferative neoplasm (MPN) patients. We collected blood samples from 40 consecutive MPN patients and healthy volunteers. We performed flow cytometry analysis of P-selectin expression and integrin beta-3, activation of glycoprotein (GP) IIb/IIIa and fibrinogen receptor exposure (PAC-1 binding). Surprisingly, we found a very low PAC-1 binding capacity in MPN patients; however, the expression of PAC-1 was almost completely recovered with aspirin intake. We hypothesize that the hypercoagulable states observed in MPN patients could depend on a primarily plasma-driven impairment of fibrin turnover and thrombin generation.

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Section: Discussionsupporting

confidence: 90%

Unexpected low expression of platelet fibrinogen receptor in patients with chronic myeloproliferative neoplasms: how does it change with aspirin?

et al. 2019

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“…Previous studies have demonstrated that patients with acute coronary syndromes (ACS) have increased platelet reactivity (13)(14)(15)(16)(17)(18). Notably, in a recent study we found that platelet reactivity in STEMI patients was increased compared to stable CAD patients, and that the difference persisted at one-month follow-up, suggesting that it might have also preceded the occurrence of the acute event (19). This finding is confirmed in the present, independent, study.…”

Section: Discussionsupporting

confidence: 90%

Persistent enhanced platelet activation in patients with acute myocardial infarction and coronary microvascular obstruction: clinical implications

Aurigemma¹,

Scalone²,

Tomai³

et al. 2014

Thromb Haemost

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About 30% of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing recanalisation of the infarct-related coronary artery do not achieve valid myocardial reperfusion (no-reflow phenomenon or coronary microvascular obstruction [MVO]). The mechanisms of MVO are incompletely understood. In this study we investigated the role platelet activation in the pathogenesis of coronary MVO in STEMI patients. We enrolled 48 STEMI patients (age 56.2 ± 11 years; 31 men), treated by primary percutaneous coronary intervention (PCI) followed by double anti-platelet treatment, and 20 control patients with stable coronary artery disease (CAD) on single anti-platelet treatment (age 57.5 ± 6 years, 12 men). STEMI patients were divided into two groups: 35 patients with complete myocardial reperfusion (MR) and 13 patients with coronary MVO despite successful PCI. Platelet activation was assessed on admission and at one-month follow-up by measuring platelet receptor expression and monocyte-platelet aggregates (MPAs). Platelet receptor expression, platelet receptor conformational change for fibrinogen binding availability and MPA formation were increased in STEMI patients with MVO compared to both STEMI patients with MR and stable CAD patients, both on admission and at one-month follow-up (p<0.05 for all).Among STEMI patients, platelet activation is greater in those who display coronary MVO, compared to those with MR, after successful PCI, both on admission and one month after STEMI, suggesting that enhanced platelet activation might be involved in the pathogenesis of MVO. The persistence of enhanced platelet activation despite double classical anti-platelet therapy suggests that new anti-platelet strategies should be considered in patients with coronary MVO.

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“…15,16 Patients in the CCR programme had significantly reduced platelet reactivity at the three-month follow-up. Although platelet function was reported to decline to some extent after an acute event, 17 we hypothesise that aggressive modification of cardiovascular risk factors (glucose homeostasis, lipid management, diet, smoking and physical exercise) creates a favourable intravascular milieu leading to reduced platelet activity. Based on these observations, we might build a new, additional non-pharmacological approach to decrease platelet reactivity.…”

Section: Discussionmentioning

confidence: 90%

Cardiac rehabilitation programme as a non-pharmacological platelet inhibitory tool in acute coronary syndrome survivors

Tóth-Zsámboki

Horváth

Hajtman

et al. 2017

Eur J Prev Cardiolog

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Background Acute coronary syndrome is associated with platelet hyperactivity, which in its persistent form, promotes recurrent thrombotic events. Complex cardiac rehabilitation after acute coronary syndrome improves clinical outcome; however, its effect on platelet hyperactivity is unknown. Design and methods We enrolled 84 acute coronary syndrome patients on dual antiplatelet therapy, who underwent a new complex cardiac rehabilitation programme (NovaCord physiotherapy, lifestyle counselling, strict diet, stress management and regular coaching) and 51 control acute coronary syndrome patients with traditional cardiac rehabilitation. Platelet functionality was determined at enrolment and at three months follow-up by aggregometry, serum platelet-derived growth factor levels, total- and platelet-derived microvesicle counts (PMV; CD41a+/CD61+, CD62P+). Results Platelet aggregation parameters and platelet-derived growth factor levels were significantly decreased in the complex cardiac rehabilitation group at three months (1 µg/ml collagen, median (interquartile range): 22 (10-45) vs 14 (7.5-25.5)%, p = 0.0015; 2 µg/ml collagen: 36 (22-60) vs 26.5 (16-37)%, p = 0.0019; 1.25 µM adenosine-diphosphate: 4.5 (1-10) vs 1 (0-3)%, p = 0.0006; 5 µM adenosine-diphosphate: 27 (16-38) vs 22 (12-31)%, p = 0.0078; epinephrine: 33 (15-57) vs 27 (12-43)%, p = 0.01; platelet-derived growth factor: 434.6 (256.0-622.7) vs 224.8 (148.5-374.1) pg/ml, p = 0.0001). In contrast, these changes were absent or did not reach statistical significance in the traditional cardiac rehabilitation group. Platelet-derived microvesicle counts were significantly decreased in both groups, while total microvesicle count was significantly reduced only in the complex cardiac rehabilitation group (median (interquartile range): 3945.5 (2138-5661) vs 1739 (780-2303) count/µl; p = 0.0001). Conclusions Platelet hyperactivity three months after acute coronary syndrome significantly decreased in patients undergoing complex cardiac rehabilitation. Besides dual antiplatelet therapy, effective management and comprehensive control of cardiovascular risk factors might represent a new, non-pharmacological approach to influence platelet functionality.

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Evidence of increased platelet reactivity in the first six months after acute ST segment elevation myocardial infarction

Cited by 18 publications

References 29 publications

Unexpected low expression of platelet fibrinogen receptor in patients with chronic myeloproliferative neoplasms: how does it change with aspirin?

Unexpected low expression of platelet fibrinogen receptor in patients with chronic myeloproliferative neoplasms: how does it change with aspirin?

Persistent enhanced platelet activation in patients with acute myocardial infarction and coronary microvascular obstruction: clinical implications

Cardiac rehabilitation programme as a non-pharmacological platelet inhibitory tool in acute coronary syndrome survivors

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