Hemostasiological Aspects of PCI: Periprocedural Changes in the Activity of the Platelet Link of Hemocoagulation on the Background of Prior Double Antiplatelet Therapy in Patients with Chronic Coronary Syndrome

Keywords: platelet hemostasis, coronary artery disease, antithrombotic therapy, P2Y12 receptors, coronary artery stenting

Abstract

The aim. To analyze changes in the activity of the platelet link of hemocoagulation in patients with chronic coronary syndrome before and after percutaneous coronary intervention (PCI) against the background of prior antiplatelet therapy.

Materials and methods. We examined 67 patients (mean age 65.2±8.6 years) who were undergoing inpatient treatment at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Patients with different regimens of antiplatelet therapy were compared before and after PCI. At the time of hospitalization, patients were receiving both monotherapy and dual antiplatelet therapy (those with a history of myocardial infarction up to 12 months) in standard doses. The control group consisted of 25 people of similar age (62.7±6.5 years). The activity of platelet hemostasis was evaluated by the turbidimetric method and the light transmission fluctuation method. Statistical processing was carried out using the MedStat v.5.2 and Statistica 8.0 software.

Results. Before PCI, dual antiplatelet therapy using aspirin and ticagrelor suppressed the activity of platelet hemostasis, compared to dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. Patients receiving monotherapy did not achieve the desired effect. After PCI, the group of patients who took the combination of aspirin and ticagrelor responded better to the therapy than those who received aspirin and clopidogrel.

Conclusions. The use of dual antiplatelet therapy with acetylsalicylic acid and ticagrelor reduced both spontaneous and induced aggregation.

References

  1. Costa F, Valgimigli M. The optimal duration of dual antiplatelet therapy after coronary stent implantation: to go too far is as bad as to fall short. Cardiovasc Diagn Ther. 2018;8(5):630-646. https://doi.org/10.21037/cdt.2018.10.01
  2. Matsuura Y, Moribayashi K, Kaikita K. Optimal Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention: A Focused Review on High Bleeding Risk. J Atheroscler Thromb. 2022;29(10):1409-1420. https://doi.org/10.5551/jat.RV17066
  3. Cao D, Chandiramani R, Chiarito M, Claessen BE, Mehran R. Evolution of antithrombotic therapy in patients undergoing percutaneous coronary intervention: a 40-year journey. Eur Heart J. 2021;42(4):339-351. https://doi.org/10.1093/eurheartj/ehaa824
  4. Galli M, Angiolillo DJ. Antiplatelet therapy in percutaneous coronary intervention: latest evidence from randomized controlled trials. Curr Opin Cardiol. 2021;36(4):390-396. https://doi.org/10.1097/HCO.0000000000000879
  5. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al.; ESC Scientific Document Group; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213-260. https://doi.org/10.1093/eurheartj/ehx419
  6. Abdennour L, Sourour N, Drir M, Premat K, Shotar E, Taylor G, et al. Preliminary Experience with Cangrelor for Endovascular Treatment of Challenging Intracranial Aneurysms. Clin Neuroradiol. 2020;30(3):453-461. https://doi.org/10.1007/s00062-019-00811-2
  7. Jastrzebska M, Marcinowska Z, Oledzki S, Chelstowski K, Siennicka A, Klysz M, et al. Variable gender-dependent platelet responses to combined antiplatelet therapy in patients with stable coronary-artery disease. J Physiol Pharmacol. 2018 Aug;69(4):595-605. https://doi.org/10.26402/jpp.2018.4.10
  8. Born GV. Aggregation of Blood Platelets by Adenosine Diphosphate and its Reversal. Nature. 1962 Jun 9;194:927-929. https://doi.org/10.1038/194927b0
  9. Gomez K, Anderson J, Baker P, Biss T, Jennings I, Lowe G, et al.; British Society for Haematology Guidelines. Clinical and laboratory diagnosis of heritable platelet disorders in adults and children: a British Society for Haematology Guideline. Br J Haematol. 2021;195(1):46-72. https://doi.org/10.1111/bjh.17690
  10. Koltai K, Kesmarky G, Feher G, Tibold A, Toth K. Platelet Aggregometry Testing: Molecular Mechanisms, Techniques and Clinical Implications. Int J Mol Sci. 2017 Aug 18;18(8):1803. https://doi.org/10.3390/ijms18081803
Published
2023-09-28
How to Cite
Kozachyshyn, N. I., Netiazhenko, V. Z., & Salo, S. V. (2023). Hemostasiological Aspects of PCI: Periprocedural Changes in the Activity of the Platelet Link of Hemocoagulation on the Background of Prior Double Antiplatelet Therapy in Patients with Chronic Coronary Syndrome. Ukrainian Journal of Cardiovascular Surgery, 31(3), 36-44. https://doi.org/10.30702/ujcvs/23.31(03)/KN045-3644

Most read articles by the same author(s)