1. Von Willebrand Factor Antigen Predicts Response to Double Dose of Aspirin and Clopidogrel by PFA-100 in Patients Undergoing Primary Angioplasty for St Elevation Myocardial Infarction
- Author
-
Alberto Ranieri De Caterina, Sergio Berti, Endrin Koni, Federica Marchi, Maria Serena Parri, Stefano Maffei, Jacopo Gianetti, and Francesca Della Pina
- Subjects
Male ,medicine.medical_specialty ,Ticlopidine ,Platelet Function Tests ,Article Subject ,Myocardial Infarction ,lcsh:Medicine ,ADAMTS13 Protein ,lcsh:Technology ,General Biochemistry, Genetics and Molecular Biology ,Von Willebrand factor ,Predictive Value of Tests ,Internal medicine ,von Willebrand Factor ,medicine ,Myocardial Revascularization ,Humans ,Platelet ,Myocardial infarction ,lcsh:Science ,General Environmental Science ,Aged ,Retrospective Studies ,Aspirin ,biology ,business.industry ,lcsh:T ,PFA-100 ,lcsh:R ,General Medicine ,Middle Aged ,medicine.disease ,Clopidogrel ,Surgery ,ADAM Proteins ,biology.protein ,Cardiology ,Platelet aggregation inhibitor ,lcsh:Q ,Female ,business ,Platelet Aggregation Inhibitors ,medicine.drug ,Follow-Up Studies ,Research Article ,circulatory and respiratory physiology - Abstract
Von Willebrand factor (VWF) is an emerging risk factor in acute coronary syndromes. Platelet Function Analyzer (PFA-100) with Collagen/Epinephrine (CEPI) is sensitive to functional alterations of VWF and also identifies patients with high on-treatment platelet reactivity (HPR). The objective of this study was to verify the effect of double dose (DD) of aspirin and clopidogrel on HPR detected by PFA-100 and its relation to VWF and to its regulatory metalloprotease ADAMTS-13. Between 2009 and 2011 we enrolled 116 consecutive patients with ST elevation myocardial infarction undergoing primary PCI with HPR at day 5 after PCI. Patients recruited were then randomized between a standard dose (SD,n=58) or DD of aspirin and clopidogrel (DD,n=58), maintained for 6 months follow-up. Blood samples for PFA-100, light transmittance aggregometry, and VWF/ADAMTS-13 analysis were collected after 5, 30, and 180 days (Times 0, 1, and 2). At Times 1 and 2 we observed a significantly higher CEPI closure times (CT) in DD as compared to SD (P<0.001). Delta of CEPI-CT(T1-T0)was significantly related to VWF (P<0.001) and inversely related to ADAMTS-13 (0.01). Responders had a significantly higher level of VWF atT0. Finally, in a multivariate model analysis, VWF and ADAMTS-13 in resulted significant predictors of CEPI-CT response (P=0.02). HRP detected by PFA-100 in acute myocardial infarction is reversible by DD of aspirin and clopidogrel; the response is predicted by basal levels of VWF and ADAMTS-13. PFA-100 may be a useful tool to risk stratification in acute coronary syndromes given its sensitivity to VWF.
- Published
- 2013
- Full Text
- View/download PDF