Konference: 2013 18th Congress of the European Hematology Association - účast ČR
Kategorie: Myeloproliferativní nemoci
Téma: Thrombosis and vascular biology
Číslo abstraktu: P500
Autoři: MUDr. Martin Jakl; Prof.MUDr. Jaroslav Malý, CSc.; Mgr. Ilona Fátorová; Prof. MUDr. Jan Horáček, Ph.D.; Prof.MUDr. Radek Pudil, Ph.D.
Background:
High on-treatment platelet reactivity is associated with increased risk of repeated acute coronary syndrome and mortality. Unfortunately, there is a lack of evidence about association with other hemostasis system abnormities. Such knowledge is necessary for effective management of patients with poor response to antiplatelet drugs.
Aims:
The aim of the study was to assess the relationship between high ontreatment platelet reactivity and other hemostasis abnormities in patients with acute coronary syndromes.
Methods:
A total of 72 patients (57 men, 15 women, average age 64.1±10.4 years) with acute myocardial infarction treated by percutaneous coronary intervention were enrolled in the study. In these patients the response to aspirin and clopidogrel was assessed by impedance aggregometry. Simultaneously NTproBNP, TNF-α, of markers of primary hemostasis (platelet count, mean platelet volume, von Willebrand factor, P-selectin), coagulation (prothrombin time, activated partial tromboplastin time, fibrinogen, D-dimers, factor VIII, tissue microparticles), fibrinolysis (plasminogen, tissue plasmin activator, plasminogen inhibitor activator1, thrombin activated fibrinolysis inhibitor) were assessed.
Results:
In patients with poor response to aspirin, we documented increased level of von Willebrand factor (380.6±35.3 % vs. 201.8±76.6% P<0.001), factor VIII (408.1±201.2% vs. 227.6±92.0 %P<0.01), fibrinogen (6.4±1.6 g/L vs. 4.8±0.8 g/L P<0.001) plasminogen inhibitor activator 1 (26.7±4.3 μg/L vs. 15.9±9.7 μg/L P<0.05), NT-proBNP (631.9±732.4 vs. 262.2±423.7, P<0.05) and TNFα (10.5±5,2 vs. 6.0±5.4 P<0.05).
Summary / Conclusion:
Poor response to aspirin is associated with severe disturbances in the whole hemostasis system. It might be related to heart failur and immune system activation as well. Detailed description of these changes is essential for improvement of acute coronary syndrome treatment.On the other side, we did not find any factor associated with poor response to clopidogrel.
The work was supported by a long-term organisation development plan 1011 (FMHS).
Datum přednesení příspěvku: 14. 6. 2013
