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
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...
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Wiley
2013-01-01
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| Series: | The Scientific World Journal |
| Online Access: | http://dx.doi.org/10.1155/2013/313492 |
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| author | Jacopo Gianetti Maria Serena Parri Francesca Della Pina Federica Marchi Endrin Koni Alberto De Caterina Stefano Maffei Sergio Berti |
| author_facet | Jacopo Gianetti Maria Serena Parri Francesca Della Pina Federica Marchi Endrin Koni Alberto De Caterina Stefano Maffei Sergio Berti |
| author_sort | Jacopo Gianetti |
| collection | DOAJ |
| description | 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 at T0. 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. |
| format | Article |
| id | doaj-art-2e148f957e7f44dfa284919cfd8fb961 |
| institution | OA Journals |
| issn | 1537-744X |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Scientific World Journal |
| spelling | doaj-art-2e148f957e7f44dfa284919cfd8fb9612025-08-20T02:38:49ZengWileyThe Scientific World Journal1537-744X2013-01-01201310.1155/2013/313492313492Von Willebrand Factor Antigen Predicts Response to Double Dose of Aspirin and Clopidogrel by PFA-100 in Patients Undergoing Primary Angioplasty for St Elevation Myocardial InfarctionJacopo Gianetti0Maria Serena Parri1Francesca Della Pina2Federica Marchi3Endrin Koni4Alberto De Caterina5Stefano Maffei6Sergio Berti7Operative Unit of Cardiology, Fondazione Gabriele Monasterio, Ospedale del Cuore “G. Pasquinucci”, Via Aurelia Sud, 54100 Massa, ItalyOperative Unit of Cardiology, Fondazione Gabriele Monasterio, Ospedale del Cuore “G. Pasquinucci”, Via Aurelia Sud, 54100 Massa, ItalyOperative Unit of Cardiology, Fondazione Gabriele Monasterio, Ospedale del Cuore “G. Pasquinucci”, Via Aurelia Sud, 54100 Massa, ItalyOperative Unit of Cardiology, Fondazione Gabriele Monasterio, Ospedale del Cuore “G. Pasquinucci”, Via Aurelia Sud, 54100 Massa, ItalyOperative Unit of Cardiology, Fondazione Gabriele Monasterio, Ospedale del Cuore “G. Pasquinucci”, Via Aurelia Sud, 54100 Massa, ItalyOperative Unit of Cardiology, Fondazione Gabriele Monasterio, Ospedale del Cuore “G. Pasquinucci”, Via Aurelia Sud, 54100 Massa, ItalyOperative Unit of Cardiology, Fondazione Gabriele Monasterio, Ospedale del Cuore “G. Pasquinucci”, Via Aurelia Sud, 54100 Massa, ItalyOperative Unit of Cardiology, Fondazione Gabriele Monasterio, Ospedale del Cuore “G. Pasquinucci”, Via Aurelia Sud, 54100 Massa, ItalyVon 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 at T0. 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.http://dx.doi.org/10.1155/2013/313492 |
| spellingShingle | Jacopo Gianetti Maria Serena Parri Francesca Della Pina Federica Marchi Endrin Koni Alberto De Caterina Stefano Maffei Sergio Berti 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 The Scientific World Journal |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | http://dx.doi.org/10.1155/2013/313492 |
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