Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation
Korean Circulation Journal
;
: 366-376, 2017.
Article
in English
| WPRIM
| ID: wpr-76470
ABSTRACT
BACKGROUND AND OBJECTIVES:
Combination antiplatelet therapy reduces the risk of ischemic stroke compared with aspirin monotherapy in non-valvular atrial fibrillation (NVAF) patients. The underlying mechanism, however, remains unclear. In addition, the association between platelet inhibition and thrombogenicity in NVAF has not been evaluated. SUBJECTS ANDMETHODS:
We randomized 60 patients with NVAF that were taking 100 mg of aspirin daily (>1 month) to adding 75 mg of clopidogrel daily (CLPD group), 100 mg of cilostazol twice daily (CILO group), or 1000 mg of omega-3 polyunsaturated fatty acid twice daily (PUFA group). Biomarkers (von Willebrand factor antigen [vWFAg], fibrinogen, D-dimer, and high-sensitivity C-reactive protein [hs-CRP]) and platelet reactivity (PR), which were the levels stimulated by adenosine diphosphate (ADP), thrombin-receptor agonist peptide, collagen, and arachidonic acid, were measured at baseline and 30-day follow-up.RESULTS:
Combination antiplatelet therapy significantly reduced vWFAg and fibrinogen levels (7.7 IU/dL, p=0.015 and 15.7 mg/dL, p=0.005, respectively), but no changes were found in D-dimer and hs-CRP levels. The CLPD and CILO groups showed fibrinogen and vWFAg level reductions (24.9 mg/dL, p=0.015 and 9.3 IU/dL, p=0.044, respectively), whereas the PUFA group did not show any differences in biomarkers. Irrespective of regimen, the changes in fibrinogen and vWFAg levels were mainly associated with the change in ADP-mediated PR (r=0.339, p=0.008 and r=0.322, p=0.012, respectively).CONCLUSION:
In patients with NVAF, combination antiplatelet therapy showed reductions for vWFAg and fibrinogen levels, which may be associated with the inhibitory levels of ADP-mediated PR. The clinical implications of these findings need to be evaluated in future trials.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Atrial Fibrillation
/
Blood Platelets
/
C-Reactive Protein
/
Fibrinogen
/
Platelet Aggregation Inhibitors
/
Biomarkers
/
Adenosine Diphosphate
/
Aspirin
/
Follow-Up Studies
/
Collagen
Type of study:
Controlled clinical trial
/
Observational study
/
Prognostic study
/
Risk factors
Limits:
Humans
Language:
English
Journal:
Korean Circulation Journal
Year:
2017
Type:
Article
Similar
MEDLINE
...
LILACS
LIS