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Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation

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 thro...

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Autores principales: Park, Yongwhi, Kim, Kye Hwan, Kang, Min Gyu, Ahn, Jong-Hwa, Jang, Jeong Yoon, Park, Hyun Woong, Koh, Jin-Sin, Park, Jeong-Rang, Hwang, Seok-Jae, Jeong, Young-Hoon, Hwang, Jin-Yong, Lee, Hye Ryun, Kwak, Choong Hwan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Cardiology 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449531/
https://www.ncbi.nlm.nih.gov/pubmed/28567087
http://dx.doi.org/10.4070/kcj.2016.0384
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author Park, Yongwhi
Kim, Kye Hwan
Kang, Min Gyu
Ahn, Jong-Hwa
Jang, Jeong Yoon
Park, Hyun Woong
Koh, Jin-Sin
Park, Jeong-Rang
Hwang, Seok-Jae
Jeong, Young-Hoon
Hwang, Jin-Yong
Lee, Hye Ryun
Kwak, Choong Hwan
author_facet Park, Yongwhi
Kim, Kye Hwan
Kang, Min Gyu
Ahn, Jong-Hwa
Jang, Jeong Yoon
Park, Hyun Woong
Koh, Jin-Sin
Park, Jeong-Rang
Hwang, Seok-Jae
Jeong, Young-Hoon
Hwang, Jin-Yong
Lee, Hye Ryun
Kwak, Choong Hwan
author_sort Park, Yongwhi
collection PubMed
description 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 AND METHODS: 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 [vWF:Ag], 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 vWF:Ag 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 vWF:Ag 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 vWF:Ag 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 vWF:Ag 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.
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spelling pubmed-54495312017-05-31 Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation Park, Yongwhi Kim, Kye Hwan Kang, Min Gyu Ahn, Jong-Hwa Jang, Jeong Yoon Park, Hyun Woong Koh, Jin-Sin Park, Jeong-Rang Hwang, Seok-Jae Jeong, Young-Hoon Hwang, Jin-Yong Lee, Hye Ryun Kwak, Choong Hwan Korean Circ J Original Article 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 AND METHODS: 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 [vWF:Ag], 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 vWF:Ag 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 vWF:Ag 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 vWF:Ag 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 vWF:Ag 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. The Korean Society of Cardiology 2017-05 2017-05-25 /pmc/articles/PMC5449531/ /pubmed/28567087 http://dx.doi.org/10.4070/kcj.2016.0384 Text en Copyright © 2017 The Korean Society of Cardiology http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Park, Yongwhi
Kim, Kye Hwan
Kang, Min Gyu
Ahn, Jong-Hwa
Jang, Jeong Yoon
Park, Hyun Woong
Koh, Jin-Sin
Park, Jeong-Rang
Hwang, Seok-Jae
Jeong, Young-Hoon
Hwang, Jin-Yong
Lee, Hye Ryun
Kwak, Choong Hwan
Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation
title Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation
title_full Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation
title_fullStr Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation
title_full_unstemmed Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation
title_short Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation
title_sort antiplatelet therapy combinations and thrombogenicity in patients with non-valvular atrial fibrillation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449531/
https://www.ncbi.nlm.nih.gov/pubmed/28567087
http://dx.doi.org/10.4070/kcj.2016.0384
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