Baseline platelet aggregation and major receptor expression predict subsequent activity following thrombolysis for acute myocardial infarction.
The early identification of patients with heightened platelet activity for aggressive antiplatelet regimens represents a critical clinical issue in acute myocardial infarction (AMI) therapy. We sought to determine whether the degree of pre-reperfusion platelet function is related to subsequent activity following thrombolysis. Platelets were investigated at baseline and at 24 h following thrombolytic therapy by aggregometry, and flow cytometry in 19 AMI patients enrolled in the GUSTO-III trial. Regression analysis revealed a significant correlation for 5 microM ADP (r2 = 0.529), 10 microM ADP (r2 = 0.445), thrombin (r2 = 0.226), collagen (r2 = 0.568), and ristocetin-induced aggregation (r2 = 0.964). Platelet expression linearly correlated for GPIIb/IIIa (r2 = 0.337), P-selectin (r = 0.817), PECAM-1 (r2 = 0.586), and the vitronectin receptor (r2 = 0.634). The data suggest that the baseline characteristics predict future platelet activity, and may prospectively identify patients who will benefit most from antiplatelet strategies after coronary thrombolysis.
Gurbel
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PA
Sinai Center for Thrombosis Research, Baltimore, MD 21215, USA. Heartdrug@aol.com
Kereiakes
D J
DJ
Atar
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Serebruany
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VL
D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy*; D019007:P-Selectin / Q000097:blood / Q000187:drug effects; D010865:Pilot Projects; D010974:Platelet Aggregation / Q000187:drug effects / Q000502:physiology*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010976:Platelet Count; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000097:blood* / Q000187:drug effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000187:drug effects / Q000378:metabolism; D010980:Platelet Membrane Glycoproteins / Q000187:drug effects / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D019030:Receptors, Vitronectin / Q000097:blood* / Q000187:drug effects; D015912:Thrombolytic Therapy
D015415:Biomarkers; D019007:P-Selectin; D010975:Platelet Aggregation Inhibitors; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D010980:Platelet Membrane Glycoproteins; D019030:Receptors, Vitronectin