Effect of clopidogrel on adhesion molecules, hemostasis, and fibrinolysis in coronary heart disease.
BACKGROUND
The interaction among inflammation, Hemostasis, and fibrinolysis plays a major role in the genesis of coronary artery disease (CAD). The aim of the study was to compare the effect of clopidogrel plus aspirin versus aspirin alone on cellular adhesion molecules on leukocytes, soluble adhesion molecules, and molecular markers of coagulation and fibrinolysis in patients with CAD.


METHODS
In this randomized, placebo-controlled, and double-blind study, 42 patients with chronic angina pectoris were included. All patients were treated with aspirin (ASA). Twenty-three patients received clopidogrel additionally (75 mg/day with a 300-mg loading dose) for 14 days. Nineteen patients received placebo additionally. Soluble adhesion molecules (sICAM-1, sVCAM-1, sP-selectin), surface expression of CD54, CD11a, CD11b, CD40, CD40L, CD41, CD42b, and CD62L on lymphocytes, monocytes, and neutrophils, and markers of hemostasis and fibrinolysis (TAT, PAP, D-dimers) were measured.


RESULTS
In the ASA + clopidogrel group, no change in surface expression of cellular adhesion molecules on leukocytes and on plasma levels of sICAM-1, sVCAM-1, sP-selectin, TAT, PAP, and D-dimers was detectable.


CONCLUSIONS
Clopidogrel plus aspirin for 2 weeks did not result in a detectable benefit versus sole aspirin therapy regarding cellular adhesion molecules on leukocytes, plasma markers of coagulation, fibrinolysis, and soluble adhesion molecules in patients with CAD.
First Department of Medicine, University Hospital Mannheim, Mannheim, Germany. thomas.walter@med.ma.uni-heidelberg.de
Thomas
T
Walter
Sebastian
S
Szabo
Silke
S
Kazmaier
Stefanie
S
Swoboda
Tim
T
Suselbeck
Martina
M
Brueckmann
M
M
Borggrefe
Martin E
ME
Beyer
Hans Martin
HM
Hoffmeister
D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy* / Q000378:metabolism; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D015815:Cell Adhesion Molecules / Q000378:metabolism*; D002908:Chronic Disease; D000077144:Clopidogrel; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D005434:Flow Cytometry; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
D015815:Cell Adhesion Molecules; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin