title: Response to antiplatelet therapy and platelet reactivity to thrombin receptor activating peptide-6 in cardiovascular interventions: Differences between peripheral and coronary angioplasty.
abstract: BACKGROUND
  The long-term prognosis of patients with peripheral arterial disease (PAD) is significantly worse than the prognosis of coronary artery disease (CAD) patients. Detrimental platelet activation could contribute to the increased rate of adverse cardiovascular events in PAD. We therefore investigated whether response to antiplatelet therapy and thrombin inducible platelet activation differ between patients with best medical therapy undergoing angioplasty and stenting for symptomatic PAD (n = 166) or CAD (n = 104).
  
  
  METHODS
  Adenosine diphosphate (ADP), arachidonic acid (AA) and thrombin receptor activating peptide (TRAP)-6 inducible platelet reactivity was measured by multiple electrode aggregometry (MEA). Platelet surface expression of P-selectin and activated glycoprotein IIb/IIIa (GPIIb/IIIa) in response to ADP, AA, and TRAP-6, and the formation of monocyte-platelet aggregates (MPA) in response to ADP and TRAP-6 were assessed by flow cytometry.
  
  
  RESULTS
  Patients with PAD had significantly higher platelet reactivity in response to ADP and AA by MEA compared to CAD patients. Likewise, the expression of P-selectin and GPIIb/IIIa following stimulation with ADP and AA, and MPA formation in response to ADP were significantly higher in PAD patients than in CAD patients. In response to TRAP-6, patients with PAD showed a significantly increased platelet aggregation by MEA, higher expression of activated GPIIb/IIIa, and more pronounced formation of MPA than CAD patients.
  
  
  CONCLUSIONS
  Following angioplasty and stenting, PAD patients exhibit a significantly diminished response to dual antiplatelet therapy and an increased susceptibility to TRAP-6 inducible platelet activation compared to CAD patients.
authors.affiliation: Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria. Electronic address: thomas.gremmel@meduniwien.ac.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gremmel
authors.affiliation: Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
authors.forename: Endri
authors.initials: E
authors.lastname: Xhelili
authors.affiliation: Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
authors.forename: Sabine
authors.initials: S
authors.lastname: Steiner
authors.affiliation: Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
authors.forename: Renate
authors.initials: R
authors.lastname: Koppensteiner
authors.affiliation: Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
authors.forename: Christoph W
authors.initials: CW
authors.lastname: Kopp
authors.affiliation: Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Simon
authors.initials: S
authors.lastname: Panzer
mesh_terms: D000244:Adenosine Diphosphate / Q000097:blood; D000368:Aged; D017130:Angioplasty; D015906:Angioplasty, Balloon, Coronary; D016718:Arachidonic Acid / Q000097:blood; D001241:Aspirin / Q000008:administration & dosage; D001792:Blood Platelets / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000378:metabolism*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000187:drug effects; D019007:P-Selectin / Q000378:metabolism; D010446:Peptide Fragments / Q000097:blood / Q000378:metabolism*; D062645:Percutaneous Coronary Intervention; D058729:Peripheral Arterial Disease / Q000097:blood / Q000188:drug therapy*; D015539:Platelet Activation / Q000187:drug effects; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000737:chemistry*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000378:metabolism; D011379:Prognosis; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D019007:P-Selectin; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; C082835:thrombin receptor peptide (42-47); D016718:Arachidonic Acid; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Angioplasty; Coronary artery disease; Peripheral arterial disease; Platelet reactivity