title: Influence of Different β-Blockers on Platelet Aggregation in Patients With Coronary Artery Disease on Dual Antiplatelet Therapy.
abstract: BACKGROUND
  The use of β-blockers in the treatment of patients with coronary heart disease is associated with a decrease in the frequency of angina pectoris and mortality of patients. Due to the severity of the disease and previous cardiovascular interventions, many patients with coronary artery disease (CAD) use dual antiplatelet therapy to achieve greater inhibition of platelet aggregation. The influence of β-blockers on platelet aggregation in patients using antiplatelet therapy is not well understood.
  
  
  OBJECTIVE
  To examine the effect of different β-blockers on platelet aggregation in patients on dual antiplatelet therapy.
  
  
  METHODS
  The study included 331 patients who were treated at the Department of Cardiology, Clinical Center Kragujevac during 2011. Patients were divided into 4 groups depending on the type of β-blockers that were used (bisoprolol, nebivolol, metoprolol, and carvedilol). Platelet aggregation was measured using the multiplate analyzer and expressed through the value of adenosine diphosphate (ADP) test (to assess the effect of clopidogrel), ASPI test (to assess the effect of acetyl salicylic acid), TRAP test (to assess baseline platelet aggregation), and the ratio of ADP/TRAP and ASPI/TRAP ASPI/TRAP (ASPI - aranchidonic acid induced aggregation, TRAP - thrombin receptor activating peptide) representing the degree of inhibition of platelet aggregation compared to the basal value. In consideration were taken the representation of demographic, clinical characteristics, laboratory parameters, and cardiovascular medications between the groups.
  
  
  RESULTS
  Patients who used nebivolol had a significantly lower value of the ratio of ADP/TRAP (0.39 ± 0.30) compared to patients who used bisoprolol (0.48 ± 0.26; P = .038), and trend toward the lower values of ADP test (328.0 ± 197.3 vs 403.7 ± 213.2; P = .059), while there was no statistically significant difference in values of other laboratory parameters of platelet function between other groups.
  
  
  CONCLUSIONS
  Patients with CAD on dual antiplatelet therapy who used nebivolol had significantly lower levels of residual ADP-induced platelet aggregation compared to baseline than patients who used bisoprolol.
authors: Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Vladimir
authors: V
authors: Ignjatovic
authors: Pacemaker center, Clinical Center Serbia, Belgrade, Serbia.
authors: Sinisa
authors: S
authors: Pavlovic
authors: Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Vladimir
authors: V
authors: Miloradovic
authors: Clinic for Hematology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Nebojsa
authors: N
authors: Andjelkovic
authors: Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Goran
authors: G
authors: Davidovic
authors: Clinic for Hematology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Predrag
authors: P
authors: Djurdjevic
authors: Clinic for Nephrology and Urology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Radojica
authors: R
authors: Stolic
authors: Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Violeta
authors: V
authors: Iric-Cupic
authors: Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Ivan
authors: I
authors: Simic
authors: Center for Nuclear Medicine, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Vesna D
authors: VD
authors: Ignjatovic
authors: Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Njegos
authors: N
authors: Petrovic
authors: Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Zorica
authors: Z
authors: Smiljanic
authors: Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Vladimir
authors: V
authors: Zdravkovic
authors: Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia simovicst@gmail.com.
authors: Stefan
authors: S
authors: Simovic
authors: Clinic for Hematology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Danijela
authors: D
authors: Jovanovic
authors: Center for Endocrinology, Clinical Center Kragujevac, Kragujevac, Serbia.
authors: Jelena
authors: J
authors: Nesic
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D017298:Bisoprolol / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D000068577:Nebivolol / Q000627:therapeutic use; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011412:Propanolamines / Q000627:therapeutic use; D011446:Prospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D002227:Carbazoles; D010975:Platelet Aggregation Inhibitors; D011412:Propanolamines; D000068577:Nebivolol; D000077261:Carvedilol; D000077144:Clopidogrel; D008790:Metoprolol; D013988:Ticlopidine; D001241:Aspirin; D017298:Bisoprolol
keywords: acute myocardial infarction; angina; antithrombotic; heart disease; ischemic; molecular biology; β-adrenergic pathways