Pharmacodynamic effects of early aspirin withdrawal after percutaneous coronary intervention in patients with atrial fibrillation treated with ticagrelor or prasugrel.

IF 2.5 3区 医学 Q3 CELL BIOLOGY
Platelets Pub Date : 2025-12-01 Epub Date: 2025-05-23 DOI:10.1080/09537104.2025.2507037
Mark A Sammut, Mohammed E F Rahman, Claire Bridge, Jessica Hanson, Heather Judge, Bethany Lynch, Emily Maz, Hannah McMellon, Janet Middle, Georgia Williamson, William A E Parker, Justin Lee, Robert F Storey
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引用次数: 0

Abstract

Dual antithrombotic therapy (DAT) without aspirin reduces bleeding compared with triple antithrombotic therapy (TAT) in patients with atrial fibrillation who have undergone percutaneous coronary intervention, without apparently increasing ischemic events. A prospective pharmacodynamic study was performed to investigate the impact of aspirin on bleeding time, platelet function and fibrin clot analysis in this population. Patients receiving TAT (n = 16), comprising aspirin, ticagrelor/prasugrel and a direct-acting oral anticoagulant (DOAC), were compared with those receiving DAT without aspirin (n = 18). Bleeding time was reduced with DAT compared with TAT (median 27.8 vs 30.0 minutes, p = .005). Assessed by light transmission aggregometry, median platelet aggregation was significantly increased with DAT compared with TAT in response to arachidonic acid (63 vs 3%, p = .002) and collagen (72 vs 37%, p < .001) but not 5-μmol/L adenosine diphosphate (25 vs 27%, p = .966) or thrombin-receptor-activating peptide (37 vs 24%, p = .086). VerifyNow P2Y12 assay showed > 70% inhibition in all patients. Fibrin clot lysis time and maximum turbidity were similar between groups. Using P2Y12 inhibitors of consistent potency, DAT improves hemostasis through sparing cyclooxygenase-1-mediated platelet activation but has a comparable effect to TAT on other pathways and fibrin clot properties. DAT with ticagrelor/prasugrel and DOAC may provide sufficient antithrombotic effect without excessive anti-hemostatic effect.

替格瑞洛或普拉格雷治疗房颤患者经皮冠状动脉介入治疗后早期停药的药效学影响。
经皮冠状动脉介入治疗的房颤患者,与三重抗血栓治疗(TAT)相比,不加阿司匹林的双重抗血栓治疗(DAT)可减少出血,且没有明显增加缺血事件。一项前瞻性药效学研究旨在调查阿司匹林对该人群出血时间、血小板功能和纤维蛋白凝块分析的影响。接受TAT的患者(n = 16),包括阿司匹林、替格瑞洛/普拉格雷和直接作用口服抗凝剂(DOAC),与不服用阿司匹林的DAT患者(n = 18)进行比较。与TAT相比,DAT组出血时间缩短(中位数27.8 vs 30.0分钟,p = 0.005)。通过光透射聚集法评估,与TAT相比,DAT组对花生四烯酸(63比3%,p = 0.002)、胶原(72比37%,p = 0.966)或凝血酶受体激活肽(37比24%,p = 0.086)的反应中位血小板聚集量显著增加。VerifyNow P2Y12检测显示,所有患者的抑制率均为bbb70 %。两组间纤维蛋白凝块溶解时间和最大浊度相似。使用一致效力的P2Y12抑制剂,DAT通过保留环氧化酶-1介导的血小板活化来改善止血,但在其他途径和纤维蛋白凝块特性上与TAT具有相当的效果。替格瑞洛/普拉格雷联合DOAC可提供足够的抗血栓作用,而不会产生过多的止血作用。
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来源期刊
Platelets
Platelets 医学-细胞生物学
CiteScore
6.70
自引率
3.00%
发文量
79
审稿时长
1 months
期刊介绍: Platelets is an international, peer-reviewed journal covering all aspects of platelet- and megakaryocyte-related research. Platelets provides the opportunity for contributors and readers across scientific disciplines to engage with new information about blood platelets. The journal’s Methods section aims to improve standardization between laboratories and to help researchers replicate difficult methods. Research areas include: Platelet function Biochemistry Signal transduction Pharmacology and therapeutics Interaction with other cells in the blood vessel wall The contribution of platelets and platelet-derived products to health and disease The journal publishes original articles, fast-track articles, review articles, systematic reviews, methods papers, short communications, case reports, opinion articles, commentaries, gene of the issue, and letters to the editor. Platelets operates a single-blind peer review policy. Authors can choose to publish gold open access in this journal.
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