Antiplatelet Therapy Combinations and Thrombogenicity in Patients with Non-Valvular Atrial Fibrillation.
- Author:
Yongwhi PARK
1
;
Kye Hwan KIM
;
Min Gyu KANG
;
Jong Hwa AHN
;
Jeong Yoon JANG
;
Hyun Woong PARK
;
Jin Sin KOH
;
Jeong Rang PARK
;
Seok Jae HWANG
;
Young Hoon JEONG
;
Jin Yong HWANG
;
Hye Ryun LEE
;
Choong Hwan KWAK
Author Information
- Publication Type:Original Article
- Keywords: Atrial fibrillation; Platelet aggregation inhibitors; Blood platelets; Biomarker
- MeSH: Adenosine Diphosphate; Arachidonic Acid; Aspirin; Atrial Fibrillation*; Biomarkers; Blood Platelets; C-Reactive Protein; Collagen; Fibrinogen; Follow-Up Studies; Humans; Platelet Aggregation Inhibitors; Stroke
- From:Korean Circulation Journal 2017;47(3):366-376
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND OBJECTIVES: Combination antiplatelet therapy reduces the risk of ischemic stroke compared with aspirin monotherapy in non-valvular atrial fibrillation (NVAF) patients. The underlying mechanism, however, remains unclear. In addition, the association between platelet inhibition and thrombogenicity in NVAF has not been evaluated. SUBJECTS AND METHODS: We randomized 60 patients with NVAF that were taking 100 mg of aspirin daily (>1 month) to adding 75 mg of clopidogrel daily (CLPD group), 100 mg of cilostazol twice daily (CILO group), or 1000 mg of omega-3 polyunsaturated fatty acid twice daily (PUFA group). Biomarkers (von Willebrand factor antigen [vWF:Ag], fibrinogen, D-dimer, and high-sensitivity C-reactive protein [hs-CRP]) and platelet reactivity (PR), which were the levels stimulated by adenosine diphosphate (ADP), thrombin-receptor agonist peptide, collagen, and arachidonic acid, were measured at baseline and 30-day follow-up. RESULTS: Combination antiplatelet therapy significantly reduced vWF:Ag and fibrinogen levels (7.7 IU/dL, p=0.015 and 15.7 mg/dL, p=0.005, respectively), but no changes were found in D-dimer and hs-CRP levels. The CLPD and CILO groups showed fibrinogen and vWF:Ag level reductions (24.9 mg/dL, p=0.015 and 9.3 IU/dL, p=0.044, respectively), whereas the PUFA group did not show any differences in biomarkers. Irrespective of regimen, the changes in fibrinogen and vWF:Ag levels were mainly associated with the change in ADP-mediated PR (r=0.339, p=0.008 and r=0.322, p=0.012, respectively). CONCLUSION: In patients with NVAF, combination antiplatelet therapy showed reductions for vWF:Ag and fibrinogen levels, which may be associated with the inhibitory levels of ADP-mediated PR. The clinical implications of these findings need to be evaluated in future trials.
