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      Decreased Threshold of Aggregation to Low-Dose Epinephrine is Evidence of Platelet Hyperaggregability in Patients with Thrombosis

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          Abstract

          Sticky platelet syndrome has been described as a hereditary thrombophilic condition. The aim of this study is to identify the presence of platelet hyperaggregability in patients who have experienced thrombosis. Light-transmittance platelet aggregometry was used to assess for spontaneous platelet aggregation, aggregation in response to full and low-dose (LD) epinephrine (Epi) and adenosine diphosphate, as well as arachidonic acid, and identify a distinct pattern of platelet hyperaggregability. Light-transmittance platelet aggregometry results were correlated with PFA-100® (Dade-Behring, Marburg, Germany) results, when available. An exaggerated response to LD Epi was found in 68% of patients with thrombosis compared to only 36% of healthy controls (P=0.034). Patients with thrombosis, either arterial or venous, demonstrated an exaggerated response to LD Epi nearly twice as frequently as healthy controls, even without significant family history of thrombophilia or other known risk factors for thrombosis. This suggests that platelet hyperaggregability may be multifactorial in nature and not necessarily hereditary.

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          Evaluation of dose-related effects of aspirin on platelet function: results from the Aspirin-Induced Platelet Effect (ASPECT) study.

          Amena Etherington, Tania Gesheff, Kevin P Bliden … (2007)
          The antiplatelet effect of aspirin is attributed to platelet cyclooxygenase-1 inhibition. Controversy exists on the prevalence of platelet resistance to aspirin in patients with coronary artery disease and effects of aspirin dose on inhibition. Our primary aim was to determine the degree of platelet aspirin responsiveness in patients, as measured by commonly used methods, and to study the relation of aspirin dose to platelet inhibition. We prospectively studied the effect of aspirin dosing on platelet function in 125 stable outpatients with coronary artery disease randomized in a double-blind, double-crossover investigation (81, 162, and 325 mg/d for 4 weeks each over a 12-week period). At all doses of aspirin, platelet function was low as indicated by arachidonic acid (AA)-induced light transmittance aggregation, thrombelastography, and VerifyNow. At any 1 dose, resistance to aspirin was 0% to 6% in the overall group when AA was used as the agonist, whereas it was 1% to 27% by other methods [collagen and ADP-induced light transmittance aggregation, platelet function analyzer (PFA-100)]. Platelet response to aspirin as measured by collagen-induced light transmittance aggregation, ADP-induced light transmittance aggregation, PFA-100 (81 mg versus 162 mg, P < or = 0.05), and urinary 11-dehydrothromboxane B2 was dose-related (81 mg versus 325 mg, P = 0.003). No carryover effects were observed. The assessment of aspirin resistance is highly assay-dependent; aspirin is an effective blocker of AA-induced platelet function at all doses, whereas higher estimates of resistance were observed with methods that do not use AA as the stimulus. The observation of dose-dependent effects despite nearly complete inhibition of AA-induced aggregation suggests that aspirin may exert antiplatelet properties through non-cyclooxygenase-1 pathways and deserves further investigation.
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            Clinical utility of the PFA-100.

            J Favaloro (2008)
            The PFA-100 (platelet function analyzer) is a relatively new tool for the investigation of primary hemostasis. This article reviews the history of the PFA-100 and details its clinical utility in several settings. The PFA-100 was first introduced to us in 1995 in an issue of Seminars in Thrombosis And Hemostasis, which included data from a field trial headed by Dr. Eberhard Mammen. Since that time, the PFA-100 has featured in nearly 500 publications and some 35 reviews. The PFA-100 has potential utility in monitoring antiplatelet therapy (including aspirin) and as a screening tool for investigating possible von Willebrand disease (VWD) and various platelet disorders. The PFA-100 also has potential value for monitoring DDAVP (desmopressin) therapy in both VWD and functional platelet disorders. Most recent attention has focused on sensitivity to antiplatelet medication, where a new language has also emerged, with researchers talking about "aspirin resistance," "aspirin responsiveness," and "aspirin nonresponsiveness." Ultimately, the greatest strengths of the PFA-100 are its simplicity in use and excellent sensitivity to various hemostatic disturbances. However, because it is a "global" test system for primary hemostasis, this also creates a significant limitation because the PFA-100 is not specific for, nor predictive of, any particular disorder. However, used appropriately, the PFA-100 can be considered a worthwhile addition to hemostasis laboratories involved in the identification or therapeutic monitoring of primary hemostatic disorders. The potential future applications for this simple instrument are also briefly assessed.
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              Aspirin and clopidogrel: efficacy, safety, and the issue of drug resistance.

              Marco Cattaneo (2004)
              Aspirin and the thienopyridines ticlopidine and clopidogrel are antiplatelet agents that display good antithrombotic activity. In the past few years, the concept of aspirin resistance has been largely emphasized in the medical literature, although its definition is still uncertain. I suggest that "aspirin-resistant" should be considered as a description for those individuals in whom aspirin fails to inhibit thromboxane A2 production, irrespective of the results of unspecific tests of platelet function, such as the bleeding time, platelet aggregation, or the PFA-100 system. Less well known than aspirin resistance, but certainly better characterized, is the issue of "clopidogrel resistance," which is probably mostly caused by inefficient metabolism of the prodrug clopidogrel to its active metabolite. At present, aspirin and clopidogrel resistance should not be looked for in the clinical setting, because there is no definite demonstration of an association with clinical events conditioning cost-effective changes in patient management.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Hematol Rep
                Journal ID (iso-abbrev): Hematol Rep
                Journal ID (publisher-id): HR
                Title: Hematology Reports
                Publisher: PAGEPress Publications, Pavia, Italy
                ISSN (Print): 2038-8322
                ISSN (Electronic): 2038-8330
                Publication date (Electronic): 26 August 2014
                Publication date Collection: 26 August 2014
                Volume: 6
                Issue: 3
                Electronic Location Identifier: 5326
                Affiliations
                Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center , Los Angeles, CA, USA
                Author notes
                Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA. +1.310.423.5471 - +1.310.423.0483. oxana.tcherniantchouk@ 123456cshs.org

                Contributions: CH, was involved in data collection, literature search, data analysis and wrote the manuscript; SK, designed the study, analyzed the data and revised the manuscript; OT conceived and supervised the project, designed the study, analyzed the data, revised the manuscript and approved the final version.

                Conflict of interests: the authors declare no potential conflict of interests.

                Article
                DOI: 10.4081/hr.2014.5326
                PMC ID: 4194382
                PubMed ID: 25317317
                SO-VID: bcb10098-7fbf-42ef-9be1-f4feb5138145
                Copyright © © Copyright C. Hayes et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 January 2014
                Date revision received : 13 June 2014
                Date accepted : 01 August 2014
                Page count
                Figures: 3, Tables: 2, Equations: 0, References: 25, Pages: 6
                Categories
                Subject: Article

                ScienceOpen disciplines: Hematology
                Keywords: light-transmittance platelet aggregometry,hyperaggregable platelets,thrombosis,sticky platelet syndrome
                Data availability:
                ScienceOpen disciplines: Hematology
                Keywords: light-transmittance platelet aggregometry, hyperaggregable platelets, thrombosis, sticky platelet syndrome

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