Cigarette Smoking and Antiplatelet Effects of Aspirin Monotherapy Versus Clopidogrel Monotherapy in Patients with Atherosclerotic Disease: Results of a Prospective Pharmacodynamic Study | springermedizin.de

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Journal of Cardiovascular Translational Research

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01.02.2014

Cigarette Smoking and Antiplatelet Effects of Aspirin Monotherapy Versus Clopidogrel Monotherapy in Patients with Atherosclerotic Disease: Results of a Prospective Pharmacodynamic Study

verfasst von: Fabiana Rollini, Francesco Franchi, Jung Rae Cho, Christopher DeGroat, Mona Bhatti, Elisabetta Ferrante, Ronakkumar Patel, Andrew Darlington, Antonio Tello-Montoliu, Bhaloo Desai, JoséLuis Ferreiro, Ana Muniz-Lozano, Martin M. Zenni, Luis A. Guzman, Theodore A. Bass, Dominick J. Angiolillo

Erschienen in: Journal of Cardiovascular Translational Research | Ausgabe 1/2014

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Abstract

Smokers have a greater relative benefit of clopidogrel therapy compared with nonsmokers, likely attributed to its enhanced pharmacodynamic (PD) effects. However, to date, all PD studies have been conducted in patients on dual antiplatelet therapy with aspirin and clopidogrel, and it is unknown whether clopidogrel monotherapy can offer more effective antithrombotic effects compared with aspirin alone among smoking patients. Sixty aspirin-treated (81 mg/day) patients with vascular disease, classified as nonsmokers, light smokers, and heavy smokers according to cotinine serum levels, were enrolled. Patients were switched to clopidogrel (75 mg/day) monotherapy for 7–10 days. PD assessments were performed before and after switch by multiple electrode aggregometry (MEA) and kaolin-activated thromboelastography (TEG). Complete PD data were obtained in 57 patients (nonsmokers, n = 27; light smokers, n = 13; heavy smokers, n = 17). On treatment platelet reactivity following MEA, adenosine diphosphate (ADP) + prostaglandin E₁ (PGE1) and thrombin receptor-activating peptide (TRAP) stimuli were significantly lower among heavy smokers following switch to clopidogrel. A significant inverse effect was observed with MEA arachidonic acid (ASPI), while neutral findings were shown with MEA collagen (COLL) stimulus. Thrombin and fibrin activity assessed by clot generation parameters were all nonsignificantly different but showed trends towards enhanced antithrombotic activity with clopidogrel among heavy smokers. In heavy smokers with vascular disease manifestations, clopidogrel is associated with enhanced platelet inhibitory effects, affecting purinergic and non-purinergic pathways, compared with aspirin as measured by MEA. Moreover, among smokers, clopidogrel offers trends towards enhanced effects on parameters of clot generation measured by TEG.

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Titel: Cigarette Smoking and Antiplatelet Effects of Aspirin Monotherapy Versus Clopidogrel Monotherapy in Patients with Atherosclerotic Disease: Results of a Prospective Pharmacodynamic Study
verfasst von: Fabiana Rollini
Francesco Franchi
Jung Rae Cho
Christopher DeGroat
Mona Bhatti
Elisabetta Ferrante
Ronakkumar Patel
Andrew Darlington
Antonio Tello-Montoliu
Bhaloo Desai
JoséLuis Ferreiro
Ana Muniz-Lozano
Martin M. Zenni
Luis A. Guzman
Theodore A. Bass
Dominick J. Angiolillo
Publikationsdatum: 01.02.2014
Verlag: Springer US
Erschienen in: Journal of Cardiovascular Translational Research / Ausgabe 1/2014
Print ISSN: 1937-5387
Elektronische ISSN: 1937-5395
DOI: https://doi.org/10.1007/s12265-013-9535-3

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