Features of platelet hemostasis changes and antiplatlet treatment sensitivity in patients with stable forms of ischemic heart disease

Abstract

Aim: To study and to estimate the aggregation activity of platelets in patients with stable forms of IHD, taking into account their sensitivity to the antiplatelet treatment and influence of ITGA2 polymorphism.Materials and methods: there were examined 45 patients, who were on treatment in the Clinic “PheopHanya” (city Kyiv) and in Kyiv clinical hospital of railway transport № 2: 22 women and 23 men (mean age – 66,8±9,5 years). The study included patients with stable forms of IHD (stable effort angina of ІІ-ІІІ FC). All patients received the antiplatelet treatment with acetylsalicylic acid (48,9%), clopidrogel (37,8%) or their combination (13,3%).The functional activity of platelets was studied on the laser aggregometer Biola Aggregation Analyser. The reaction to the antiplatelet treatment was confirmed using Aggredyne-test. C807T polymorphism of ITGA2 was determined by the method of polymerase chain reaction (PCR).Based on the results of aggregation activity, sensitivity to the antiplatelet treatment, patients were distributed in two groups: І group – persons with the different degree of resistance to antiplatelet drugs (21 patients), ІІ group – sensitive to the treatment (24 persons). Polymorphism of ITGA2 and features of platelets functional activity depending on genotype were analyzed in each group.Results: Among all inductors of aggregation, only the reaction to arachidonic acid (AA) was less than control values (by 12,7%, р<0,05). The degree of the spontaneous and adenosine dyphosphate (ADP)-induced aggregation didn’t differ from the norm, collagen-induced one was 1,21 times higher than the control. The quantity of patients, insufficiently sensitive to the treatment was 46,7 % (21persons), according to the data of Aggredyne-test, 24 persons had an adequate response to the treatment. At the analysis of ITGA2 polymorphism Т/Т genotype prevailed in patients “non-respondents”, in ‘respondents” - С/С genotype. Т-allele presence among respondents was 90,5% persons, so the probability of its influence on sensitivity to the antiplatelet treatment was rather high.Conclusions: The decrease of sensitivity to antiplatelet drugs, connected with ITGA 2 polymorphism was observed in 46,7% of patients with stable IHD: resistance to the antiplatelet therapy is associated with Т/Т genotype of ITGA 2, presence of Т-allele in the genotype of patients-“non-respondents” was observed in 90,5% of persons, С/С genotype prevails at a positive response to the treatment