Platelet function, coagulation and fibrinolysis in patients with previous coronary and cerebrovascular ischemic events

Carlos José Dornas Gonçalves Barbosa,Renata De Souza Barreiros,André Franci,Flávia Bittar Brito Arantes,Remo Holanda De Mendonça Furtado,Célia Maria Cassaro Strunz,Tânia Rúbia Flores Da Rocha,Luciano Moreira Baracioli,José Antônio Franchini Ramires,Roberto Kalil-Filho,José Carlos Nicolau

doi:10.6061/clinics/2019/e1222

Abstract

OBJECTIVES:Ischemic stroke (IS) or transient ischemic attack (TIA) history is present in 4-17% of patients with coronary artery disease (CAD). This subgroup of patients is at high risk for both ischemic and bleeding events. The aim of this study was to determine the role of platelet aggregability, coagulation and endogenous fibrinolysis in patients with CAD and previous IS or TIA.METHODS:A prospective case-control study that included 140 stable CAD patients divided into two groups: the CASE group (those with a previous IS/TIA, n=70) and the CONTROL group (those without a previous IS/TIA, n=70). Platelet aggregability (VerifyNow Aspirin® and VerifyNow P2Y12®), coagulation (fibrinogen and thromboelastography by Reorox®) and endogenous fibrinolysis (D dimer and plasminogen activator inhibitor-1) were evaluated.RESULTS:Patients in the CASE group presented significantly higher systolic blood pressure levels (135.84±16.09 vs 123.68±16.11, p<0.01), significantly more previous CABG (25.71% vs 10%, p=0.015) and significantly higher calcium channel blocker usage (42.86% vs 24.29%, p=0.02) than those in the control group. In the adjusted models, low triglyceride values, low hemoglobin values and higher systolic blood pressure were significantly associated with previous IS/TIA (CASE group). Most importantly, platelet aggregability, coagulation and fibrinolysis tests were not independently associated with previous cerebrovascular ischemic events (CASE group).CONCLUSION:Platelet aggregability, coagulation and endogenous fibrinolysis showed similar results among CAD patients with and without previous IS/TIA. Therefore, it remains necessary to identify other targets to explain the higher bleeding risk presented by these patients.

Highlights

Study population Of the total 140 patients included in the analyses, 70%
Despite the fact that we did not analyze the eventual antiplatelet response to clopidogrel, the subanalysis of the POPULAR Trial did this, analyzing patients with and without previous Ischemic stroke (IS)/transient ischemic attack (TIA), and the results indicated that there were no significant differences in the PRU after clopidogrel use between the groups [13]
Three of the adjusted models used in our study suggested a relationship between low triglyceride levels and a previous IS/TIA

Summary

Introduction

Ischemic stroke (IS) or transient ischemic attack (TIA) history is present in approximately 4-8% [1,2,3] of patients with acute coronary syndrome (ACS) and approximately 4-17% of patients with stable atherosclerotic disease (CAD) [4,5,6] This patient population has a higher prevalence of cardiovascular risk factors and a higher prevalence of established. These characteristics imply a high risk for major cardiovascular events, including cardiovascular mortality [4,5,6,7]

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Conclusion