The Impact of Patient Characteristics and Antiplatelet Regimes on Clot Microstructure in Patients Treated for ST Elevation Myocardial Infarction: Clot Microstructure can Evaluate Therapeutic Efficacy.

Autor: Lawrence MJ; Welsh Centre for Emergency Medicine Research, 7757Swansea Bay University Health Board, Swansea, UK., Obaid DR; Medical School, 7759Swansea University, Swansea, UK., Sabra A; Morriston Regional Heart Centre, 7757Swansea Bay University Health Board, Swansea, UK., Whitley J; Welsh Centre for Emergency Medicine Research, 7757Swansea Bay University Health Board, Swansea, UK.; Medical School, 7759Swansea University, Swansea, UK., Quarry R; Morriston Regional Heart Centre, 7757Swansea Bay University Health Board, Swansea, UK., Pillai S; Welsh Centre for Emergency Medicine Research, 7757Swansea Bay University Health Board, Swansea, UK.; Medical School, 7759Swansea University, Swansea, UK., Chase AJ; Medical School, 7759Swansea University, Swansea, UK.; Morriston Regional Heart Centre, 7757Swansea Bay University Health Board, Swansea, UK., Smith D; Medical School, 7759Swansea University, Swansea, UK.; Morriston Regional Heart Centre, 7757Swansea Bay University Health Board, Swansea, UK., Williams PR; College of Engineering, 7759Swansea University, Swansea, UK., Hawkins K; Medical School, 7759Swansea University, Swansea, UK., Morris RHK; School of Applied Science, 11352Cardiff Metropolitan University, Cardiff, UK., Evans PA; Welsh Centre for Emergency Medicine Research, 7757Swansea Bay University Health Board, Swansea, UK.; Medical School, 7759Swansea University, Swansea, UK.
Jazyk: angličtina
Zdroj: Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis [Clin Appl Thromb Hemost] 2023 Jan-Dec; Vol. 29, pp. 10760296221131563.
DOI: 10.1177/10760296221131563
Abstrakt: Background: Unfavourable clot microstructure is associated with adverse outcomes in ST elevation myocardial infarction (STEMI). We investigated the effect of comorbidities and anti-platelet treatment on clot microstructure in STEMI patients using fractal dimension (d f ), a novel biomarker of clot microstructure derived from the visco-elastic properties of whole blood.
Methods: Patients with STEMI (n = 187) were recruited sequentially receiving aspirin with Clopidogrel (n = 157) then Ticagrelor (n = 30). Patient characteristics and blood for rheological analysis obtained. We quantified d f using sequential frequency sweep tests to obtain the phase angle of the Gel Point which is synonymous with the clot microstructure.
Results: Higher d f was observed in males (1.755 ± 0.068) versus females (1.719 ± 0.061, p  = .001), in patients with diabetes (1.786 ± 0.067 vs 1.743 ± 0.046, p  < .001), hypertension (1.760 ± 0.065 vs 1.738 ± 0.069, p  = .03) and previous MI (1.787 ± 0.073 vs 1.744 ± 0.066, p  = .011) compared to without. Patients receiving Ticagrelor had lower d f than those receiving Clopidogrel (1.708 ± 0.060 vs 1.755 ± 0.067, p  < .001). Significant correlation with d f was found with haematocrit (r = 0.331, p  < .0001), low-density lipoprotein (LDL) (r = 0.155, p  = .046) and fibrinogen (r = 0.182, p  = .014). Following multiple regression analysis, diabetes, LDL, fibrinogen and haematocrit remained associated with higher d f while treatment with Ticagrelor remained associated with lower d f .
Conclusions: The biomarker d f uniquely evaluates the effect of interactions between treatment and underlying disease on clot microstructure. STEMI patients with diabetes and elevated LDL had higher d f, indicating denser clot. Ticagrelor resulted in a lower d f than Clopidogrel signifying a less compact clot.
Databáze: MEDLINE
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