Effect of cilostazol on platelet reactivity among patients with peripheral artery disease on clopidogrel therapy
Autor: | Jorge Duconge, Mario J. Garcia, Hector Núñez-Medina, Angel López-Candales, Stuart A. Scott, Jose Wiley, Lorraine Marshall, Kyle Melin, Dagmar F. Hernandez-Suarez, Karid Nieves-Borrero, Christina Rodriguez-Ruiz |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Blood Platelets
Male medicine.medical_specialty ATP Binding Cassette Transporter Subfamily B Ticlopidine Platelet Function Tests Tetrazoles Pilot Projects CYP2C19 030204 cardiovascular system & hematology Hematocrit 030226 pharmacology & pharmacy Gastroenterology Article 03 medical and health sciences Peripheral Arterial Disease 0302 clinical medicine P2Y12 Internal medicine Diabetes mellitus medicine Humans Pharmacology (medical) Platelet General Pharmacology Toxicology and Pharmaceutics Aged medicine.diagnostic_test business.industry Aryldialkylphosphatase Drug Synergism medicine.disease Clopidogrel PON1 Receptors Purinergic P2Y12 Cilostazol Cytochrome P-450 CYP2C19 Cross-Sectional Studies Drug Therapy Combination Female business Platelet Aggregation Inhibitors medicine.drug |
Popis: | Background:Antiplatelet therapy with clopidogrel is recommended to reduce cardiovascular events in patients with peripheral artery disease (PAD); however, clopidogrel efficacy has not been adequately studied in this patient population. Therefore, we aimed to determine the effects of cilostazol therapy on platelet reactivity among PAD patients on clopidogrel.Methods:We performed a cross-sectional pilot study of 46 Puerto Rican patients diagnosed with PAD. The cohort was divided based on use of clopidogrel and cilostazol (n=24) or clopidogrel alone (n=22). Platelet function was measuredex vivousing the VerifyNow P2Y12 assay. Genomic DNA was extracted from peripheral blood samples using the QIAamp DNA Blood Midi Kit, which was subjected to candidate variant genotyping (CYP2C19,ABCB1,PON1andP2RY12) using TaqMan quantitative polymerase chain reaction assays. All analyses were performed using SAS version 9.4 (SAS Institute).Results:Among all enrolled patients, 18 (39%) had high on-treatment platelet reactivity (HTPR). The mean platelet reactivity was 207±53 (range, 78–325) with higher P2Y12 reaction units in the non-cilostazol group, 224±45 vs. 191±55 on the cilostazol group (p=0.03). No significant differences were observed in the clinical or genetic variables between the two groups. A multiple regression analysis determined that history of diabetes mellitus (p=0.03), use of cilostazol (p=0.03) and hematocrit (p=0.02) were independent predictors of platelet reactivity.Conclusions:In Puerto Rican PAD patients on clopidogrel therapy, history of diabetes mellitus, use of cilostazol and hematocrit are independent predictors of platelet reactivity. Adjunctive cilostazol therapy may enhance clopidogrel efficacy among PAD patients with HTPR. |
Databáze: | OpenAIRE |
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