In cardiology, functional platelet activity is not routinely monitored. Platelet function assays should be able to identify patients with high residual platelet reactivity (HPR). High on-treatment platelet reactivity is apparent risk factor for atherothrombosis, however not the only one. Since there are many contributing factors (platelet activation, endothelial dysfunction, and plaque rupture) influencing atherothrombosis. Antiplatelet treatment is targeted to diminish platelet activation. The unique pharmacodynamics, pharmacokinetics of each agent and the pharmacogenetic profile of the recipient need to be taken into consideration. The aim of this review article is to summarize current knowledge of platelet function monitoring and its usefulness in clinical cardiology.
- Keywords
- aspirinová/clopidogrelová rezistence, vysoká reziduální reaktivita,
- MeSH
- Platelet Activation genetics immunology drug effects MeSH
- Aspirin administration & dosage adverse effects therapeutic use MeSH
- Plaque, Atherosclerotic diagnosis etiology complications MeSH
- Cyclooxygenase 1 MeSH
- Platelet Aggregation Inhibitors * administration & dosage adverse effects therapeutic use MeSH
- Cyclooxygenase Inhibitors MeSH
- Drug Resistance genetics immunology drug effects MeSH
- Humans MeSH
- Meta-Analysis as Topic MeSH
- Risk Factors MeSH
- Statistics as Topic MeSH
- Cytochrome P-450 Enzyme System MeSH
- Ticlopidine analogs & derivatives administration & dosage adverse effects MeSH
- Thrombosis diagnosis etiology complications MeSH
- Platelet Function Tests methods utilization MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Antiagregancia patří mezi skupinu široce používaných léčiv v klinické praxi. V současné době zaznamenáváme velmi rychlý vývoj nových antiagregačních preparátů a jsme také svědky rozsáhlých diskusí o rezistenci na antiagregační léčbu. Cílem tohoto článku je popsat základy farmakologických vlastnosti již déle užívaných i nových antiagregačních léčiv, představit metody umožňující identifikovat pacienty rezistentní na antiagregační léčbu a ukázat na možný přínos těchto metod v běžné klinické praxi.
Antiaggregation treatment is widely used in daily clinical practice. New antiaggregation drugs have been presented and other are under rapid development. Physicians are facing large discussions regarding resistance and responsiveness to antiaggregation treatment. The goal of this review article is to describe pharmacological effect of previously used and new antiaggregant, present methods that can identify patients resistant to treatment and show possible impact of this testing in daily clinical practice.
- Keywords
- laboratorní metody,
- MeSH
- Adenosine Diphosphate antagonists & inhibitors MeSH
- Platelet Aggregation drug effects MeSH
- Aspirin pharmacokinetics therapeutic use MeSH
- Financing, Organized MeSH
- Drug Evaluation MeSH
- Platelet Aggregation Inhibitors pharmacokinetics pharmacology therapeutic use MeSH
- Ischemia MeSH
- Cardiovascular Diseases drug therapy prevention & control MeSH
- Clinical Trials as Topic MeSH
- Drug Resistance MeSH
- Humans MeSH
- Flow Cytometry methods utilization MeSH
- Pyridines pharmacokinetics classification therapeutic use MeSH
- Sensitivity and Specificity MeSH
- Platelet Function Tests methods utilization MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Krevní destičky jsou klíčovým elementem ve vzniku aterotrombózy jako podkladu akutního koronárního syndromu. Znalost patofyziologie adheze, aktivace a agregace je nutná pro interpretaci terapeutických zásahů při prevenci vzniku a léčby trombózy. Funkční testování účinnosti léčby protidestičkovými léky, byť zatím není rutinně prováděno, bude v budoucnu patrně cestou k dalšímu snížení výskytu trombotických komplikací.
Thrombocytes are crucial elements in the development of arterial thrombosis as an underlying condition of the acute coronary syndrome. Knowledge of the pathophysiology of adhesion, activation and aggregation of thrombocytes is essential for the interpretation of therapeutic targets for thrombosis prevention and treatment. Functional testing of the efficacy of antiplatelet drugs, though not yet routinely performed, is likely to bring further decline in thrombotic complications in the near future.
- Keywords
- prasugrel, clopidogrel, funkční testy, agregace, adheze, clopidogrel, prasugrel,
- MeSH
- Platelet Adhesiveness physiology drug effects MeSH
- Platelet Aggregation physiology drug effects MeSH
- Platelet Activation physiology drug effects MeSH
- Aspirin MeSH
- Financing, Organized MeSH
- Platelet Aggregation Inhibitors pharmacology classification MeSH
- Humans MeSH
- Practice Guidelines as Topic MeSH
- Thrombosis physiopathology prevention & control MeSH
- Platelet Function Tests methods utilization MeSH
- Check Tag
- Humans MeSH
- MeSH
- Purpura, Thrombocytopenic, Idiopathic MeSH
- Liver metabolism pathology MeSH
- Hematologic Diseases diagnosis therapy MeSH
- Radionuclide Imaging methods utilization MeSH
- Chromium Radioisotopes diagnostic use MeSH
- Radioisotopes diagnostic use therapeutic use MeSH
- Spleen metabolism pathology MeSH
- Platelet Function Tests methods utilization MeSH
Cílem naší studie bylo zjistit prevalenci destičkových polymorfizmů, které jsou spojovány s „aspirinovou rezistencí“ či s variabilitou odpovědi na léčbu clopidogrelem v české populaci. Metody: Ke zjištění frekvence polymorfizmů GP IIIa (HPA-1; rs5918), P2Y12 (H1/H2 haplotyp; rs2046934) and COX-1 (-842A/G; rs10306114) bylo provedeno anonymní testování DNA od 1?450 dárců krve pomocí PCR na analyzátoru Light Cycler 480 (ROCHE). Výsledky: Byly zjištěny tyto frekvence: GP IIIa (HPA-1) – 27,40?% heterozygotů, 3,66?% homozygotů a 68,94?% wild type homozygotů, P2Y12 (H1/H2 haplotyp) – 25,92?% heterozygotů, 2,63?% homozygotů a 71,46?% wild type homozygotů a COX-1 (-842A/G) – 12,00?% heterozygotů, 0,41?% homozygotů a 87,59?% wild type homozygotů v testované skupině. Tyto frekvence jsou tedy v souladu s odhadovanou 10–40?% variabilitou účinku protidestičkové léčby. Dále je uveden přehled o významu laboratorních vyšetření pro rutinní monitorování protidestičkové léčby.
The aim of study was to assess the frequencies of platelet polymorphisms which are connected with „aspirin resistance“ or/and variability of clopidogrel response in Czech population. The anonymous testing of 1,450 blood donors DNA by PCR using Light Cycler 480 (ROCHE) were used in finding of GP IIIa (HPA-1; rs5918), P2Y12 (H1/H2 haplotype; rs2046934) and COX-1 (-842A/G; rs10306114) polymorphisms frequencies. Results. The frequencies of GP IIIa (HPA1) were: 27.40?% heterozygotes, 3.66?% homozygotes and 68.94?% wild type homozygotes, frequencies of P2Y12 (H1/H2 haplotype) were 25.92?% heterozygotes, 2.63?% homozygotes and 71.46?% wild type homozygotes and frequencies of COX-1 (-842A/G) were 12.00?% heterozygotes, 0.41?% homozygotes and 87.59?% wild type homozygotes in tested group of healthy persons. In conclusion, the frequencies are in accordance with estimated 10–40?% variability of antiplatelets drug response. The paper also reviews the impact of laboratory assays for routine monitoring of antiplatelet therapy.
- MeSH
- Acute Coronary Syndrome drug therapy MeSH
- Aspirin administration & dosage pharmacology therapeutic use MeSH
- Financing, Organized MeSH
- Platelet Aggregation Inhibitors administration & dosage pharmacology therapeutic use MeSH
- Data Interpretation, Statistical MeSH
- Clinical Laboratory Techniques methods trends utilization MeSH
- Drug Resistance genetics immunology drug effects MeSH
- Humans MeSH
- Polymerase Chain Reaction methods utilization MeSH
- Polymorphism, Genetic genetics drug effects MeSH
- Ticlopidine analogs & derivatives administration & dosage pharmacology MeSH
- Blood Platelets immunology drug effects MeSH
- Platelet Function Tests methods utilization MeSH
- Check Tag
- Humans MeSH
- MeSH
- Medical History Taking MeSH
- Diagnosis, Differential * MeSH
- Child MeSH
- Hematologic Tests methods utilization MeSH
- Blood Coagulation Disorders * diagnosis etiology surgery MeSH
- Hemorrhage diagnosis etiology prevention & control MeSH
- Humans MeSH
- Preoperative Care * methods utilization MeSH
- Surveys and Questionnaires standards utilization MeSH
- Reference Standards MeSH
- Risk Factors MeSH
- Thrombocytopenia diagnosis complications prevention & control MeSH
- Platelet Function Tests methods utilization MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- MeSH
- Platelet Aggregation physiology genetics drug effects MeSH
- Atherosclerosis diagnosis etiology prevention & control MeSH
- Biomedical Research MeSH
- Hemostasis * physiology genetics drug effects MeSH
- Hyperlipoproteinemias * diagnosis therapy MeSH
- Myocardial Ischemia diagnosis prevention & control MeSH
- Humans MeSH
- Reference Standards MeSH
- Blood Component Removal * methods instrumentation utilization MeSH
- Statistics as Topic MeSH
- Platelet Function Tests methods utilization MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Platelet Adhesiveness * drug effects MeSH
- Aprotinin pharmacology blood MeSH
- Benzenesulfonates pharmacology blood MeSH
- Hematologic Tests * methods utilization MeSH
- Hemostasis drug effects MeSH
- Kallikreins * antagonists & inhibitors pharmacology blood MeSH
- Tranexamic Acid pharmacology blood MeSH
- Humans MeSH
- Statistics as Topic MeSH
- Platelet Function Tests methods utilization MeSH
- Check Tag
- Humans MeSH
