Acute Myocardial Infarction, Antiplatelet Therapy, ST-segment Elevation Myocardial Infarction (STEMI)
Conditions
Keywords
STEMI, Acute myocardial infarction, Antiplatelet therapy, aspirin, clopidogrel, VerifyNow aggregometry, Multiplate aggregometry
Brief summary
Background: Dual antithrombotic treatment with aspirin and clopidogrel is recommended in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The European Society of Cardiology (ESC) Guidelines recommend a bolus dose of aspirin of 250-500 mg and a 600 mg bolus dose of clopidogrel as soon as STEMI is suspected. Studies have shown that more newly produced platelets are present in the acute phase of STEMI, and it is likely that these immature platelets are haemostatically more active and might be of importance in thrombus formation. The enhanced platelet reactivity may reduce the effect of aspirin and clopidogrel in the acute phase of STEMI compared to measurements made in the same patients 3 months after primary PCI. Aim: This study aims to compare platelet response to aspirin and clopidogrel in the acute phase of STEMI with the platelet response in the same patients 3 months after STEMI . Design: This study is an observational follow-up study. Materials and methods: 46 patients with STEMI referred to primary PCI at Aarhus University Hospital, Skejby will be included in the study. A total of 3 blood samples are obtained in the acute phase of STEMI: Prior to primary PCI (Blood sample 1), at 4 hours (Blood sample 2) and at 12 hours (Blood sample 3) after administration of loading dose aspirin and clopidogrel. When patients are in a stable phase 3 month later, a final blood sample is taken (Blood sample 4). The blood is analyzed 30 minutes after withdrawal of blood by the platelet aggregation test Multiplate® aggregometry (agonists: Collagen, arachidonic acid and adenosinediphosphate) and VerifyNow® arachidonic acid and P2Y12 aggregometry. Platelet count, volume and the immature platelet fraction (IPF) will be measured using Sysmex® flowcytometry.
Interventions
None listed
Sponsors
AP Moeller Foundation
University of Aarhus
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Above 18 years of age * Patients with ST-segment elevation myocardial infarction (STEMI) referred to primary PCI at University Hospital of Aarhus, Skejby.
Exclusion criteria
* Treatment with NSAID, ticlopidine and dipyramidole. * Treatment with anticoagulants (Vitamin K antagonists) * Patients diagnosed with platelet disease or haemophilia. * Patients unable to give written, informed consent to participation in this project.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference between aggregation measured by VerifyNow® Aggregometry using the P2Y12-kit (Unit = PRU). | Approximately 2-3 months | Outcome is the difference between aggregation measurements. In this case between: Blood sample 1: Obtained immediately before primary PCI in the catherization laboratory. The blood sample is obtained from the femoral artery catheter. Blood sample 4: 2-3 months after primary PCI. |
| Difference between aggregation induced by agonist collagen (1 μg/ml) measured by Multiplate® Aggregometry (Unit=AUC). | Approximately 2-3 months | Outcome is the difference between aggregation measurements. In this case between: Blood sample 1: Obtained immediately before primary PCI in the catherization laboratory. The blood sample is obtained from the femoral artery catheter. Blood sample 4: 2-3 months after primary PCI. |
| Difference between aggregation induced by agonist arachidonic acid (1,0 mM) measured by Multiplate® Aggregometry (Unit=AUC). | Approximately 2-3 months | Outcome is the difference between aggregation measurements. In this case between: Blood sample 1: Obtained immediately before primary PCI in the catherization laboratory. The blood sample is obtained from the femoral artery catheter. Blood sample 4: 2-3 months after primary PCI. |
| Difference between aggregation induced by agonist adenosine diphosphate (20 µM) measured by Multiplate® Aggregometry (Unit=AUC). | Approximately 2-3 months | Outcome is the difference between aggregation measurements. In this case between: Blood sample 1: Obtained immediately before primary PCI in the catherization laboratory. The blood sample is obtained from the femoral artery catheter. Blood sample 4: 2-3 months after primary PCI. |
| Difference between aggregation measured by VerifyNow® Aggregometry using the ASPI-kit (Unit = ARU). | Approximately 2-3 months | Outcome is the difference between aggregation measurements. In this case between: Blood sample 1: Obtained immediately before primary PCI in the catherization laboratory. The blood sample is obtained from the femoral artery catheter. Blood sample 4: 2-3 months after primary PCI. |
| Difference between aggregation induced by agonist adenosine diphosphate (6,4 µM) measured by Multiplate® Aggregometry (Unit=AUC). | Approximately 2-3 months | Outcome is the difference between aggregation measurements. In this case between: Blood sample 1: Obtained immediately before primary PCI in the catherization laboratory. The blood sample is obtained from the femoral artery catheter. Blood sample 4: 2-3 months after primary PCI. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Difference in serum P-selectin | Approximately 2-3 months | Outcome is the difference between measurements. In this case between: Blood sample 1: Obtained immediately before primary PCI in the catherization laboratory. The blood sample is obtained from the femoral artery catheter. Blood sample 4: 2-3 months after administration of LD aspirin and clopidogrel. |
| Difference in serum trombopoietin | Approximately 2-3 months | Outcome is the difference between measurements. In this case between: Blood sample 1: Obtained immediately before primary PCI in the catherization laboratory. The blood sample is obtained from the femoral artery catheter. Blood sample 4: 2-3 months after administration of LD aspirin and clopidogrel. |
| Difference in serum thromboxane B2 | Approximately 2-3 months | Outcome is the difference between measurements. In this case between: Blood sample 1: Obtained immediately before primary PCI in the catherization laboratory. The blood sample is obtained from the femoral artery catheter. Blood sample 4: 2-3 months after administration of LD aspirin and clopidogrel. |
| Difference in immature platelet fraction measured by Sysmex® flowcytometry. | Approximately 2-3 months | Outcome is the difference between measurements. In this case between: Blood sample 1: Obtained immediately before primary PCI in the catherization laboratory. The blood sample is obtained from the femoral artery catheter. Blood sample 4: 2-3 months after administration of LD aspirin and clopidogrel. |
Countries
Denmark
Outcome results
None listed