Pulmonary Hypertension
Conditions
Keywords
prostacyclin analogues, pulmonary arterial hypertension, platelet reactivity, extracellular vesicles, thrombus formation
Brief summary
Background: Prostacyclin analogues (epoprostenol, treprostinil and iloprost) induce vasodilation in advanced pulmonary arterial hypertension (PAH) but also inhibit platelets, increasing patients' bleeding risk. The antiplatelet effects of different prostacyclin analogues have never been compared head-to-head. The goal of the PAPAYA (Platelet Reactivity and Treatment With Prostacyclin Analogues in Pulmonary Arterial Hypertension) trial is(i) to compare platelet function (platelet reactivity, extracellular vesicles concentration and thrombus formation) in patients with PAH treated with prostacyclin analogues on top of endothelin receptor antagonists (ERA) and/or phosphodiesterase type 5 inhibitors (PDE5i) and patients treated only with ERA and PDE5i, and (ii) to compare the antiplatelet effect of different prostacyclin analogues. Venous blood will be collected from patients treated with prostacyclin analogues (study group; n=40) and patients treated with ERA or PDE5i (control group; n=40). Platelet reactivity will be analysed in whole blood by impedance aggregometry using arachidonic acid, adenosine diphosphate and thrombin receptor-activating peptide as agonists. Concentrations of extracellular vesicles from all platelets (CD61+), activated platelets (CD62P+), leukocytes (CD45+) and endothelial cells (CD146+) will be analysed in platelet-depleted plasma using flow cytometry (A-60 Micro). Platelet-rich thrombus formation will be measured using whole blood perfusion system. The study will determine the antiplatelet effect of prostacyclin analogues and compare different prostacyclin analogues head-to-head to identify the best drugs to use in case of thrombosis or bleeding.
Interventions
None listed
Sponsors
European Health Centre Otwock
Medical University of Warsaw
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Inclusion criteria
* Informed consent to participate in the study * Pulmonary arterial hypertension confirmed with right heart catheterization * Treatment with prostacyclin analogues (epoprostenol, treprostinil, iloprost) - study group * Treatment with endothelin receptor antagonists and phosphodiesterase type 5 inhibitors - control group
Exclusion criteria
* Known coagulopathy * Active pathological bleeding * Known history of bleeding disorder * Severe thrombocytopenia (platelet count \< 50,000/μL ) * Need for antiplatelet therapy with acetylsalicylic acid or P2Y12 antagonists * Severe chronic renal failure (estimated glomerular filtration rate \< 30 mL/min) * Severe liver insufficiency (Child-Pugh class C) * Known pregnancy, breast-feeding, or intention to become pregnant during the study period * Study drug intolerance * Participation in any previous study with prostacyclin analogues
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Platelet reactivity | July 5, 2017 - November 30, 2019 | Difference in platelet reactivity between patients treated with prostacyclin analogues and treated with ERA and/ or PDE5-i, assessed using impedance aggregometry |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Concentration of extracellular vesicles from platelets, leukocytes and endothelial cells | July 5, 2017 - November 30, 2019 | Differences in concentration of extracellular vesicles from platelets, leukocytes and endothelial cells between patients treated with prostacyclin analogues and treated with ERA and/ or PDE5i, assessed using flow cytometry |
| Platelet-rich thrombus formation parameters | July 5, 2017 - November 30, 2019 | Differences in platelet-rich thrombus formation parameters between patients treated with prostacyclin analogues and treated with ERA and/ or PDE5i, assessed using whole-blood flow-chamber perfusion system |
Countries
Poland
Outcome results
None listed