PMID- 12355033
OWN - NLM
STAT- MEDLINE
DCOM- 20030926
LR  - 20191106
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 13
IP  - 3
DP  - 2002 Jun
TI  - Decreased platelet reactivity in blood anticoagulated with bivalirudin or 
      enoxaparin compared with unfractionated heparin: implications for coronary 
      intervention.
PG  - 161-5
AB  - BACKGROUND: Platelet reactivity predicts complications after percutaneous 
      coronary intervention (PCI). Accordingly, agents that suppress platelet 
      reactivity should decrease adverse events after PCI. This study was designed to 
      determine the effects of therapeutic concentrations of unfractionated heparin 
      (UFH), bivalirudin, or enoxaparin alone or in combination with tirofiban on 
      platelet reactivity. METHODS: Blood taken from 13 patients with coronary artery 
      disease was exposed to each anticoagulant alone or in combination with tirofiban 
      ex vivo. Platelet reactivity was characterized with flow cytometry to quantify 
      the percentage of platelets capable of binding fibrinogen (activation of 
      glycoprotein IIb-IIIa) and expressing P-selectin in response to adenosine 
      diphosphate (ADP, 0, 0.2, and 1 microM). RESULTS: Platelet reactivity was greater 
      in blood treated with UFH than in blood anticoagulated with bivalirudin with 
      respect to both the capacity to bind fibrinogen (by 4 +/- 1.8%, p = 0.01) and 
      P-selectin expression (by 7.7 +/- 0.7%, p, < 0.0001) in response to 1 microM ADP. 
      Platelet reactivity was greater in blood treated with UFH than in blood exposed 
      to enoxaparin with respect to P-selectin expression (by 7 +/- 1.1%, p, < 0.0001) 
      in response to 1 microM ADP. Platelet reactivity was similar in blood treated 
      with bivalirudin or enoxaparin. Addition of tirofiban suppressed the capacity to 
      bind fibrinogen in the presence of each anticoagulant to a similar extent. 
      CONCLUSIONS: As platelet reactivity is greater in blood anticoagulated with UFH 
      in comparison with blood anticoagulated with enoxaparin or bivalirudin, the use 
      of bivalirudin or enoxaparin rather than UFH during PCI should contribute to a 
      reduced incidence of adverse cardiac events after PCI.
FAU - Aggarwal, Atul
AU  - Aggarwal A
AD  - Department of Medicine, The University of Vermont College of Medicine, 
      Burlington, VT, USA. atul.aggarwal@vtmednet.org
FAU - Sobel, Burton E
AU  - Sobel BE
FAU - Schneider, David J
AU  - Schneider DJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Hirudins)
RN  - 0 (P-Selectin)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - 61D2G4IYVH (Adenosine Diphosphate)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Adenosine Diphosphate/pharmacology
MH  - Aged
MH  - Anticoagulants/*pharmacology
MH  - Coronary Artery Disease/blood/*drug therapy
MH  - Drug Evaluation
MH  - Enoxaparin/pharmacology
MH  - Flow Cytometry
MH  - Heparin/pharmacology
MH  - Hirudins/*analogs & derivatives/pharmacology
MH  - Humans
MH  - Middle Aged
MH  - P-Selectin/analysis
MH  - Peptide Fragments/pharmacology
MH  - Platelet Activation/*drug effects
MH  - Platelet Function Tests
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/metabolism
MH  - Recombinant Proteins/pharmacology
EDAT- 2002/10/02 04:00
MHDA- 2003/09/27 05:00
CRDT- 2002/10/02 04:00
PHST- 2002/10/02 04:00 [pubmed]
PHST- 2003/09/27 05:00 [medline]
PHST- 2002/10/02 04:00 [entrez]
AID - 10.1023/a:1020478923794 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2002 Jun;13(3):161-5. doi: 10.1023/a:1020478923794.