PMID- 17659921
OWN - NLM
STAT- MEDLINE
DCOM- 20071002
LR  - 20181201
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 100
IP  - 3
DP  - 2007 Aug 1
TI  - Comparison of platelet function and morphology in patients undergoing 
      percutaneous coronary intervention receiving bivalirudin versus unfractionated 
      heparin versus clopidogrel pretreatment and bivalirudin.
PG  - 417-24
AB  - We hypothesized that direct thrombin inhibition could attenuate platelet 
      activation and release of soluble CD40 ligand (sCD40L), a marker of inflammation, 
      during percutaneous coronary intervention (PCI). To assess platelet function 
      under flow conditions with bivalirudin versus unfractionated heparin (UFH), we 
      employed the cone and plate(let) analyzer (CPA) assay in drug-spiked blood 
      samples from volunteers (n = 3) in vitro, and then in PCI patients who received 
      bivalirudin alone (n = 20), UFH alone (n = 15), and clopidogrel pretreatment plus 
      bivalirudin (n = 15). Scanning electron microscopy was employed to image 
      bivalirudin or UFH-treated platelets to determine whether platelet function 
      observations had a morphologic explanation. Enzyme immunoassay was used to 
      measure sCD40L levels in PCI patients. In vitro, bivalirudin decreased platelet 
      surface coverage; UFH increased platelet surface coverage. In PCI patients, 
      bivalirudin alone decreased platelet surface coverage, UFH alone increased 
      platelet surface coverage, and clopidogrel pretreatment plus bivalirudin 
      additively reduced platelet surface coverage. Unlike UFH, bivalirudin did not 
      activate platelets in SEM studies. Bivalirudin alone or coupled with clopidogrel 
      significantly reduced plasma sCD40L in PCI patients. In conclusion, our findings 
      suggest that under flow conditions, bivalirudin alone or coupled with clopidogrel 
      may have an antiplatelet effect versus UFH alone during PCI. These data suggest 
      that bivalirudin and UFH may confer an anti-inflammatory effect by reducing 
      sCD40L during PCI.
FAU - Anand, Sunil X
AU  - Anand SX
AD  - The Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of 
      Medicine, New York, New York, USA.
FAU - Kim, Michael C
AU  - Kim MC
FAU - Kamran, Mazullah
AU  - Kamran M
FAU - Sharma, Samin K
AU  - Sharma SK
FAU - Kini, Annapoorna S
AU  - Kini AS
FAU - Fareed, Jawed
AU  - Fareed J
FAU - Hoppensteadt, Debra A
AU  - Hoppensteadt DA
FAU - Carbon, Frank
AU  - Carbon F
FAU - Cavusoglu, Erdal
AU  - Cavusoglu E
FAU - Varon, David
AU  - Varon D
FAU - Viles-Gonzalez, Juan F
AU  - Viles-Gonzalez JF
FAU - Badimon, Juan J
AU  - Badimon JJ
FAU - Marmur, Jonathan D
AU  - Marmur JD
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20070613
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Recombinant Proteins)
RN  - 147205-72-9 (CD40 Ligand)
RN  - 9005-49-6 (Heparin)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - *Angioplasty, Balloon, Coronary
MH  - Anticoagulants/*pharmacology
MH  - Blood Platelets/cytology/*drug effects/metabolism/physiology
MH  - CD40 Ligand/blood
MH  - Clopidogrel
MH  - Coronary Angiography
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Heparin
MH  - Hirudins/*pharmacology
MH  - Humans
MH  - Male
MH  - Microscopy, Electron, Scanning
MH  - Middle Aged
MH  - Peptide Fragments/*pharmacology
MH  - Platelet Activation/drug effects
MH  - Platelet Adhesiveness/drug effects
MH  - Platelet Aggregation/drug effects
MH  - Platelet Aggregation Inhibitors/*pharmacology
MH  - Recombinant Proteins/pharmacology
MH  - Ticlopidine/*analogs & derivatives/pharmacology
EDAT- 2007/07/31 09:00
MHDA- 2007/10/03 09:00
CRDT- 2007/07/31 09:00
PHST- 2006/09/29 00:00 [received]
PHST- 2007/02/26 00:00 [revised]
PHST- 2007/02/26 00:00 [accepted]
PHST- 2007/07/31 09:00 [pubmed]
PHST- 2007/10/03 09:00 [medline]
PHST- 2007/07/31 09:00 [entrez]
AID - S0002-9149(07)00816-8 [pii]
AID - 10.1016/j.amjcard.2007.02.106 [doi]
PST - ppublish
SO  - Am J Cardiol. 2007 Aug 1;100(3):417-24. doi: 10.1016/j.amjcard.2007.02.106. Epub 
      2007 Jun 13.