PMID- 26857781 OWN - NLM STAT- MEDLINE DCOM- 20170130 LR - 20220331 IS - 1590-3729 (Electronic) IS - 0939-4753 (Linking) VI - 26 IP - 4 DP - 2016 Apr TI - Uric acid and high-residual platelet reactivity in patients treated with clopidogrel or ticagrelor. PG - 352-8 LID - S0939-4753(15)30125-3 [pii] LID - 10.1016/j.numecd.2015.12.015 [doi] AB - BACKGROUND AND AIM: High residual platelet reactivity (HRPR) is still an important challenge, despite the advent of new potent ADP-antagonists. Therefore it is of extreme importance to identify factors that can influence platelet activation. Serum uric acid (SUA) has been largely addressed in the past as a possible risk factor for coronary artery disease, with a possible association with platelets hyperreactivity. So far no studies have assessed the role of serum uric acid on the response to dual antiplatelet therapy. Therefore, the aim of our study was to evaluate the impact of uric acid levels on platelet function in patients treated with dual antiplatelet therapy (DAPT) with clopidogrel or ticagrelor. METHODS AND RESULTS: We scheduled for platelet function assessment at 30-90 days post-discharge patients treated with DAPT (ASA + clopidogrel or ticagrelor) for an ACS or elective percutaneous coronary intervention (PCI). Platelet function was assessed by whole blood impedance aggregometry (Multiplate((R))-Roche Diagnostics AG), HRPR was considered for ASPI test >862 AU( *)min (for ASA) and ADP test values >/=417 AU* min (for ADP-antagonists). RESULTS: We included a total of 493 patients (262 were on ASA and clopidogrel and 231 on ASA and ticagrelor). Patients were divided according to quartiles of serum uric acid levels measured at the time of platelet aggregation assessment (Group 1 <4.6 mg/dL, n = 114; Group 2, 4.7-5.8 mg/dL, n = 133; Group 3, 5.9-6.8 mg/dL, n = 124; Group 4, >6.9, n = 122). Patients with higher uric acid levels were older, more often smokers, with history of hypertension and previous coronary artery bypass surgery and renal failure and were more often on therapy with diuretics at admission. Patients with higher SUA had higher triglycerides and fibrinogen. Uric acid levels did not influence ASPI, COL, TRAP and ADP tests. High residual platelet reactivity (HRPR) was observed in 1.5% of patients treated with ASA, with no difference according to SUA quartiles (p = 0.60), confirmed at multivariate analysis after correction for baseline confounders (adjusted OR[95%CI] = 1.05 [0.44-2.52], p = 0.90). HRPR for ADP-antagonists was observed in 23.6% of patients, with no difference according to SUA quartiles (p = 0.47); this result was confirmed also after correction for baseline confounders (adjusted OR[95%CI] = 1.04 [0.84-1.28], p = 0.73). Moreover, no association was found between HRPR and uric acid levels both among patients treated with clopidogrel (p = 0.35) or ticagrelor (p = 0.74), that was confirmed after correction for baseline confounding factors (adjusted OR[95%CI] = 1.18 [0.90-1.55], p = 0.23) and (adjusted OR[95%CI] = 0.96 [0.63-1.47], p = 0.85). The absence of association between SUA and platelet reactivity was confirmed at linear regression analysis both with clopidogrel (r = 0.03, p = 0.55) or ticagrelor (r = -0.01, p = 0.85). CONCLUSION: This is the first large study showing that in patients receiving DAPT, uric acid levels do not influence response to ticagrelor and clopidogrel or the effectiveness of ASA. CI - Copyright (c) 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved. FAU - Barbieri, L AU - Barbieri L AD - Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont University, Novara, Italy. FAU - Verdoia, M AU - Verdoia M AD - Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont University, Novara, Italy. FAU - Pergolini, P AU - Pergolini P AD - Clinical Chemistry, Azienda Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont University, Novara, Italy. FAU - Nardin, M AU - Nardin M AD - Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont University, Novara, Italy. FAU - Rolla, R AU - Rolla R AD - Clinical Chemistry, Azienda Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont University, Novara, Italy. FAU - Marino, P AU - Marino P AD - Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont University, Novara, Italy. FAU - Bellomo, G AU - Bellomo G AD - Clinical Chemistry, Azienda Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont University, Novara, Italy. FAU - Suryapranata, H AU - Suryapranata H AD - Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands. FAU - De Luca, G AU - De Luca G AD - Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@maggioreosp.novara.it. CN - Novara Atherosclerosis Study Group (NAS) LA - eng PT - Journal Article DEP - 20160106 PL - Netherlands TA - Nutr Metab Cardiovasc Dis JT - Nutrition, metabolism, and cardiovascular diseases : NMCD JID - 9111474 RN - 0 (Platelet Aggregation Inhibitors) RN - 0 (Triglycerides) RN - 268B43MJ25 (Uric Acid) RN - 9001-32-5 (Fibrinogen) RN - A74586SNO7 (Clopidogrel) RN - GLH0314RVC (Ticagrelor) RN - K72T3FS567 (Adenosine) RN - OM90ZUW7M1 (Ticlopidine) SB - IM MH - Adenosine/administration & dosage/adverse effects/*analogs & derivatives MH - Aged MH - Aged, 80 and over MH - Blood Platelets/*drug effects/metabolism MH - Clopidogrel MH - Coronary Artery Disease/blood MH - Female MH - Fibrinogen/metabolism MH - Humans MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Percutaneous Coronary Intervention MH - Platelet Aggregation/drug effects MH - Platelet Aggregation Inhibitors/administration & dosage/*adverse effects MH - Platelet Function Tests MH - Risk Factors MH - Ticagrelor MH - Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives MH - Triglycerides/blood MH - Uric Acid/*blood OTO - NOTNLM OT - Antithrombotic therapy OT - Bleedings OT - Thrombosis OT - Uric acid EDAT- 2016/02/10 06:00 MHDA- 2017/01/31 06:00 CRDT- 2016/02/10 06:00 PHST- 2015/07/21 00:00 [received] PHST- 2015/09/11 00:00 [revised] PHST- 2015/12/30 00:00 [accepted] PHST- 2016/02/10 06:00 [entrez] PHST- 2016/02/10 06:00 [pubmed] PHST- 2017/01/31 06:00 [medline] AID - S0939-4753(15)30125-3 [pii] AID - 10.1016/j.numecd.2015.12.015 [doi] PST - ppublish SO - Nutr Metab Cardiovasc Dis. 2016 Apr;26(4):352-8. doi: 10.1016/j.numecd.2015.12.015. Epub 2016 Jan 6.