PMID- 29206072
OWN - NLM
STAT- MEDLINE
DCOM- 20180918
LR  - 20181202
IS  - 1369-1635 (Electronic)
IS  - 0953-7104 (Linking)
VI  - 29
IP  - 3
DP  - 2018 May
TI  - Cigarette smoking reduces platelet reactivity independently of clopidogrel 
      treatment in patients with non-ST elevation acute coronary syndromes.
PG  - 309-311
LID - 10.1080/09537104.2017.1394452 [doi]
AB  - Smokers receiving clopidogrel show a lower residual platelet reactivity than 
      non-smokers, a phenomenon generally ascribed to smoking-induced increased 
      production of clopidogrel active metabolite, but also associated with the high 
      hemoglobin levels of smokers, which decreases platelet reactivity in tests that 
      measure platelet function in whole blood. We evaluated the impact of cigarette 
      smoking and of hemoglobin levels on platelet reactivity index (PRI) measured by 
      the vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) assay in whole 
      blood samples from patients with non-ST elevation acute coronary syndrome 
      (NSTE-ACS) undergoing percutaneous coronary interventions, both before and after 
      clopidogrel administration. PRI was measured in 718 clopidogrel-naive NSTE-ACS 
      patients, both before and 1 month after treatment with clopidogrel (75 mg daily). 
      Smokers (n = 347, 48%) had significantly lower mean PRI levels at both baseline 
      (57.7 +/- 24.1 vs. 64.8 +/- 19.8, p < 0.001) and 1 month (43.4 +/- 20.3% vs. 
      46.8 +/- 18.0%, p = 0.017) than non-smokers. After adjusting for potential 
      confounders (age, sex, diabetes, chronic kidney disease, Syntax score>15), the beta 
      coefficient of smoke on PRI was -8.51 [-11.90 to -5.11, p < 0.001] at baseline 
      and -3.41 [-6.30 to -0.51, p = 0.02] after 1 month. Hemoglobin was higher in 
      smokers (13.8 +/- 1.5 g/dL) than non-smokers (13.1 +/- 1.7 g/dL, p < 0.001), but was 
      not significantly correlated with PRI both at baseline (Rho = 0.02, p = 0.60) and 
      at 1 month (Rho = 0.01, p = 0.80). Our analysis confirms that clopidogrel-treated 
      smokers have lower platelet reactivity, measured by the VASP-P assay, compared to 
      clopidogrel-treated non-smokers. However, smokers had lower platelet reactivity 
      already before receiving clopidogrel treatment, suggesting that smoke affects 
      platelet reactivity independently of its potential effect on the pharmacokinetics 
      of clopidogrel. Our data also indicate that such an effect is not mediated by 
      increased hemoglobin levels.
FAU - Crimi, Gabriele
AU  - Crimi G
AUID- ORCID: 0000-0002-2852-061X
AD  - a Division of Cardiology , Fondazione IRCCS Policlinico San Matteo , Pavia , 
      Italy.
FAU - Somaschini, Alberto
AU  - Somaschini A
AUID- ORCID: 0000-0003-1223-6128
AD  - b Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, 
      Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
FAU - Cattaneo, Marco
AU  - Cattaneo M
AD  - c Medicina III, ASST Santi Paolo e Carlo--Dipartimento di Scienze della Salute , 
      Universita degli Studi di Milano , Milano , Italy.
FAU - Angiolillo, Dominick J
AU  - Angiolillo DJ
AD  - d Division of Cardiology , University of Florida College of Medicine , 
      Jacksonville , FL , USA.
FAU - Piscione, Federico
AU  - Piscione F
AD  - e Department of Medicine and Surgery , University of Salerno , Salerno , Italy.
FAU - Palmerini, Tullio
AU  - Palmerini T
AD  - f Dipartimento Cardio-Toraco-Vascolare , Policlinico S. Orsola , Bologna , Italy.
FAU - De Servi, Stefano
AU  - De Servi S
AD  - g IRCCS Multimedica, Sesto San Giovanni , Milano , Italy.
LA  - eng
PT  - Journal Article
DEP - 20171205
PL  - England
TA  - Platelets
JT  - Platelets
JID - 9208117
RN  - 0 (Biomarkers)
RN  - 0 (Purinergic P2Y Receptor Antagonists)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
MH  - Acute Coronary Syndrome/*blood/diagnosis/*drug therapy/etiology
MH  - Aged
MH  - Aged, 80 and over
MH  - Biomarkers
MH  - Blood Platelets/*drug effects/*metabolism
MH  - Cigarette Smoking/*adverse effects
MH  - Clopidogrel
MH  - Comorbidity
MH  - Electrocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Activation/*drug effects
MH  - Platelet Function Tests
MH  - Purinergic P2Y Receptor Antagonists/pharmacology/*therapeutic use
MH  - Ticlopidine/*analogs & derivatives/pharmacology/therapeutic use
MH  - Treatment Outcome
OTO - NOTNLM
OT  - clopidogrel
OT  - dapt
OT  - high on-treatment platelet reactivity
OT  - smokers paradox
OT  - vasp test
EDAT- 2017/12/06 06:00
MHDA- 2018/09/19 06:00
CRDT- 2017/12/06 06:00
PHST- 2017/12/06 06:00 [pubmed]
PHST- 2018/09/19 06:00 [medline]
PHST- 2017/12/06 06:00 [entrez]
AID - 10.1080/09537104.2017.1394452 [doi]
PST - ppublish
SO  - Platelets. 2018 May;29(3):309-311. doi: 10.1080/09537104.2017.1394452. Epub 2017 
      Dec 5.