PMID- 36994631
OWN - NLM
STAT- MEDLINE
DCOM- 20230331
LR  - 20230402
IS  - 1938-2723 (Electronic)
IS  - 1076-0296 (Print)
IS  - 1076-0296 (Linking)
VI  - 29
DP  - 2023 Jan-Dec
TI  - The Impact of Patient Characteristics and Antiplatelet Regimes on Clot 
      Microstructure in Patients Treated for ST Elevation Myocardial Infarction: Clot 
      Microstructure can Evaluate Therapeutic Efficacy.
PG  - 10760296221131563
LID - 10.1177/10760296221131563 [doi]
LID - 10760296221131563
AB  - BACKGROUND: Unfavourable clot microstructure is associated with adverse outcomes 
      in ST elevation myocardial infarction (STEMI). We investigated the effect of 
      comorbidities and anti-platelet treatment on clot microstructure in STEMI 
      patients using fractal dimension (d(f)), a novel biomarker of clot microstructure 
      derived from the visco-elastic properties of whole blood. METHODS: Patients with 
      STEMI (n = 187) were recruited sequentially receiving aspirin with Clopidogrel 
      (n = 157) then Ticagrelor (n = 30). Patient characteristics and blood for 
      rheological analysis obtained. We quantified d(f) using sequential frequency 
      sweep tests to obtain the phase angle of the Gel Point which is synonymous with 
      the clot microstructure. RESULTS: Higher d(f) was observed in males 
      (1.755 +/- 0.068) versus females (1.719 +/- 0.061, p = .001), in patients with 
      diabetes (1.786 +/- 0.067 vs 1.743 +/- 0.046, p < .001), hypertension (1.760 +/- 0.065 
      vs 1.738 +/- 0.069, p = .03) and previous MI (1.787 +/- 0.073 vs 1.744 +/- 0.066, 
      p = .011) compared to without. Patients receiving Ticagrelor had lower d(f) than 
      those receiving Clopidogrel (1.708 +/- 0.060 vs 1.755 +/- 0.067, p < .001). 
      Significant correlation with d(f) was found with haematocrit (r = 0.331, 
      p < .0001), low-density lipoprotein (LDL) (r = 0.155, p = .046) and fibrinogen 
      (r = 0.182, p = .014). Following multiple regression analysis, diabetes, LDL, 
      fibrinogen and haematocrit remained associated with higher d(f) while treatment 
      with Ticagrelor remained associated with lower d(f). CONCLUSIONS: The biomarker 
      d(f) uniquely evaluates the effect of interactions between treatment and 
      underlying disease on clot microstructure. STEMI patients with diabetes and 
      elevated LDL had higher d(f,) indicating denser clot. Ticagrelor resulted in a 
      lower d(f) than Clopidogrel signifying a less compact clot.
FAU - Lawrence, Matthew J
AU  - Lawrence MJ
AD  - Welsh Centre for Emergency Medicine Research, 7757Swansea Bay University Health 
      Board, Swansea, UK.
FAU - Obaid, Daniel R
AU  - Obaid DR
AD  - Medical School, 7759Swansea University, Swansea, UK.
FAU - Sabra, Ahmed
AU  - Sabra A
AD  - Morriston Regional Heart Centre, 7757Swansea Bay University Health Board, 
      Swansea, UK.
FAU - Whitley, Janet
AU  - Whitley J
AD  - Welsh Centre for Emergency Medicine Research, 7757Swansea Bay University Health 
      Board, Swansea, UK.
AD  - Medical School, 7759Swansea University, Swansea, UK.
FAU - Quarry, Rhianwen
AU  - Quarry R
AD  - Morriston Regional Heart Centre, 7757Swansea Bay University Health Board, 
      Swansea, UK.
FAU - Pillai, Suresh
AU  - Pillai S
AD  - Welsh Centre for Emergency Medicine Research, 7757Swansea Bay University Health 
      Board, Swansea, UK.
AD  - Medical School, 7759Swansea University, Swansea, UK.
FAU - Chase, Alexander J
AU  - Chase AJ
AD  - Medical School, 7759Swansea University, Swansea, UK.
AD  - Morriston Regional Heart Centre, 7757Swansea Bay University Health Board, 
      Swansea, UK.
FAU - Smith, David
AU  - Smith D
AD  - Medical School, 7759Swansea University, Swansea, UK.
AD  - Morriston Regional Heart Centre, 7757Swansea Bay University Health Board, 
      Swansea, UK.
FAU - Williams, Phylip R
AU  - Williams PR
AD  - College of Engineering, 7759Swansea University, Swansea, UK.
FAU - Hawkins, Karl
AU  - Hawkins K
AD  - Medical School, 7759Swansea University, Swansea, UK.
FAU - Morris, Roger H K
AU  - Morris RHK
AD  - School of Applied Science, 11352Cardiff Metropolitan University, Cardiff, UK.
FAU - Evans, Phillip A
AU  - Evans PA
AUID- ORCID: 0000-0002-0814-5162
AD  - Welsh Centre for Emergency Medicine Research, 7757Swansea Bay University Health 
      Board, Swansea, UK.
AD  - Medical School, 7759Swansea University, Swansea, UK.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Appl Thromb Hemost
JT  - Clinical and applied thrombosis/hemostasis : official journal of the 
      International Academy of Clinical and Applied Thrombosis/Hemostasis
JID - 9508125
RN  - GLH0314RVC (Ticagrelor)
RN  - A74586SNO7 (Clopidogrel)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Biomarkers)
RN  - 9001-32-5 (Fibrinogen)
SB  - IM
MH  - Male
MH  - Female
MH  - Humans
MH  - Ticagrelor/therapeutic use
MH  - Clopidogrel/therapeutic use
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - *ST Elevation Myocardial Infarction/drug therapy/etiology
MH  - *Thrombosis/etiology
MH  - Biomarkers
MH  - Fibrinogen
MH  - Treatment Outcome
MH  - *Percutaneous Coronary Intervention/adverse effects
PMC - PMC10064466
OTO - NOTNLM
OT  - ST elevation myocardial infarction (STEMI)
OT  - clot microstructure
OT  - diabetes
OT  - fractal analysis
OT  - lipids
COIS- The author(s) declared no potential conflicts of interest with respect to the 
      research, authorship, and/or publication of this article.
EDAT- 2023/03/31 06:00
MHDA- 2023/03/31 06:41
PMCR- 2023/03/30
CRDT- 2023/03/30 04:13
PHST- 2023/03/31 06:41 [medline]
PHST- 2023/03/30 04:13 [entrez]
PHST- 2023/03/31 06:00 [pubmed]
PHST- 2023/03/30 00:00 [pmc-release]
AID - 10.1177_10760296221131563 [pii]
AID - 10.1177/10760296221131563 [doi]
PST - ppublish
SO  - Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296221131563. doi: 
      10.1177/10760296221131563.