期刊
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
卷 51, 期 2, 页码 249-259出版社
SPRINGER
DOI: 10.1007/s11239-020-02327-w
关键词
Platelet reactivity; Aspirin; Ticagrelor; Light transmission aggregometry; African-American; European-American
资金
- National Institutes of Health [R01HL118049]
- National Center for Research Resources, a component of the NIH [5UL1RR024128]
- National Institutes of General Medical Sciences [5RC1GM091083]
- Centers for Disease Control and Prevention [5U01DD000014]
- DukeNational University Singapore [2012/0003R]
Platelet gene polymorphisms are associated with variable on-treatment platelet reactivity and differ by race. African-Americans demonstrated lower platelet reactivity at baseline and on treatment compared to European-Americans. European-Americans experienced greater platelet suppression on aspirin and ticagrelor than African-Americans.
Platelet gene polymorphisms are associated with variable on-treatment platelet reactivity and vary by race. Whether differences in platelet reactivity and aspirin or ticagrelor exist between African-American and European-Americans remains poorly understood. Biological samples from three prior prospective antiplatelet challenge studies at the Duke Clinical Research Unit were used to compare platelet reactivity between African-American and European-American subjects. Platelet reactivity at baseline, on-aspirin, on-ticagrelor, and the treatment effect of aspirin or ticagrelor were compared between groups using an adjusted mixed effects model. Compared with European-Americans (n = 282; 50% female; mean +/- standard deviation age, 50 +/- 16), African-Americans (n = 209; 67% female; age 48 +/- 12) had lower baseline platelet reactivity with platelet function analyzer-100 (PFA-100) (p < 0.01) and with light transmission aggregometry (LTA) in response to arachidonic acid (AA), adenosine diphosphate (ADP), and epinephrine agonists (p < 0.05). African-Americans had lower platelet reactivity on aspirin in response to ADP, epinephrine, and collagen (p < 0.05) and on ticagrelor in response to AA, ADP, and collagen (p < 0.05). The treatment effect of aspirin was greater in European-Americans with an AA agonist (p = 0.002). Between-race differences with in vitro aspirin mirrored those seen in vivo. The treatment effect of ticagrelor was greater in European-Americans in response to ADP (p < 0.05) but with collagen, the treatment effect was greater for African-Americans (p < 0.05). Platelet reactivity was overall lower in African-Americans off-treatment, on aspirin, and on ticagrelor. European-Americans experienced greater platelet suppression on aspirin and on ticagrelor. The aspirin response difference in vivo and in vitro suggests a mechanism intrinsic to the platelet. Whether the absolute level of platelet reactivity or the degree of platelet suppression after treatment is more important for clinical outcomes is uncertain.
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