ИНДИВИДУАЛЬНЫЙ ПОДХОД К ПРИМЕНЕНИЮ АНТИТРОМБОЦИТАРНОЙ ТЕРАПИИ. НА ЧТО ОПЕРЕТЬСЯ В РЕШЕНИИ?

Use of antiplatelet therapy in the world indicates real difference in individual drug effect between patients, including the effect on prognosis. Problems of personification of individual approach, concerning antiplatelet therapy, are discussed.Опыт применения антиагрегантной терапии указывает на существенную разницу в реакции больных на антиагреганты, вызывающую различия в выраженности эффекта терапии по влиянию на исходы заболевания. Обсуждены проблемы индивидуального подхода в антиагрегантной терапии

ANTI-INFLAMMATORY EFFECT OF CLOPIDOGREL IN ATHEROSCLEROSIS

Aim. To analyze the literary and own data about clopidogrel influence on platelets during inflammation and to reveal particularities of its usage in ischemic heart disease (IHD) patients with active inflammation. Material and methods. The platelet morphology and a number of leukocyte-platelet aggregates (LTA) were investigated with scanning electron microscopy in 110 patients with stable angina pectoris of I-III functional class and 18 healthy volunteers. Spontaneous and ADP-induced platelet aggregation were assessed with laser aggregatometre manufactured by LLC “BIOLA”. Mean platelet volume (MPV) was estimated with the hematological analyzer . All investigations were performed in IHD patients before and after 2 months of clopidogrel treatment 75 mg a day. Results. IHD patients demonstrated appearance of LTA and big reticular platelets in the blood, increase in MPV and spontaneous aggregation. ADP-induced platelet aggregation was rarely increased probably due to acetylsalicylic acid therapy in all IHD patients. These platelet activity changes are connected with increased risk of thrombotic events and correlated with inflammation markers levels. After 2 months of clopidogrel treatment LTA number reduced in 4 times and big reticular platelets number decreased in 2.5 times as well as MPV and spontaneous aggregation achieved the normal ranges. Conclusion. Clopidogrel has not only antithrombotic effect but also can diminish platelets morphological and functional changes connected with inflammation

Thrombocytopenia and prospective endovascular intervention in a patient with coronary artery disease

Thrombocytopenia in blood count may be a reflex of haemostatic problems of different origin – from autoimmune disease to iatrogenic nature. Sometimes, thrombocytopenia may be revealed in patient with coronary heart disease before PCI procedure as well as some hours or days later. Dual antithrombotic therapy and thrombocytopenia have the same main side effect – bleeding. Etiology of disease and details of medical decision before percutаneous coronary intervention (PCI) in CHD patients are discussed

Anti-aggregant therapy in patients with coronary heart disease and gastric ulcer

Aim. To evaluate primary haemostasis parameters during two-month Zyllt therapy in patients with coronary heart disease (CHD) and gastric ulcer. Material and methods. In 60 patients with CHD, hyperlipidaemia, and gastric ulcer in remission, the effects of Zyllt (clopidogrel), in combination with lipid-lowering Vasilip (simvastatin) treatment, were investigated. Antiaggregant effects of Zyllt were assessed by measuring spontaneous and ADP-induced platelet aggregation at baseline, 5 days and 2 months after the therapy start. At baseline and in the end of the study, total blood cell count, lipid profile, and the levels of hepatic enzymes and C-reactive protein were examined. Results. Without the loading dose administration, the anti-aggregant effect of Zyllt was moderate at Day 5. In 37,2 % of the patients, all aggregation parameters were normalized, while in the other participants, they remained elevated. After 2 months of the treatment, aggregation parameters normalized in 78,7 %, and remained elevated in 20,7 % (n=12). Among these 12 individuals, no spontaneous aggregation was observed in 7, while ADP-induced aggregation substantially decreased, as a marker of Zyllt effects on its therapeutic target. In addition, Vasilip demonstrated good lipid-lowering effect in the study participants. Conclusion. Zyllt is an effective anti-aggregant, which is well-tolerated, without inducing hypocoagulation. In case of combined therapy, both lipid-lowering effect of Vasilip and anti-aggregant effect of Zyllt were observed. This combination did not result in hepatic or renal disturbances, or increased risk of cardiovascular events. The effectiveness of anti-aggregant therapy could be assessed by monitoring platelet aggregation

Clinical Significance of Thrombin Blockade with Low Doses (2.5 mg) of Rivaroxaban in Ischemic Heart Disease Patients

Arterial thrombosis is a result of complex interaction between blood cells, soluble coagulation factors in plasma and vessel wall. Antiplatelet drugs do not always provide the necessary antithrombotic effect of sufficient strength, because their influence does not extend to all three factors involved in this process. Low doses of direct oral inhibitors of thrombin are able to potentiate antithrombotic effect of antiplatelet therapy. The combination of rivaroxaban in a dose of 2.5 mg and standard double antiplatelet therapy turned out to be the most promising for clinical use, since studies with dabigatran and apixaban at the II and III stages of the trials were found to be unsuccessful due to the unacceptably high frequency of bleeding. Studies of the combination of rivaroxaban at a dose of 2.5 mg and standard antiplatelet therapy conducted in previous years among patients with acute myocardial infarction showed a decrease in the frequency of complications of atherothrombosis associated with their ischemic nature, while at the same time there was a slight increase in hemorrhagic complications. In the COMPASS study the combination of rivaroxaban (2.5 mg) plus aspirin reduced the risk of the primary endpoint (myocardial infarction, ischemic stroke, cardiovascular death) more significantly than aspirin alone in patients with stable ischemic heart disease and ischemic brain disease. The pathophysiological rationales for the use of low doses of rivaroxaban when added to dual antiplatelet therapy are considered, and the significance of recent studies in patients with acute coronary syndrome, stable ischemic heart disease and in the prevention of ischemic stroke is discussed