No description available.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia with a prevalence of 15% of patients over 80 years. Coronary artery disease co-exists in 20–30% of patients with atrial fibrillation. The need for triple anticoagulation therapy makes the management of these patients challenging following PCI. Methods: Nationwide inpatient sample which is a set of longitudinal hospital inpatient databases was used to evaluate the outcome of patients with AF who underwent PCI. All patients undergoing PCI between 2002 and 2011 were included in the study. Specific ICD-9-CM codes were used to identify the study patients and their outcomes. Results: There were 3,226,405 PCIs during the time period of the study of which 472,609 (14.6%) patients had AF. AF patients were older and predominantly male (60%). The number of PCIs had a declining trend from 2002 to 2011. Age adjusted inpatient mortality was significantly higher in PCI AF group compared to the PCI non-AF group (100.82 ± 9.03 vs 54.07 ± 8.96 per 100,000; P < 0.01). Post PCI predictors of mortality were AF (OR 1.56, CI 1.53–1.59), CKD (OR 1.41, CI 1.37–1.46), PAD (OR 1.20, CI 1.15–1.24), acute myocardial infarction (OR 2.42 CI 2.37–2.46 and cardiogenic shock (OR 13.92 CI 13.60–14.24) P < 0.001. Conclusion: AF is common in patients undergoing PCI and those AF patients have a higher age-adjusted all cause inpatient mortality. There is a decline in total number of PCIs over time in US. Atrial fibrillation, chronic kidney disease, peripheral artery disease, MI and cardiogenic shock were associated with increased mortality following PCI.

no / Aspirin, formally known as acetylsalicylic (ASA), is most widely used and cheapest over-the counter drugs. It is used not only for the common fevers, headaches and inflammation, but also for reducing the risk of heart attacks. In recent years, it is also linked to anti-cancer potential. Recently the US Preventive Services Working Group (UPSTF) release aspirin as a guide for cardiovascular disease and primary prevention of colorectal cancer. Platelets have been shown to play a crucial role in cancer metastasis for many years and are proposed to have an intimate reciprocal crosstalk with cancer cells. They may alter the properties of each other and have reciprocal effects. But the exact role of platelets in modifying the tumor cell properties has not been established. In clinical, cancer patients may receive platelets from outside to treat thrombocytopenia and bleeding induced by intensive chemotherapy. Therefore understanding the exact role of platelets in carcinogenesis always is a research interest, especially when evaluating anti-cancer drugs. In this study we exam the effect of platelets on viability, proliferation and adhesion of lung cancer cells A549 in culture conditions, using different concentrations of platelet rich plasma (PRP) with and without the presence of antiplatelet drug aspirin. The tumor cell EMT transformation was also investigated under different combination of PRP and aspirin in vitro. Our data showed that low-dose of aspirin can promote cell proliferation and high-dose of aspirin could inhibit cell proliferation. High concentrations of platelet-rich plasma can inhibit cell proliferation but low concentrations of platelet-rich plasma had no significant effect on cell proliferation. Platelet-rich plasma can gather around the cell to form a gelatinous film, and this lead us to a promoted tumor cell distant metastasis model. We further found out that the combination of aspirin and PRP could increase cell viability compared to single use of PRP and Aspirin can affect cell proliferation by inhibiting platelet effects. Platelet-rich plasma reduces the adhesion of A549 cell can be attenuated by aspirin. Further works will focus on combination of different doses of aspirin and PRP to confirm the above results. Other format of aspirin (nano-form) and other NSAID inflammatory drugs like Ibuprofen will also be tested. / Abstract of conference paper.

Η συγκόλληση των αιμοπεταλίων προάγεται από το ινωδογόνο, μια εξωκυττάρια πρωτεΐνη, η οποία δεσμεύεται εκλεκτικά στον υποδοχέα GP IIb/IIIa. Το τριπεπτίδιο RGD (Arg-Gly-Asp) συνιστά τη μικρότερη αλληλουχία, η οποία είναι απαραίτητη για την αναγνώριση και πρόσδεση του ινωδογόνου στον υποδοχέα και απαντάται και σε άλλες συγκολλητικές πρωτεΐνες, οι οποίες είναι παρούσες στον εξωκυττάριο χώρο και στο αίμα, όπως η ινοσυνδετίνη, το κολλαγόνο, ο παράγοντας Von Willebrand, κτλ. Η αντιπηκτική θεραπεία έχει βασιστεί σε δύο διαφορετικές προσεγγίσεις του προβλήματος. Η μία προσέγγιση αφορά την εμπόδιση της πρωταρχικής διέγερσης των αιμοπεταλίων από διάφορους αγωνιστές, όπως θρομβίνη, επινεφρίνη, κολλαγόνο, κτλ. Η άλλη προσέγγιση περιλαμβάνει την διακοπή του μηχανισμού μεταγωγής σήματος, ο οποίος ακολουθεί την πρόσδεση του αγωνιστή στην επιφάνεια των αιμοπεταλίων. Η ασπιρίνη, παράγωγο του σαλικυλικού οξέος, αναστέλλει το πρώτο βήμα στη βιοσύνθεση της θρομβοξάνης Α2 από αραχιδονικό οξύ μέσω ακετυλίωσης του ενζύμου κυκλοοξυγενάση 1. Στην παρούσα διατριβή πραγματοποιήθηκε ο σχεδιασμός και η σύνθεση γραμμικών και κυκλικών αναλόγων του τριπεπτιδίου RGD με ενσωματωμένο σαλικυλικό οξύ ή παράγωγά του. Τα διάφορα ανάλογα συντέθηκαν με κλασικές μεθόδους πεπτιδικής σύνθεσης σε υγρή και στερεά φάση. Τη σύνθεση των αναλόγων ακολούθησε καθαρισμός τους (HPLC) και προσδιορισμός της δομής τους με (ESI-MS). Στη συνέχεια, προσδιορίστηκε in vitro με φωτομετρική μέθοδο στους 37C και συνεχή καταγραφή της διερχόμενης ακτινοβολίας με ειδικό όργανο (Dual Channel Aggregometer) η ανασταλτική τους δράση στη συγκολλητικότητα των αιμοπεταλίων του ανθρώπου. Προς περαιτέρω επιβεβαίωση των πειραμάτων συσσώρευσης και μελέτη της πρόσδεσης των αναλόγων στις ιντεγκρίνες χρησιμοποιήθηκε η κυτταρομετρία ροής με μονοκλωνικά αντισώματα έναντι των υποδοχέων Gp Ia, Gp IIb/IIIa, Gp IIIa και GMp 140. Αναλύοντας τα αποτελέσματα των βιολογικών μελετών, τόσο της αναστολής της συσσωμάτωσης των αιμοπεταλίων του ανθρώπου in vitro όσο και της κυτταρομετρίας ροής σε ενεργοποιημένα αιμοπετάλια για τα δραστικά πεπτίδια, οδηγούμαστε στα επόμενα συμπεράσματα: 1. Από τη σειρά των RGD γραμμικών αναλόγων που μελετήθηκαν, βρέθηκαν δραστικά μόνο στην περίπτωση που τα πεπτίδια έχουν στο C-τελικό τους άκρο αμίδιο. 2. Η σύζευξη του σαλικυλικού οξέος στο τριπεπτίδιο - αμίδιο RGD ενισχύει την αντισυγκολλητική του δράση έναντι των αιμοπεταλίων in vitro. Από αυτά τα ανάλογα 26 (IC50= 50μΜ), 27 (38μΜ) και 28 (53μΜ) (ενσωματωμένο σαλικυλικό οξύ στο τριπεπτίδιο) έχουν την ισχυρότερη δράση, ενώ μόνο το τριπεπτίδιο 23 έχει IC50= 540μΜ 3. Η προστασία του β-καρβοξυλίου του Asp με βενζυλομάδα αυξάνει τη δράση του πεπτιδίου σε σχέση με την ύπαρξη ελεύθερου β-καρβοξυλίου. Αυτό διαπιστώνεται από το γεγονός ότι όλα τα βιολογικώς δραστικά ανάλογα έχουν το β-καρβοξύλιο προστατευμένο με βενζυλομάδα και αυτό έρχεται σε συμφωνία με βιβλιογραφικά δεδομένα άλλων ερευνητών περί αναγκαιότητας ύπαρξης λιπόφιλης ομάδας στο C-τελικό άκρο του πεπτιδίου. 4. Αντίθετα, η ενσωμάτωση σαλικυλο-παραγώγων (βρώμο-, χλώρο-, νίτρο-, άμινο-, κτλ) στα ανάλογα δίνει πολύ μικρή αντισυγκολλητική δράση στα αιμοπετάλια του ανθρώπου in vitro σε σχέση με το σαλικυλικό οξύ. 5. Από τα συντεθέντα κυκλικά ανάλογα μόνο το ανάλογο 61, που φέρει δισουλφιδικό δεσμό μεταξύ της κυστεΐνης και του θειοσαλικυλικού οξέος, επέδειξε ισχυρή αντισυγκολλητική δράση έναντι των αιμοπεταλίων του ανθρώπου in vitro με τιμή IC50= 8μΜ, που είναι και η καλύτερη τιμή IC50 για όλα τα ανάλογα που συντέθηκαν (γραμμικά και κυκλικά). 6. Και στην περίπτωση των κυκλικών πεπτιδίων, τα ανάλογα με το προστατευμένο β-καρβοξύλιο εμφανίζουν ισχυρότερη ανασταλτική δράση έναντι εκείνων που φέρουν το β-καρβοξύλιο ελεύθερο. 7. Από όλα τα γραμμικά ανάλογα που περιέχουν παράγωγα του σαλικυλικού οξέος το ανάλογο 39 που περιέχει το 5-χλωρο σαλικυλικό οξύ εμφανίζει ισχυρή ανασταλτική δράση έναντι του υποδοχέα Gp Ib. 8. Τέλος, θα πρέπει να αναφερθεί ότι είναι η πρώτη φορά που συνθετικά πεπτιδικά ανάλογα του RGD εμφανίζουν ισχυρή πρόσδεση στον υποδοχέα Gp Ib, o οποίος ευθύνεται για την προσκόλληση των αιμοπεταλίων στο κυτταρικό τοίχωμα. / Integrins constitute a large family of heterodimeric cell-surface, transmembrane receptors, which play a major role in cell/cell and cell/matrix adhesive interactions. The Arg-Gly-Asp (RGD) sequence is known to be the integrin recognition site of many extracellular matrix proteins such as fibronectin, osteopontin, collagen, fibrinogen, von Willebrand factor, laminin, etc. On the other hand, it is well known that low doses of aspirin (acetyl salicylic acid) decrease platelet aggregation by causing an inhibitory effect on thromboxane A2 production by platelets. Several antiplatelet strategies have already been developed and are under preclinical or clinical investigation. In the present thesis, the synthesis of linear and cyclic RGD analogs incorporating salicylic acid derivatives is reported. The syntheses of the new analogs were carried out by using classic methods of peptide synthesis in liquid or solid phase. The synthesized compounds were purified by RP-HPLC and lyophilised to give fluffy solid, identified by ESI-MS spectra. These compounds were tested for inhibitory activity on human platelet aggregation in vitro, by adding common aggregation reagents to citrated platelet rich plasma (PRP). The aggregation was determined using a dual channel electronic aggregometer by recording the increase of light transmission. Their specificity for the Gp receptors was checked by using flow cytometry with monoclonal antibodies against Gp Ib, Gp IIb/IIIa, Gp IIIa and GMP140 receptors. Based on the results of the biological studies we could report the next inferences: 1. From the studied synthetic RGD analogs only peptides – amides are active against human platelet aggregation in vitro. 2. The coupling of salicylic acid with the RGD peptides enforces the antiplatelet activity in vitro of the single tripeptide. From the above peptides, the analog 26 (tripeptide incorporating salicylic acid) shows strong antiplatelet activity (IC50=50 μΜ), whereas the analog 23 (only tripeptide) has IC50= 540μΜ. 3. The protection of the β-carboxy group of Asp as benzylester increases the activity of the peptides in comparison with those having the β-carboxy group unprotected. Thus, our results ensure the theory of necessity of the existence a lipophile center on the C-terminal side of the peptide. 4. The incorporation of salicylic acid derivatives in the RGD peptide does not increase further the antiplatelet activity than the incorporation of salicylic acid does. 5. Among the cyclic RGD peptides only the analog 61, having the disulfide bridge between the cysteine and the thiosalicylic acid, shows strong antiplatelet activity in vitro (IC50= 8μΜ). 6. Most of the analogs show high binding affinity for the Gp Ib receptor. The cyclic analog 61 shows special selectivity for this receptor at concetrations of 110 μΜ. 7. The analog 39, although it shows low antiplatelet activity, has high binding affinity for the Gp Ib receptor. Probably, this activity is due to the atom of Cl at the 5 position of aromatic ring of salicylic acid. 8. According to the literature data, it is the first time that synthetic RGD peptides show strong binding affinity for the Gp Ib receptor, which is responsible for the platelet adhesion to the subenthothelium.

Introduction Prior to percutaneous coronary intervention (PCI) guidelines recommend that patients with ST- elevation myocardial infarction (STEMI) receive dual antiplatelet therapy (DAPT) consisting of P2Y12 inhibition and acetylsalicylic acid (aspirin). However, in rare occasions, patients admitted with STEMI as preliminary diagnosis require acute thoracic surgery and oral P2Y12 inhibitors increases the bleeding risk over several hours. Cangrelor is an intravenous reversible P2Y12 antagonist with normal platelet function returning within 60 minutes and might therefore be an attractive alternative to oral P2Y12 inhibition.Aim Firstly, to quantify P2Y12 pre-treatment with ticagrelor in patients undergoing acute thoracic surgery and the mortality and morbidity rate associated with DAPT prior to surgery. Secondly, to estimate cost-benefit differences between cangrelor and ticagrelor pre-treatment.Material and Methods A descriptive cohort study using retrospective data. The inclusion criteria were patients undergoing acute thoracic surgery (≤ 24 hours) between January 2015 and December 2017, in the catchment area of Örebro University Hospital. Patients were stratified into groups depending on whether they had received pre-treatment with DAPT or not before surgery. Statistical analyses were made in SPSS and Excel.Results A total of 50 patients were included. 8 patients received DAPT before surgery. There was no mortality in patients receiving DAPT but TIMI major bleeding was more frequent compared to the group with no pre-treatment. The DAPT group required numerically more units of platelets and plasma, however the result was not significant. Direct treatment costs for ticagrelor was 20.14 SEK (the dosage is 2 tablets) and cangrelor was 3 059 SEK.Conclusions DAPT pre-treatment with ticagrelor was not associated with increased mortality but TIMI major bleeding was more frequent compared to the group with no pre-treatment. Direct treatment costs with cangrelor was higher compared to ticagrelor treatment. Further studies, with larger study samples, are needed to investigate complications associated with P2Y12 pre-treatment in patients undergoing acute thoracic surgery.

Background Many risk factors for stroke are well characterized and might, at least to some extent, be similar for first-ever stroke and for recurrent stroke events. However, previous studies have shown heterogeneous results on predictors and rates of stroke recurrence. Patients who survive spontaneous intracerebral hemorrhage (ICH) often have compelling indications for antithrombotic (AT) treatment (antiplatelet (AP) and/or anticoagulant (AC) treatment), but due to controversy of the decision to treat, a large proportion of these patients are untreated. In the absence of evidence from randomized controlled trials (RCTs), there is need for more high- quality observational data on the clinical impact of, and optimal timing of AT in ICH survivors. The aims of this thesis were to assess time trends in stroke recurrence, to determine the factors associated with an increased risk of stroke recurrence – including socioeconomic factors – and to determine to what extent ICH survivors with and without atrial fibrillation (AF) receive AT treatment and to determine the optimal timing (if any) of such treatment.  Methods The population-based Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) stroke incidence register was used to assess the epidemiology and predictors of stroke recurrence after ischemic stroke (IS) and ICH from 1995 to 2008 in northern Sweden. Riksstroke, the Swedish stroke register, linked with the National Patient Register and the Swedish Dispensed Drug Register, made it possible to identify survivors of first-ever ICH from 2005 to 2012 with and without concomitant AF to investigate to what extent these patients were prescribed AP and AC therapy. The optimal timing of initiating treatment following ICH in patients with AF 2005–2012 was described through separate cumulative incidence functions for severe thrombotic and hemorrhagic events and for the combined endpoint “vascular death or non-fatal stroke”. Riksstroke data on first-ever stroke patients from 2001 to 2012 was linked to the Longitudinal Integration Database for Health Insurance and Labour market studies to add information on education and income to investigate the relationship between socioeconomic status and risk of recurrence. Results Comparison between the cohorts of 1995–1998 and 2004–2008 showed declining risk of stroke recurrence (hazard ratio: 0.64, 95% confidence interval (CI): 0.52-0.78) in northern Sweden. Significant factors associated with an increased risk of stroke recurrence were age and diabetes. Following ICH, a majority (62%) of recurrent stroke events were ischemic.  The nationwide Riksstroke study confirmed the declining incidence, and it further concluded that low income, primary school as highest attained level of education, and living alone were associated with a higher risk of recurrence beyond the acute phase. The inverse effects of socioeconomic status on risk of recurrence did not differ between men and women and persisted over the study period. Of Swedish ICH-survivors with AF, 8.5% were prescribed AC and 36.6% AP treatment, within 6 months of ICH. In patients with AF, predictors of AC treatment were less severe ICH, younger age, previous anticoagulation, valvular disease and previous IS. High CHA2DS2-VASc scores did not seem to correlate with AC treatment. We observed both an increasing proportion of AC treatment at time of the initial ICH (8.1% in 2006 compared with 14.6% in 2012) and a secular trend of increasing AC use one year after discharge (8.3% in 2006 versus 17.2% in 2011) (p&lt;0.001 assuming linear trends). In patients with high cardiovascular event risk, AC treatment was associated with a reduced risk of vascular death and non-fatal stroke with no significantly increased risk of severe hemorrhage. The benefit appeared to be greatest when treatment was started 7–8 weeks after ICH. For high-risk women, the total risk of vascular death or stroke recurrence within three years was 17.0% when AC treatment was initiated eight weeks after ICH and 28.6% without any antithrombotic treatment (95% CI for difference: 1.4% to 21.8%). For high-risk men, the corresponding risks were 14.3% vs. 23.6% (95% CI for difference: 0.4% to 18.2%). Conclusion Stroke recurrence is declining in Sweden, but it is still common among stroke survivors and has a severe impact on patient morbidity and mortality. Age, diabetes and low socioeconomic status are predictors of stroke recurrence. Regarding ICH survivors with concomitant AF, physicians face the clinical dilemma of balancing the risks of thrombosis and bleeding. In awaiting evidence from RCTs, our results show that AC treatment in ICH survivors with AF was initiated more frequently over the study period, which seems beneficial, particularly in high-risk patients. The optimal timing of anticoagulation following ICH in AF patients seems to be around 7–8 weeks following the hemorrhage.

No description available.

Les plaquettes sont considérées comme l'un des réservoirs les plus importants non seulement des facteurs de croissance, mais aussi des facteurs neurotrophiques qui pourraient contribuer à la réparation des lésions vasculaires et à la prévention de la détérioration neurologique. Parmi ces facteurs, le facteur neurotrophique dérivé du cerveau (Brain-Derived Neurotrophic Factor ou BDNF) – une protéine appartenant à la famille des neurotrophines– est largement exprimée à la fois dans l'hippocampe et au niveau des plaquettes. Les plaquettes constituent un important réservoir de BDNF; cependant, on ne sait que peu de choses sur les facteurs modulant la libération de ce dernier dans la circulation et si les médicaments antiplaquettaires affectent cette sécrétion. Dans le cadre de ce projet, nous avons émis l’hypothèse principale que les différentes voies d’activation plaquettaire peuvent mener à une libération de BDNF, où celle-ci est affectée par les antiplaquettaires. A cette fin, les plaquettes ont été isolées à partir d’échantillons sanguins de volontaires sains (Groupe 1), de patients souffrant de maladies cardiovasculaires stables requérant la prise de médicaments antiplaquettaires [en prévention secondaire et en double thérapie à l’acide acétylsalicylique (ASA ou Aspirine) en association avec un antagoniste du récepteur P2Y12], (Groupe 2) ou en monothérapie à l’ASA (Groupe 3), versus de patients atteints de maladies valvulaires ou de cardiomyopathies ne requérant pas la prise de médicaments antiplaquettaires (Groupe 4). L’agrégation plaquettaire a été étudiée par agrégométrie optique en réponse à des agonistes spécifiques : adénosine diphosphate (ADP), acide arachidonique (AA), épinéphrine, collagène et Thrombin-receptor activated peptide 6 (TRAP-6 amide). Les antiplaquettaires testés sont dirigés contre la cyclo-oxygénase-1 ou COX-1 (ASA), contre le récepteur de P2Y12 de l’ADP (AR-C) et contre le récepteur αIIbβ3 du fibrinogène (Abciximab). La libération du BDNF a été quantifiée par ELISA. La présence du BDNF et de son récepteur Tropomyosin-Related Kinase Receptor type B (TrKB) a été détectée par immunobuvardage. Nous avons montré que l’activation des plaquettes par les différents agonistes testés induit une agrégation plaquettaire de l’ordre de 80% et permet de libérer jusqu’à 5 fois plus de BDNF, passant de 2500 pg / 250 x 106 plaquettes à l’état basal à approximativement 13000 pg / 250 x 106 plaquettes à l’état stimulé. Tous les antiplaquettaires testés réduisent la libération de BDNF par les plaquettes stimulées. Cependant, le niveau d’inhibition et sa significativité dépendent de la nature de l’agoniste; à savoir que l’ASA réduit significativement la sécrétion de BDNF en réponse à l’AA, à l’épinéphrine et au TRAP-6; alors que l’AR-C était plus efficace en réponse à l’ADP, l’AA et l’épinéphrine. L’Abciximab est un antagoniste qui inhibe la sécrétion de BDNF en réponse à tous les agonistes, en inhibant aussi l’agrégation plaquettaire. Notons que la libération de BDNF en réponse au collagène est inhibée par l’ASA et l’AR-C, alors que l’agrégation n’a pas été affectée. Ainsi, aucune corrélation positive et significative entre l’agrégation plaquettaire et la libération de BDNF n’a pu être obtenue. La présence des antiplaquettaires réduits à différents degrés la libération de BDNF chez les différents groupes des patients, malgré que son expression intraplaquettaire était similaire entre les groupes. On remarque que les antiplaquettaires réduisent plus significativement la quantité du BDNF relâchée chez les patients sous mono ou double thérapie antiplaquettaire en comparaison avec les volontaires sains et les patients atteints de maladies valvulaires. Nous avons aussi démontré que le BDNF exogène active les plaquettes isolées et lavées chez les volontaires sains, en induisant une forte agrégation stable et irréversible. Par contre, le BDNF exogène n’arrive pas à agréger les plaquettes en plasma riche en plaquettes. De plus, nos résultats indiquent que la forme tronquée du récepteur BDNF, le TrKB, est exprimée au niveau des plaquettes de volontaires sains. L’inhibition de l’activité kinase du TrKB abolit l’agrégation induite par le BDNF. Ces résultats suggèrent que l’action du BDNF dans les plaquettes lavées pourrait passer par l’intermédiaire du TrKB. Cette étude nous permet de conclure que le BDNF est présent dans les plaquettes et est libéré suite à l’activation plaquettaire et que cette libération est réduite par les antiplaquettaires. Cependant, l’agrégation plaquettaire ne semble pas être associée directement à la sécrétion du BDNF, ce qui suggère que d’autres mécanismes sous-jacents pourraient intervenir dans le contrôle de cette sécrétion. Les antiplaquettaires réduisent la libération de BDNF et il semble que l’action pro-agrégante du BDNF sur les plaquettes lavées passe par l’intermédiaire du TrKB, sans exclure la possibilité que d’autres types de récepteurs plaquettaires soient impliqués dans le signal déclenché par le BDNF. L’implication physiopathologique du BDNF libéré suite à l’activation plaquettaire ou sa biodisponibilité en présence des antiplaquettaires au niveau cardiovasculaire reste à être élucidée afin de révéler son potentiel diagnostique ou thérapeutique. / Platelets are considered one of the most important reservoirs not only of growth factors but also of neurotrophic factors that may contribute to the repair of vascular lesions and prevention of neurological deterioration. Among these factors, the Brain-Derived Neurotrophic Factor (BDNF), a protein belonging to the neurotrophin family, is largely expressed in both the hippocampus and platelets. In fact, platelets constitute an important reservoir of BDNF; however, little is known about the factors controlling its release into the circulation and whether antiplatelet drugs affect this secretion. Henceforth, the main hypothesis of this project is that platelet activation pathways lead to BDNF release which is affected by antiplatelet agents. For this purpose, platelets were isolated from the blood of four groups of human subjects following their consent. Group 1 consisted of healthy volunteers; Group 2 and Group 3 consisted of patients with stable cardiovascular disease on, respectively, dual antiplatelet therapy (aspirin + P2Y12 receptor antagonist) or monotherapy (aspirin) as secondary prevention; and Group 4 consisted of patients with valvular disease or cardiomyopathy who are not on antiplatelet therapy. Platelet aggregation was studied by optical aggregometry in response to the following agonists: adenosine diphosphate (ADP), arachidonic acid (AA), epinephrine, collagen, and thrombin-receptor activated peptide 6 (TRAP-6 amide). The antiplatelet agents that were tested antagonize cyclooxygenase-1 (COX-1) (acetylsalicylic acid (ASA) or aspirin), ADP P2Y12 receptor (AR-C), and fibrinogen receptor αIIbβ3 (Abciximab). BDNF release was quantified by ELISA. BDNF protein and its Tropomyosin-Related Kinase Receptor Type B (TrKB) receptor were detected by immunoblotting. Our results show that platelet activation in response to several agonists tested induced 80% platelet aggregation and augmented BDNF release by 5 folds, from 2500 pg / 250 x 106 platelets at baseline to approximately 13000 pg / 250 x 106 after stimulation. Moreover, all the tested antiplatelet agents reduced the release of BDNF by stimulated platelets. However, the level of reduction varied differentially between platelet antagonists depending on the platelet agonist used. Indeed, ASA significantly reduced BDNF secretion in response to AA, epinephrine, and TRAP-6, whereas AR-C was more effective in response to ADP, AA, and epinephrine. Abciximab inhibited BDNF secretion as well as platelet aggregation in response to all agonists. Noteworthy, the release of BDNF in response to collagen was inhibited by ASA and AR-C, while platelet aggregation was not affected. Accordingly, no significant correlation between platelet aggregation and BDNF release could be obtained. Although intra-platelet expression was similar in the different groups, the presence of antiplatelet agents reduced the release of BDNF to varying degrees between groups. As such, antiplatelet agents reduced BDNF release more significantly in patients on dual or mono antiplatelet therapy (Groups 2 and 3) as compared to healthy volunteers (Group 1) and valvular disease patients (Group 4). We have also shown that exogenous BDNF activated isolated/washed platelets from healthy volunteers, inducing strong, stable, and irreversible aggregation. In contrast, exogenous BDNF could not induce aggregation of platelets in platelet-rich plasma. In addition, our results indicate that the truncated form of the BDNF receptor, TrKB, is expressed in platelets of healthy volunteers. Hence, the inhibition of TrKB kinase activity abolished BDNF-induced aggregation. These results suggest that the action of BDNF in washed platelets might ensue through TrKB. We conclude from this study that BDNF is present in platelets and released following platelet activation, and its release is reduced by antiplatelet agents. However, platelet aggregation does not appear to be directly associated with BDNF secretion, suggesting that other underlying mechanisms may be involved in controlling its secretion. Antiplatelet agents reduce the release of BDNF, and it appears that the pro-aggregating action of BDNF on washed platelets ensues, non-exclusively, through TrKB, which means that other types of platelet receptors may also be involved in BDNF signaling. The pathophysiological implication of BDNF released following platelet activation or its bioavailability in the presence of antiplatelet agents in the cardiovascular system thus remain to be elucidated in order to reveal its diagnostic or therapeutic potential.

Anticoagulants, also known as antithrombotics, are among the most commonly prescribed medications in the United States. Understanding how these medications work, the propensity for interactions with other drugs, dietary factors, and disease states is important for clinicians assessing and providing care to patients in all environments. In this review, we seek to provide essential information for the home health care provider for evaluating patients receiving anticoagulants commonly prescribed in the home health care setting. The low-molecular-weight heparins and vitamin K antagonists are the most commonly used agents for outpatient anticoagulation. New agents, such as the direct factor Xa inhibitors and direct thrombin inhibitors have recently been approved with additional new agents in the approval process and development pipeline. We seek to review the most pertinent information for each of these classes of medications providing information on pharmacology, interactions with other drugs, diet, and diseases and important clinical information.

Background: Dual antiplatelet therapy (DAPT) is a mainstay treatment for hospital survivors of an acute myocardial infarction (AMI). However, there are extremely limited data on the prescribing patterns of DAPT among patients hospitalized with AMI. Objective: To examine decade-long trends (2001-2011) in the use of DAPT versus antiplatelet monotherapy and patient characteristics associated with DAPT use. Methods: The study population consisted of 2,389 adults hospitalized with an initial AMI at all 11 central Massachusetts medical centers on a biennial basis between 2001 and 2011. DAPT was defined as the discharge use of aspirin plus either clopidogrel or prasugrel. Logistic regression analysis was used to identify patient characteristics associated with DAPT use. Results: The average age of the study population was 65 years, and 69% of them were discharged on DAPT. The use of DAPT at the time of hospital discharge increased from 49% in 2001 to 74% in 2011; this increasing trend was seen across all age groups, both sexes, types of AMI, and in those who underwent a PCI. After multivariable adjustment, older age was the only factor associated with lower odds of receiving DAPT, while being male, receiving additional evidence-based cardioprotective therapy and undergoing cardiac stenting were associated with higher odds of receiving DAPT. Conclusions: Between 2001 and 2011, the use of DAPT increased markedly among patients hospitalized with AMI. However, a significant proportion of patients were not discharged on this therapy. Greater awareness is needed to incorporate DAPT into the management of patients with AMI.