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Cardiologia Croatica, Vol. 18 No. 11-12, 2023.

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https://doi.org/10.15836/ccar2023.311

Does platelet reactivity depend on chronic oral anticoagulation choice in patients undergoing pulmonary vein isolation?

Petar Samardžić orcid id orcid.org/0009-0006-7604-2989 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Marijan Pašalić orcid id orcid.org/0000-0002-3197-2190 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Laura Rudelj orcid id orcid.org/0009-0009-7314-2783 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Hrvoje Jurin ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Ivo Planinc orcid id orcid.org/0000-0003-0561-6704 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Maja Čikeš orcid id orcid.org/0000-0002-4772-5549 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Boško Skorić orcid id orcid.org/0000-0001-5979-2346 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Vedran Velagić orcid id orcid.org/0000-0001-5425-5840 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Jure Samardžić orcid id orcid.org/0000-0002-9346-6402 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Davor Miličić orcid id orcid.org/0000-0001-9101-1570 ; University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

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preuzimanja: 57

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Sažetak

Ključne riječi

direct oral anticoagulants; vitamin K antagonists; atrial fibrillation; pulmonary vein isolation; platelet reactivity

Hrčak ID:

310241

URI

https://hrcak.srce.hr/310241

Datum izdavanja:

28.11.2023.

Posjeta: 156 *

Copyright statement: Croatian Cardiac Society

Copyright: 2023, Croatian Cardiac Society

Date received: 20 September 2023

Date accepted: 27 September 2023

Publication date (print and electronic): September 2023

Volume: 18

Issue: 11-12

Pages: 311-312

Publisher ID: CC 2023 18_11-12_311-2

DOI: 10.15836/ccar2023.311

Article Information (continued)

Categories:

Subject: Extended Abstract

Categories:

Subject: Miscellaneous

KEYWORDS: :

KEYWORDS:

Keyword: direct oral anticoagulants

Keyword: vitamin K antagonists

Keyword: atrial fibrillation

Keyword: pulmonary vein isolation

Keyword: platelet reactivity

Does platelet reactivity depend on chronic oral anticoagulation choice in patients undergoing pulmonary vein isolation?

[https://orcid.org/0009-0006-7604-2989] Petar Samardžić

[https://orcid.org/0000-0002-3197-2190] Marijan Pašalić

[https://orcid.org/0009-0009-7314-2783] Laura Rudelj

[https://orcid.org/0000-0002-2599-553X] Hrvoje Jurin

[https://orcid.org/0000-0003-0561-6704] Ivo Planinc

[https://orcid.org/0000-0002-4772-5549] Maja Čikeš

[https://orcid.org/0000-0001-5979-2346] Boško Skorić

[https://orcid.org/0000-0001-5425-5840] Vedran Velagić

[https://orcid.org/0000-0002-9346-6402] Jure Samardžić[*]

[https://orcid.org/0000-0001-9101-1570] Davor Miličić

 

University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia

Author notes:

Correspondence to: [*] ADDRESS FOR CORRESPONDENCE: Jure Samardžić, Klinički bolnički centar Zagreb, Kišpatićeva 12, HR-10000 Zagreb, Croatia. / Phone: +385-98-537-864 / E-mail: jure.samardzic@gmail.com

Introduction: Direct oral anticoagulants (DOACs) are recommended in preference to vitamin K antagonists (VKA) in patients with atrial fibrillation (Afib) (1). There is no direct comparison between DOACs and substantial share of patients are still treated with VKAs due to certain comorbidities or financial reasons. Pulmonary vein isolation (PVI) is an established procedure to treat paroxysmal and persistent Afib but it increases thromboembolic risk (2). The aim of this study was to compare periinterventional platelet reactivity (PR) in Afib patients undergoing PVI on different chronic oral anticoagulation.

Patients and Methods: PR was analyzed with Multiplate function analyzer in 136 patients undergoing PVI procedures in our institution. Blood samples were drawn before the procedure and on the following morning. ASPItest, ADPtest and TRAPtest were used as assays for the quantitative in vitro determination of PR triggered by arachidonic acid, adenosine diphosphate and thrombin receptor activating peptide-6, respectively. Fourty three patients (31.6%) were taking VKA, while 38 (27.9%), 29 (21.3%) and 26 (19.1%) patients were treated with dabigatran, rivaroxaban and apixaban, respectively. Edoxaban was not available during the investigation.

Results: There was no significant difference in demographics between the groups. Patients on VKA had lower mean platelet volume (MPV) compared to patients on DOACs (9.9 vs 10.7-10.8 fL; p=0.020). Patients on xabans (rivaroxaban and apixaban) had lower baseline PR compared to VKA and dabigatran (Table 1). One day after PVI, there was no significant change from PR baseline in all four groups (Figure 1).

TABLE 1 Study patient characteristics.
Patients’ characteristicsVKA
(n=43)		Dabigatran
(n=38)		Rivaroxaban
(n=29)		Apixaban (n=26)p
Age, years, mean (min-max)58.2 (36-73)61.7 (45-76)59.3 (42-77)60.1 (45-76)0.659
Men, n (%)31 (72.1)27 (71.1)22 (75.9)15 (57.7)0.487
BMI, kg/m2, mean (min-max)
Paroxysmal Afib, n (%)		29.2 (22.0-37.6)
32 (74.4)		28.96 (21.4-38.1)
31 (81.6)		27.68 (22.1-34.7)
20 (68.9)		28.67 (23.1-38.3)
23 (88.5)		0.560
0.307
Arterial hypertension, n (%)
Hyperlipidemia, n (%)		33 (76.7)
22 (51.2)		30 (78.9)
23 (60.5)		20 (68.9)
14 (48.3)		24 (92.3)
12 (46.2)		0.206
0.654
Diabetes mellitus, n (%)
CrCl<60 mL/min, n (%)
CHA2DS2-VASc, mean (min-max)
HAS-BLED, mean (min-max)		1 (2.3)
2 (4.6)
1.72 (0-5)
0.77 (0-4)		3 (7.9)
6 (15.8)
1.94 (0-6)
1.12 (0-3)		4 (13.8)
4 (13.8)
2.07 (0-4)
1.00 (0-3)		3 (11.5)
3 (11.5)
2.54 (0-5)
1.15 (0-4)		0.310
0.343
0.095
0.238
Platelets, x109/L, mean (min-max)
MPV, fL, mean (min-max)
PR before PVI
ASPItest, mean (U)
ADPtest, mean (U)
TRAPtest, mean (U)
Periinterventional UFH administration, mean (IU) (min-max)		227.8 (134-379)
9.9 (7.8-12.2)
35.4
28.9
37.5
11952
(7000-24000)		214.8 (126-318)
10.7 (8.2-12.8)
29.1
23.6
37.4
13844
(7000-30000)		214.8 (126-318)
10.7 (8.6-13.2)
14.2
16.9
24.3
11944
(5000-26000)		217.6 (119-308)
10.8 (8.4-13.1)
20.1
13.4
22.1
13650
(9000-23000)		0.896
0.020
0.022
0.049
0.251
0.203
Afib = atrial fibrillation; ASPItest = assay for determination of platelet function triggered by arachidonic acid; ADPtest = assay for determination of platelet function triggered by adenosine diphosphate; BMI = body mass index; MPV = mean platelet volume; PR = platelet reactivity; PVI = pulmonary vein isolation; TRAPtest = assay for determination of platelet function triggered by thrombin receptor activating peptide-6; UFH = unfractionated heparin
FIGURE 1 Platelet reactivity change one day after pulmonary vein isolation in patients on different oral anticoagulation. ASPItest = assay for determination of platelet function triggered by arachidonic acid; ADPtest = assay for determination of platelet function triggered by adenosine diphosphate; VKA = vitamin K antagonist; TRAPtest = assay for determination of platelet function triggered by thrombin receptor activating peptide-6
CC202318_11-12_311-2-f1

Conclusion: Our results show that there is no significant effect of PVI on PR one day after the procedure regardless of chronic oral anticoagulation that was used. Lower basal PR was noted in patients on xabans compared to direct thrombin inhibitor and VKA. This antiplatelet mechanism is not fully understood but might be associated with multiple direct and indirect pathways which could contribute to potential differences in events between patients on certain DOACs. This warrants further investigation in seeking optimal DOAC choice for each patient.

Acknowledgement: This study was part of SPARELIFE-CVD project funded by the Croatian Science Foundation.

LITERATURE

1 

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021 February 1;42(5):373–498. https://doi.org/10.1093/eurheartj/ehaa612 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/32860505

2 

Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017 October;14(10):e275–444. https://doi.org/10.1016/j.hrthm.2017.05.012 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/28506916

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