1.
Chewing versus Swallowing Ticagrelor to Accelerate Platelet Inhibition in Acute Coronary Syndrome - the CHEERS study. For The PLATIS (Platelets and Thrombosis in Sheba) Study Group.
Asher, E, Frydman, S, Katz, M, Regev, E, Sabbag, A, Mazin, I, Abu-Much, A, Kukuy, A, Mazo, A, Erez, A, et al
Thrombosis and haemostasis. 2017;(4):727-733
Abstract
It was the study objective to evaluate whether chewing a 180 mg loading dose of ticagrelor versus an equal dose of traditional oral administration, enhances inhibition of platelet aggregation 1 hour (h) after administering a ticagrelor loading dose in non-ST elevation myocardial infarction (NSTEMI) patients. Dual anti-platelet therapy represents standard care for treating NSTEMI patients. Ticagrelor is a direct acting P2Y12 inhibitor and, unlike clopidogrel and prasugrel, does not require metabolic activation. Fifty NSTEMI patients were randomised to receive either a chewing loading dose of 180 mg ticagrelor or an equal standard oral dose of ticagrelor. Platelet reactivity was evaluated by VerifyNow at baseline, 1 and 4 h post-loading dose. Results are reported in P2Y12 reaction units. Patients then continued to receive standard 90 mg oral ticagrelor twice daily. Baseline characteristics did not differ between the two groups. P2Y12 reaction units in the chewing group compared with the standard group at 0, 1 and 4 h after ticagrelor loading dose were: 245 vs 239 (p=0.59), 45 vs 130 (p=0.001) and 39 vs 60 (p=0.12), respectively, corresponding to a relative inhibition of platelet aggregation of 83 % vs only 47 % at 1 h (p< 0.001), and 84 % vs 77 % (p=0.59) at 4 h. Major adverse cardiac and cardiovascular events at 30 days were low (2 %), occurring in only one patient in the standard group. In conclusion, chewing a 180 mg ticagrelor loading dose is feasible and facilitates both faster and improved early inhibition of platelet aggregation in NSTEMI patients, compared with a standard oral-loading dose.
2.
Effect of palm-based tocotrienols and tocopherol mixture supplementation on platelet aggregation in subjects with metabolic syndrome: a randomised controlled trial.
Gan, YL, Fu, JY, Lai, OM, Chew, BH, Yuen, KH, Teng, KT, Nesaretnam, K, Selvaduray, KR, Meganathan, P
Scientific reports. 2017;(1):11542
Abstract
Tocotrienols, the unsaturated form of vitamin E, were reported to modulate platelet aggregation and thrombotic mechanisms in pre-clinical studies. Using a Food and Drug Administration (FDA)-approved cartridge-based measurement system, a randomised, double-blind, crossover and placebo-controlled trial involving 32 metabolic syndrome adults was conducted to investigate the effect of palm-based tocotrienols and tocopherol (PTT) mixture supplementation on platelet aggregation reactivity. The participants were supplemented with 200 mg (69% tocotrienols and 31% α-tocopherol) twice daily of PTT mixture or placebo capsules for 14 days in a random order. After 14 days, each intervention was accompanied by a postprandial study, in which participants consumed 200 mg PTT mixture or placebo capsule after a meal. Blood samples were collected on day 0, day 14 and during postprandial for the measurement of platelet aggregation reactivity. Subjects went through a 15-day washout period before commencement of subsequent intervention. Fasting platelet aggregation reactivity stimulated with adenosine diphosphate (ADP) did not show substantial changes after supplementation with PTT mixture compared to placebo (p = 0.393). Concomitantly, changes in postprandial platelet aggregation reactivity remained similar between PTT mixture and placebo interventions (p = 0.408). The results of this study highlight the lack of inhibitory effect on platelet aggregation after short-term supplementation of PTT mixture in participants with metabolic syndrome.
3.
[Effect of Radix notoginseng saponins on platelet activating molecule expression and aggregation in patients with blood hyperviscosity syndrome].
Wang, J, Xu, J, Zhong, JB
Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine. 2004;(4):312-6
Abstract
OBJECTIVE In order to explore the relationship between the active components and the functional links of Chinese herbs, the effect of Xuesaitong capsule, a preparation made of multi-component Panax notoginseng saponins (PNS) on platelet activating molecule expression and aggregation in patients with blood hyperviscosity syndrome (BHS) was observed, with aspirin (ASP) as a control. METHODS One hundred and twenty patients with BHS were divided, adopting randomized, double-blinded and double simulated principle into 2 groups, the PNS group and the ASP group, 60 in each group. Changes of the TCM clinical syndrome, platelet adhesion and aggregation, endothelin (ET), prostacyclin, thromboxane, CD62P and CD41 before treatment and after 28 days treatment were observed. RESULTS Comparison between the therapeutic effects of the two groups on TCM clinical syndrome showed that the total effective rate in the PNS group was 86.67% and that in the ASP group 56.67%, showing significant difference (P < 0.05). Compared with before treatment, after treatment, levels of platelet adhesion and aggregation, endothelin, prostacyclin and thromboxane were significantly different in both groups (P < 0.05 or P < 0.01); levels of CD62P and CD41 in the PNS group were also significantly different, but the difference was insignificant in the ASP group; no significant difference was shown in both groups in levels of triglyceride, total cholesterol and very low density lipoprotein-cholesterol. CONCLUSION PNS may inhibit activation of platelet through multiple components and multiple pathways, which is different from that of ASP, only through inhibition on arachidonic acid metabolism to suppress platelet aggregation. PNS has effects of decreasing platelet superficial activation, inhibiting platelet adhesion and aggregation, preventing thrombosis and improving microcirculation, and its therapeutic effect on clinical syndrome is better than that of ASP.