Key result
Above-median vWF/ADAMTS13 ratio linked to ~86% greater risk of major events in stable CAD.
Why the study?
Are ADAMTS13 levels and vWF/ADAMTS13 ratio associated with high residual platelet reactivity and clinical outcomes in stable CAD patients on aspirin?
Cohort (n=999)
No
Are ADAMTS13 levels and vWF/ADAMTS13 ratio associated with high residual platelet reactivity and clinical outcomes in stable CAD patients on aspirin?
Lower ADAMTS13 levels and higher vWF/ADAMTS13 ratios are associated with high residual platelet reactivity and an increased risk of adverse clinical outcomes in stable CAD patients on aspirin.
Answers are grounded in this paper and cite their sources.
Higher vWF/ADAMTS13 ratio associated with increased events on aspirin in stable CAD; hypothesis-generating and requires prospective validation before clinical consideration.
The mechanisms behind residual platelet reactivity (RPR) despite aspirin treatment are not established. It has been shown that coronary artery disease (CAD) patients with high on-aspirin RPR have elevated levels of von Willebrand factor (vWF). ADAMTS13 is a metalloprotease cleaving ultra large vWF multimers into less active fragments. Our aim was to investigate whether ADAMTS13 and vWF/ADAMTS13 ratio were associated with high RPR, and further with clinical endpoints after 2 years. Stable aspirin-treated CAD patients (n = 999) from the ASCET trial. RPR was assessed by PFA-100. ADAMTS13 antigen and activity were analysed using chromogenic assays. Endpoints were a composite of acute myocardial infarction, stroke and death. The number of patients with high RPR was 258 (25.8%). Their serum thromboxane B2 (TxB2) levels were low, indicating inhibition of COX-1. They had significantly lower levels of ADAMTS13 antigen compared to patients with low RPR (517 vs 544 ng/mL, p = 0.001) and significantly lower ADAMTS13 activity (0.99 vs 1.04 IU/mL, p = 0.020). The differences were more pronounced when relating RPR to ratios of vWF/ADAMTS13 antigen and vWF/ADAMTS13 activity (p < 0.001, both). We found an inverse correlation between vWF and ADAMTS13 antigen (r = −0.14, p < 0.001) and ADAMTS13 activity (r = −0.11, p < 0.001). No correlations between TxB2 and ADAMTS13 antigen or activity, were observed, implying that ADAMTS13 is not involved in TxB2 production. Patients who experienced endpoints (n = 73) had higher vWF level (113 vs 105%, p = 0.032) and vWF/ADAMTS13 antigen ratio (0.23 vs 0.20, p = 0.012) compared to patients without. When dichotomizing vWF/ADAMTS13 antigen at median level we observed that patients above median had higher risk for suffering endpoints, with an adjusted OR of 1.86 (95% CI 1.45, 2.82). These results indicate that ADAMTS13 is of importance for RPR, and that it in combination with vWF also is associated with clinical endpoints in stable CAD patients on aspirin. Clinicaltrials.gov NCT00222261 . Registered 13.09.2005. Retrospectively registered.
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Warlo et al. (2017) conducted a cohort in Stable coronary artery disease (n=999). vWF/ADAMTS13 antigen ratio above median vs. vWF/ADAMTS13 antigen ratio below median was evaluated on Composite of acute myocardial infarction, stroke and death (OR 1.86, 95% CI 1.45-2.82, p=0.045). In patients with stable coronary artery disease on aspirin, a vWF/ADAMTS13 antigen ratio above the median was associated with an increased risk of myocardial infarction, stroke, or death (adjusted OR 1.86).
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