Key result
High reticulated platelets linked to ~3-fold higher rate of low aspirin response.
Why the study?
The relationship between reticulated platelets, platelet size, and platelet function in stable CAD patients on aspirin and clopidogrel was not well characterized.
Does a higher proportion of reticulated platelets and larger platelet size correlate with increased platelet reactivity and reduced response to dual antiplatelet therapy in patients with stable coronary artery disease?
Cross-Sectional (n=90)
Does a higher proportion of reticulated platelets and larger platelet size correlate with increased platelet reactivity and reduced response to dual antiplatelet therapy in patients with stable coronary artery disease?
In patients with stable CAD on dual antiplatelet therapy, a higher proportion of reticulated (young) platelets and larger platelet size strongly correlate with decreased responsiveness to both aspirin and clopidogrel.
Answers are grounded in this paper and cite their sources.
May flag low DAPT responders via reticulated platelet tertiles; leaves open randomized validation before guiding therapy in stable CAD.
OBJECTIVES: The aim of this study was to evaluate the relationship between reticulated platelets (RPs), platelet size, and platelet function in patients with stable coronary artery disease (CAD) taking aspirin and clopidogrel. BACKGROUND: Reticulated platelets are young platelets that are larger and possibly more active than non-RPs. METHODS: Flow cytometry was used to measure RPs after staining with thiazole orange and to define the upper 20% and lower 20% of platelets by size. Platelet aggregation was measured with light transmission aggregometry (LTA); platelet activation was assessed by measuring activated platelet surface expression of P-selectin and glycoprotein (GP) IIb/IIIa. RESULTS: Ninety patients were recruited and stratified into tertiles of %RPs. Patients in the upper tertile displayed greater platelet aggregation to 5-mumol/l adenosine diphosphate (ADP) (50.7 +/- 16.4% vs. 34.2 +/- 17.3%, p < 0.001), 1.5-mmol/l arachidonic acid (AA) (27.3 +/- 16.9% vs. 11.7 +/- 9.3%, p < 0.001), and 1-mug/ml collagen (18 +/- 11.6% vs. 12.1 +/- 8.7%, p < 0.05) and greater expression of GP IIb/IIIa (4.7 +/- 1.8% vs. 3.1 +/- 2.2%, p < 0.001). Frequency of low response to aspirin (AA LTA >20%) was higher in the upper tertile (53% vs. 17%, p < 0.001) compared with the lower tertile; low response to clopidogrel (ADP LTA >50%) was also elevated in the upper tertile (50% vs. 13%, p = 0.003). The larger platelet gate had a higher % of RPs compared with the smaller gate (15.4 +/- 16.7% vs. 1.7 +/- 2.3%, p < 0.001) and greater GP IIb/IIIa (5.7 +/- 3.1 vs. 2.1 +/- 1.2, p < 0.001) and P-selectin expression (7.8 +/- 4.9 vs. 4.6 +/- 2.7, p < 0.001). CONCLUSIONS: The proportion of circulating RPs strongly correlates with response to antiplatelet therapy in patients with stable CAD. Large platelets exhibit increased reactivity despite dual antiplatelet therapy, compared with smaller platelets.
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Guthikonda et al. (2008) conducted a cross-sectional in Stable coronary artery disease (n=90). Higher proportion of reticulated platelets (upper tertile) vs. Lower proportion of reticulated platelets (lower tertile) was evaluated on Low response to aspirin (AA LTA >20%) (p=<0.001). Patients in the upper tertile of reticulated platelets had a significantly higher frequency of low response to aspirin (53% vs 17%, p<0.001) and clopidogrel (50% vs 13%, p=0.003).
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