Longitudinal assessment of thrombin generation potential in response to alteration of antiplatelet therapy after TIA or ischaemic stroke.

Hdl Handle:
http://hdl.handle.net/10147/302026
Title:
Longitudinal assessment of thrombin generation potential in response to alteration of antiplatelet therapy after TIA or ischaemic stroke.
Authors:
Tobin, W O; Kinsella, J A; Kavanagh, G F; O'Donnell, J S; McGrath, R A; Collins, D R; Coughlan, T; O'Neill, D; Egan, B; Tierney, S; Feeley, T M; Murphy, R P; McCabe, Dominick J H
Affiliation:
Department of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Trinity College Dublin, Tallaght, Dublin, 24, Ireland.
Citation:
Longitudinal assessment of thrombin generation potential in response to alteration of antiplatelet therapy after TIA or ischaemic stroke. 2013, 260 (2):590-6 J. Neurol.
Journal:
Journal of neurology
Issue Date:
Feb-2013
URI:
http://hdl.handle.net/10147/302026
DOI:
10.1007/s00415-012-6684-2
PubMed ID:
23064666
Abstract:
The impact of changing antiplatelet therapy on thrombin generation potential in patients with ischaemic cerebrovascular disease (CVD) is unclear. We assessed patients within 4 weeks of TIA or ischaemic stroke (baseline), and then 14 days (14d) and >90 days (90d) after altering antiplatelet therapy. Thrombin generation was assessed in platelet poor plasma. Ninety-one patients were recruited. Twenty-four were initially assessed on no antiplatelet therapy, and then after 14d (N = 23) and 90d (N = 8) on aspirin monotherapy; 52 were assessed on aspirin monotherapy, and after 14 and 90 days on aspirin and dipyridamole combination therapy; 21 patients were assessed on aspirin and after 14 days (N = 21) and 90 days (N = 19) on clopidogrel. Peak thrombin generation and endogenous thrombin potential were reduced at 14 and 90 days (p ≤ 0.04) in the overall cohort. We assessed the impact of individual antiplatelet regimens on thrombin generation parameters to investigate the cause of this effect. Lag time and time-to-peak thrombin generation were unchanged at 14 days, but reduced 90 days after commencing aspirin (p ≤ 0.009). Lag time, peak thrombin generation and endogenous thrombin potential were reduced at both 14 and 90 days after adding dipyridamole to aspirin (p ≤ 0.01). Lag time was reduced 14 days after changing from aspirin to clopidogrel (p = 0.045), but this effect was not maintained at 90 days (p = 0.2). This pilot study did not show any consistent effects of commencing aspirin, or of changing from aspirin to clopidogrel on thrombin generation potential during follow-up. The addition of dipyridamole to aspirin led to a persistent reduction in peak and total thrombin generation ex vivo, and illustrates the diverse, potentially beneficial, newly recognised 'anti-coagulant' effects of dipyridamole in ischaemic CVD.
Item Type:
Article
Language:
en
MeSH:
Adult; Aged; Aspirin; Dipyridamole; Female; Humans; Ischemic Attack, Transient; Longitudinal Studies; Male; Middle Aged; Pilot Projects; Platelet Aggregation Inhibitors; Statistics, Nonparametric; Stroke; Thrombin; Ticlopidine
ISSN:
1432-1459

Full metadata record

DC FieldValue Language
dc.contributor.authorTobin, W Oen_GB
dc.contributor.authorKinsella, J Aen_GB
dc.contributor.authorKavanagh, G Fen_GB
dc.contributor.authorO'Donnell, J Sen_GB
dc.contributor.authorMcGrath, R Aen_GB
dc.contributor.authorCollins, D Ren_GB
dc.contributor.authorCoughlan, Ten_GB
dc.contributor.authorO'Neill, Den_GB
dc.contributor.authorEgan, Ben_GB
dc.contributor.authorTierney, Sen_GB
dc.contributor.authorFeeley, T Men_GB
dc.contributor.authorMurphy, R Pen_GB
dc.contributor.authorMcCabe, Dominick J Hen_GB
dc.date.accessioned2013-09-20T15:37:23Z-
dc.date.available2013-09-20T15:37:23Z-
dc.date.issued2013-02-
dc.identifier.citationLongitudinal assessment of thrombin generation potential in response to alteration of antiplatelet therapy after TIA or ischaemic stroke. 2013, 260 (2):590-6 J. Neurol.en_GB
dc.identifier.issn1432-1459-
dc.identifier.pmid23064666-
dc.identifier.doi10.1007/s00415-012-6684-2-
dc.identifier.urihttp://hdl.handle.net/10147/302026-
dc.description.abstractThe impact of changing antiplatelet therapy on thrombin generation potential in patients with ischaemic cerebrovascular disease (CVD) is unclear. We assessed patients within 4 weeks of TIA or ischaemic stroke (baseline), and then 14 days (14d) and >90 days (90d) after altering antiplatelet therapy. Thrombin generation was assessed in platelet poor plasma. Ninety-one patients were recruited. Twenty-four were initially assessed on no antiplatelet therapy, and then after 14d (N = 23) and 90d (N = 8) on aspirin monotherapy; 52 were assessed on aspirin monotherapy, and after 14 and 90 days on aspirin and dipyridamole combination therapy; 21 patients were assessed on aspirin and after 14 days (N = 21) and 90 days (N = 19) on clopidogrel. Peak thrombin generation and endogenous thrombin potential were reduced at 14 and 90 days (p ≤ 0.04) in the overall cohort. We assessed the impact of individual antiplatelet regimens on thrombin generation parameters to investigate the cause of this effect. Lag time and time-to-peak thrombin generation were unchanged at 14 days, but reduced 90 days after commencing aspirin (p ≤ 0.009). Lag time, peak thrombin generation and endogenous thrombin potential were reduced at both 14 and 90 days after adding dipyridamole to aspirin (p ≤ 0.01). Lag time was reduced 14 days after changing from aspirin to clopidogrel (p = 0.045), but this effect was not maintained at 90 days (p = 0.2). This pilot study did not show any consistent effects of commencing aspirin, or of changing from aspirin to clopidogrel on thrombin generation potential during follow-up. The addition of dipyridamole to aspirin led to a persistent reduction in peak and total thrombin generation ex vivo, and illustrates the diverse, potentially beneficial, newly recognised 'anti-coagulant' effects of dipyridamole in ischaemic CVD.en_GB
dc.language.isoenen
dc.rightsArchived with thanks to Journal of neurologyen_GB
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAspirin-
dc.subject.meshDipyridamole-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshIschemic Attack, Transient-
dc.subject.meshLongitudinal Studies-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshPilot Projects-
dc.subject.meshPlatelet Aggregation Inhibitors-
dc.subject.meshStatistics, Nonparametric-
dc.subject.meshStroke-
dc.subject.meshThrombin-
dc.subject.meshTiclopidine-
dc.titleLongitudinal assessment of thrombin generation potential in response to alteration of antiplatelet therapy after TIA or ischaemic stroke.en_GB
dc.typeArticleen
dc.contributor.departmentDepartment of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Trinity College Dublin, Tallaght, Dublin, 24, Ireland.en_GB
dc.identifier.journalJournal of neurologyen_GB
dc.description.fundingNo fundingen
dc.description.provinceLeinsteren
dc.description.peer-reviewpeer-reviewen

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