Longitudinal assessment of thrombin generation potential in response to alteration of antiplatelet therapy after TIA or ischaemic stroke.
AuthorsTobin, W O
Kinsella, J A
Kavanagh, G F
O'Donnell, J S
McGrath, R A
Collins, D R
Feeley, T M
Murphy, R P
McCabe, Dominick J H
AffiliationDepartment of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Trinity College Dublin, Tallaght, Dublin, 24, Ireland.
Ischemic Attack, Transient
Platelet Aggregation Inhibitors
MetadataShow full item record
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.
JournalJournal of neurology
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.
- Longitudinal assessment of von Willebrand factor antigen and von Willebrand factor propeptide in response to alteration of antiplatelet therapy after TIA or ischaemic stroke.
- Authors: Tobin WO, Kinsella JA, Kavanagh GF, O'Donnell JS, McGrath RT, Coughlan T, Collins DR, O'Neill D, Egan B, Tierney S, Feeley TM, Murphy RP, McCabe DJ
- Issue date: 2014 Jul
- High on-treatment platelet reactivity on commonly prescribed antiplatelet agents following transient ischaemic attack or ischaemic stroke: results from the Trinity Antiplatelet Responsiveness (TRAP) study.
- Authors: Tobin WO, Kinsella JA, Coughlan T, Collins DR, O'Neill D, Murphy RP, Egan B, Tierney S, Feeley TM, McCabe DJ
- Issue date: 2013 Feb
- Prevalence of ex vivo high on-treatment platelet reactivity on antiplatelet therapy after transient ischemic attack or ischemic stroke on the PFA-100(®) and VerifyNow(®).
- Authors: Kinsella JA, Tobin WO, Cox D, Coughlan T, Collins R, O'Neill D, Murphy RP, McCabe DJ
- Issue date: 2013 Oct
- Antiplatelet profiles of the fixed-dose combination of extended-release dipyridamole and low-dose aspirin compared with clopidogrel with or without aspirin in patients with type 2 diabetes and a history of transient ischemic attack: a randomized, single-blind, 30-day trial.
- Authors: Serebruany VL, Malinin AI, Pokov AN, Hanley DF
- Issue date: 2008 Feb
- Enhanced ex vivo inhibition of platelet function following addition of dipyridamole to aspirin after transient ischaemic attack or ischaemic stroke: first results from the TRinity AntiPlatelet responsiveness (TrAP) study.
- Authors: Tobin WO, Kinsella JA, Collins DR, Coughlan T, O'Neill D, Egan B, Tierney S, Feeley TM, Murphy RP, McCabe DJ
- Issue date: 2011 Mar