Details

Autor(en) / Beteiligte

• Nardin, Matteo, MD
• Verdoia, Monica, MD
• Pergolini, Patrizia, MD
• Rolla, Roberta, MD
• Barbieri, Lucia, MD
• Schaffer, Alon, MD
• Marino, Paolo, MD
• Bellomo, Giorgio, MD
• Suryapranata, Harry, MD, PhD
• De Luca, Giuseppe, MD, PhD

Titel

Serum uric acid levels during dual antiplatelet therapy with ticagrelor or clopidogrel: results from a single center study

Ist Teil von

• Nutrition, metabolism, and cardiovascular diseases, 2016-07, Vol.26 (7), p.567-574

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2016

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background New antithrombotic therapies have significantly improved the outcomes of patients with Acute Coronary Syndromes (ACS), where the introduction of ticagrelor has provided the greatest mortality benefits. However, ticagrelor treatment has been associated with a potential raise in serum uric acid (SUA), whose contribution to endothelial dysfunction and pro-thrombotic status may affect the risk of acute cardiovascular events in patients requiring dual antiplatelet therapy (DAPT). The aim of the present study was to compare the impact of the antiplatelet agents ticagrelor or clopidogrel on SUA levels and their effect on platelet reactivity. Methods We included patients admitted for ACS or elective percutaneous coronary intervention and discharged with ASA (100-160 mg) and clopidogrel (75 mg) or ticagrelor (90 mg twice a day). Chemistry was assessed at admission (baseline) and after a 30-90 days period of DAPT (together with platelet reactivity). Absolute and percentage variations of SUA after DAPT instruction were considered. Multiple-electrode aggregometry was used to assess platelet function. Results A total of 378 patients were enrolled, 145 in aspirin and clopidogrel (AC) treatment, 233 in aspirin and ticagrelor (AT). AC patients displayed higher age (p=0.003), more often elective PCI as indication to DAPT (<0.001), chronic therapy with ARB (p=0.001), nitrates (p=0.044), CCB (p=0.005), diuretics (p=0.044). AT patients displayed higher percentage of ACS diagnosis (p<0.001), chronic therapy with ACE-inhibitors (p=0.001), beta blockers (p=0.001), statins (p=0.013). AC patients displayed higher platelet reactivity at COL test, ASPI test and ADP test (p=0.03, 0.001 and <0.001, respectively) and higher percentage of HRPR at ADP-test (p=0.001). No difference was found in baseline uric acid and creatinine levels between AC and AT patients. At 30-90 days a significant absolute and percentage increase in SUA levels was found in AT as compared to AC patients (0.204 mg/dl VS -0.165 mg/dl, p=0.034; 6,26% VS -0.005%, p=0.018, respectively). Results were not influenced by variations in renal function. At multivariate analysis, in fact, ticagrelor therapy emerged as an independent predictor of increase of uric acid levels (OR[95%CI]= 2.79 [1.66-4.67], p<0.001). However SUA levels variation did not affect platelet reactivity or HRPR in both AC and AT patients. Conclusion Among patients receiving chronic dual antiplatelet therapy ticagrelor but not clopidogrel treatment is associated with an increase in serum uric acid levels at 30-90 days. However, the SUA changes do not impact on platelet aggregation.