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Inflammatory and Antioxidant Pattern Unbalance in "Clopidogrel-Resistant" Patients during Acute Coronary Syndrome

Background. In acute coronary syndrome (ACS), inflammation and redox response are associated with increased residual platelet reactivity (RPR) on clopidogrel therapy. We investigated whether clopidogrel interaction affects platelet function and modulates factors related to inflammation and oxidation...

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Main Authors: Raffaele Caruso (Author), Silvia Rocchiccioli (Author), Anna Maria Gori (Author), Antonella Cecchettini (Author), Betti Giusti (Author), Guido Parodi (Author), Lorena Cozzi (Author), Rossella Marcucci (Author), Marina Parolini (Author), Ilaria Romagnuolo (Author), Lorenzo Citti (Author), Rosanna Abbate (Author), Oberdan Parodi (Author)
Format: Book
Published: Hindawi Limited, 2015-01-01T00:00:00Z.
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Summary:Background. In acute coronary syndrome (ACS), inflammation and redox response are associated with increased residual platelet reactivity (RPR) on clopidogrel therapy. We investigated whether clopidogrel interaction affects platelet function and modulates factors related to inflammation and oxidation in ACS patients differently responding to clopidogrel. Material and Methods. Platelet aggregation was measured in 29 ACS patients on dual (aspirin/clopidogrel) antiplatelet therapy. Nonresponders (NR) were defined as RPR ≥70% by ADP. Several inflammatory and redox parameters were assayed and platelet proteome was determined. Results. Eight (28%) out of 29 ACS patients resulted NR to clopidogrel. At 24 hours, the levels of Th2-type cytokines IL-4, IFNγ, and MCP-1 were higher in NR, while blood GSH (r-GSHbl) levels were lower in NR than responders (R). Proteomic analysis evidenced an upregulated level of platelet adhesion molecule, CD226, and a downregulation of the antioxidant peroxiredoxin-4. In R patients the proinflammatory cytokine IL-6 decreased, while the anti-inflammatory cytokine IL-1Ra increased. Conclusions. In patients with high RPR on clopidogrel therapy, an unbalance of inflammatory factors, platelet adhesion molecules, and circulatory and platelet antioxidant molecules was observed during the acute phase. Proinflammatory milieu persists in nonresponders for a long time after the acute event while antioxidant blood factors tend to conform to normal responsiveness.
Item Description:0962-9351
1466-1861
10.1155/2015/710123

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