The Effect of Dual Antiplatelet Post Percutaneous Coronary Intervention On Aggregation of Platelet In Myocardial Infarction Patients With Diabetes Mellitus and Non Diabetes Mellitus

Yessi Asli Rahmawati; Mohammad Yogiarto; Bambang Subakti Zulkarnaen

doi:10.14499/indonesianjpharm29iss1pp44

The Effect of Dual Antiplatelet Post Percutaneous Coronary Intervention On Aggregation of Platelet In Myocardial Infarction Patients With Diabetes Mellitus and Non Diabetes Mellitus

Yessi Asli Rahmawati, Mohammad Yogiarto, Bambang Subakti Zulkarnaen

Abstract

To analyze the differences in the effect of dual antiplatelet post PCI on the percentage of aggregation in myocardial infarction patients with DM and non DM. Percentage of aggregation were analyzed using light transmission aggregometry (LTA) before loading dose, after PCI, and after maintenance dose of dual antiplatelet (aspirin 100mg and clopidogrel 75mg). Total 22 patients were participated in this study divided into 10 and 12 patients in diabetic and non diabetic group. Percentage of aggregation after taking dual antiplatelet maintenace dose decrease significantly in both group (p=0.006 in diabetic group and p=0.002 in non diabetic group). Mean reduction of percentage of aggregation in diabetic group (3.30±2.91%) is less than non diabetic group (6.83±5.97%). Statistical analysis shows that the mean reduction of percentage of aggregation between two groups were not significantly different (p>0.05). Mean percentage of aggregation after dual antiplatelet maintenance dose was higher in diabetic group and mean reduction of percentage of aggregation was higher in non diabetic group, although statistically in both group it is not significantly different.

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References

Amsterdam EA., Wenger NK., Brindis RG., Kontos MC., Casey DE., et al. 2014. AHA/ ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndrome: A Report of the American College Cardiology/ American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 64: e139-e228.

Angiolillo DJ., Jakubowski JA., Ferreiro JL., Tello-Montoliu A., Rollini F., Franchi, F., Ueno M., et al. 2014. Impaired Responsiveness to the Platelet P2Y12 Receptor Antagonist Clopidogrel in Patients With Type 2 Diabetes and Coronary Artery Disease. Journal of The American College of Cardiology. 64: 1005-1014.

Angiolillo DJ., Shoemaker SB., Desai B., Yuan, H., Charlton RK., Bernardo E., et al. High Clopidogrel Maintenance Dose in Patients With Diabetes Mellitus and Coronary Artery Disease: Results of the Optimizing Antiplatelet Therapy in Diabetes Mellitus (OPTIMUS) Study. Circulation. 115: 708-716.

Cattaneo, M., 2009. Light Transmission Aggregometry and ATP Release for the Diagnostic Assesment of Platelet Function. Semin. Thromb. Hemost. 35: 158-167.

DiChiara J., Bliden KP., Tantry US., Hamed MS., Antonino MJ., Suarez TA., et al. 2007. The Effect of Aspirin Dosing on Platelet Function in Diabetic and Nondiabetic Patients: An Analysis From the Aspirin-Induced Platelet Effect (ASPECT) Study. Diabetes. 56: 3014-3019.

Ferreiro JL. and Angiolillo DJ., 2011. Diabetes and Antiplatelet Therapy in Acute Coronary Syndrome. Circulation. 123: 798-813.

Gurbel PA., Bliden KP., Butler K., Tantry U S., Gesheff T., Wei C., et al. 2009. Randomized Double-Blind Assessment of the ONSET and OFFSET of the Antiplatelet Effects of Ticagrelor Versus Clopidogrelin Patients With Stable Coronary Artery Disease. Circulation. 120: 2577-2585.

Jiang, XL., Samant S., Lesko LJ., and Schmidt, S., 2015. Clinical Pharmacokinetics and Pharmaco-dynamics of Clopidogrel. Clinical Pharmacokinetics. 54: 147-166.

Kakouros, N., Rade, J. J., Kourliouros, A. and Resar, J. R., 2011. Platelet Function in Patients with Diabetes Mellitus: From a Theoretical to a Practical Perspective. International Journal of Endocrinology. 2011.

Lee SH., Park SW., Hong MK., Kim YH., Lee BK. Song JM., et al. 2005. Triple Versus Dual Antiplatelet Therapy After Coronary Stenting. Journal of the American College of Cardiology. 46: 1833-1837.

Luscher TF., Steffel J., Erberli FR., Joner M., Nakazawa G., et al 2007. Drug-Eluting Stent and Coronary Thrombosis: Biological Mechanisms and Clinical Implications. Circulation. 115: 1051-1058.

O’Gara PT., Kushner FG., Ascheim DD., Casey DE., Chung, MK et al., 2013. AACF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 61: e78-e140.

Patrono C. and Rocca B. Apirin and Other COX-1 Inhibitors. In: Gresele, P., Born, G. V. R., Patrono, C. and Page, C. P. 2012. Handbook of Experimental Pharmacology: Antiplatelet Agents. Volume 2012. Springer Heidelberg, New York. pp. 138-159.

Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI). 2015. Pedoman Tatalaksana Sindrom Koroner Akut. Edisi Ketiga. Centra Communications, Jakarta. pp. 3-4

Rocca B. and Petrucci G., 2013. Variability in the Responsiveness to Low-Dose Aspirin: Pharmacological and Disease-Related Mechanisms. Thrombosis. 2012.

Schneider DJ., 2009. Factors Contributing to Increased Platelet Reactivity in People With Diabetes. Diabetes Care. 32: 525-527.

Schuette C., Steffens D., Witkowski M., Stellbaum C., Bobbert P., et al., 2015. The effect of clopidogrel on platelet activity in patients with and without type-2 diabetes mellitus: a comparative study. Cardiovascular Diabetology. 14: 1-15.

Zafari AM., Abdou MH., Talavera F., Yang, EH., Garas, SM., et al., 2016. Myocardial Infarction, (http://emedicine.medscape.com/ accesed 11 April 2016).

DOI: http://dx.doi.org/10.14499/indonesianjpharm29iss1pp44