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. 1996 Aug;76(2):166–172. doi: 10.1136/hrt.76.2.166

Changes in membrane glycoproteins of circulating platelets after coronary stent implantation.

M Gawaz 1, F J Neumann 1, I Ott 1, A May 1, S Rüdiger 1, A Schömig 1
PMCID: PMC484467  PMID: 8795482

Abstract

OBJECTIVES: To evaluate platelet function in patients with coronary stents. DESIGN: A non-randomised control trial in 30 patients who had immediate implantation of Palmaz-Schatz coronary stents because of a suboptimal angioplasty result. All patients received a standardised anticoagulation regimen including intravenous heparin (activated partial thromboplastin time (APTT) 80 to 120 s), oral vitamin K antagonist (target international normalised ratio (INR) of 3.5), and 100 mg aspirin twice daily. Platelet surface expression of glycoprotein IIb-IIIa, activated fibrinogen receptor, and P-selectin as well as binding of von Willebrand factor and fibrinogen were determined by flow cytometry in peripheral venous blood samples collected before the intervention and then daily for 4 days after it. The results were compared with those in 30 patients undergoing elective coronary balloon angioplasty. SETTING: University hospital. RESULTS: After coronary stenting surface expression of the activated fibrinogen receptor significantly increased, peaking at day 2 (P < 0.001). Similar results were found for von Willebrand factor binding and P-selectin surface expression, with a maximum at day 2 to 4 after stenting (von Willebrand factor, P < 0.001; P-selectin, P < 0.001). The changes in platelet membrane glycoproteins coincided with a significant drop in peripheral platelet count after stent placement (P < 0.01). No significant change in fibrinogen receptor activity, von Willebrand factor binding, P-selectin surface expression, or platelet count was seen in the control group. CONCLUSIONS: The present study shows that current anticoagulation treatment is inefficient in suppressing platelet activation in patients with coronary stents and, therefore, might not be the best treatment for reducing the incidence of subacute stent thrombosis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abrams C., Shattil S. J. Immunological detection of activated platelets in clinical disorders. Thromb Haemost. 1991 May 6;65(5):467–473. [PubMed] [Google Scholar]
  2. Arnold A. E., Simoons M. L., Van de Werf F., de Bono D. P., Lubsen J., Tijssen J. G., Serruys P. W., Verstraete M. Recombinant tissue-type plasminogen activator and immediate angioplasty in acute myocardial infarction. One-year follow-up. The European Cooperative Study Group. Circulation. 1992 Jul;86(1):111–120. doi: 10.1161/01.cir.86.1.111. [DOI] [PubMed] [Google Scholar]
  3. Becker R. C. Antiplatelet therapy in coronary heart disease. Emerging strategies for the treatment and prevention of acute myocardial infarction. Arch Pathol Lab Med. 1993 Jan;117(1):89–96. [PubMed] [Google Scholar]
  4. Fischman D. L., Leon M. B., Baim D. S., Schatz R. A., Savage M. P., Penn I., Detre K., Veltri L., Ricci D., Nobuyoshi M. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med. 1994 Aug 25;331(8):496–501. doi: 10.1056/NEJM199408253310802. [DOI] [PubMed] [Google Scholar]
  5. Fuster V., Badimon L., Cohen M., Ambrose J. A., Badimon J. J., Chesebro J. Insights into the pathogenesis of acute ischemic syndromes. Circulation. 1988 Jun;77(6):1213–1220. doi: 10.1161/01.cir.77.6.1213. [DOI] [PubMed] [Google Scholar]
  6. Gawaz M. P., Dobos G., Späth M., Schollmeyer P., Gurland H. J., Mujais S. K. Impaired function of platelet membrane glycoprotein IIb-IIIa in end-stage renal disease. J Am Soc Nephrol. 1994 Jul;5(1):36–46. doi: 10.1681/ASN.V5136. [DOI] [PubMed] [Google Scholar]
  7. Gawaz M. P., Mujais S. K., Schmidt B., Gurland H. J. Platelet-leukocyte aggregation during hemodialysis. Kidney Int. 1994 Aug;46(2):489–495. doi: 10.1038/ki.1994.299. [DOI] [PubMed] [Google Scholar]
  8. Gawaz M., Fateh-Moghadam S., Pilz G., Gurland H. J., Werdan K. Severity of multiple organ failure (MOF) but not of sepsis correlates with irreversible platelet degranulation. Infection. 1995 Jan-Feb;23(1):16–23. doi: 10.1007/BF01710051. [DOI] [PubMed] [Google Scholar]
  9. Gawaz M., Neumann F. J., Ott I., Schiessler A., Schömig A. Platelet function in acute myocardial infarction treated with direct angioplasty. Circulation. 1996 Jan 15;93(2):229–237. doi: 10.1161/01.cir.93.2.229. [DOI] [PubMed] [Google Scholar]
  10. Gawaz M., Ott I., Reininger A. J., Neumann F. J. Effects of magnesium on platelet aggregation and adhesion. Magnesium modulates surface expression of glycoproteins on platelets in vitro and ex vivo. Thromb Haemost. 1994 Dec;72(6):912–918. [PubMed] [Google Scholar]
  11. George J. N., Nurden A. T., Phillips D. R. Molecular defects in interactions of platelets with the vessel wall. N Engl J Med. 1984 Oct 25;311(17):1084–1098. doi: 10.1056/NEJM198410253111705. [DOI] [PubMed] [Google Scholar]
  12. Gershlick A. H. Principles of platelet inhibitor therapy--where we stood in 1993. Eur Heart J. 1994 Feb;15(2):149–155. doi: 10.1093/oxfordjournals.eurheartj.a060467. [DOI] [PubMed] [Google Scholar]
  13. Ginsberg M. H., Frelinger A. L., Lam S. C., Forsyth J., McMillan R., Plow E. F., Shattil S. J. Analysis of platelet aggregation disorders based on flow cytometric analysis of membrane glycoprotein IIb-IIIa with conformation-specific monoclonal antibodies. Blood. 1990 Nov 15;76(10):2017–2023. [PubMed] [Google Scholar]
  14. Haude M., Erbel R., Issa H., Straub U., Rupprecht H. J., Treese N., Meyer J. Subacute thrombotic complications after intracoronary implantation of Palmaz-Schatz stents. Am Heart J. 1993 Jul;126(1):15–22. doi: 10.1016/s0002-8703(07)80005-6. [DOI] [PubMed] [Google Scholar]
  15. Herlihy T., McIvor M. E., Cummings C. C., Siu C. O., Alikahn M. Nausea and vomiting during acute myocardial infarction and its relation to infarct size and location. Am J Cardiol. 1987 Jul 1;60(1):20–22. doi: 10.1016/0002-9149(87)90976-3. [DOI] [PubMed] [Google Scholar]
  16. Herrmann H. C., Buchbinder M., Clemen M. W., Fischman D., Goldberg S., Leon M. B., Schatz R. A., Tierstein P., Walker C. M., Hirshfeld J. W., Jr Emergent use of balloon-expandable coronary artery stenting for failed percutaneous transluminal coronary angioplasty. Circulation. 1992 Sep;86(3):812–819. doi: 10.1161/01.cir.86.3.812. [DOI] [PubMed] [Google Scholar]
  17. Kastrati A., Schömig A., Dietz R., Neumann F. J., Richardt G. Time course of restenosis during the first year after emergency coronary stenting. Circulation. 1993 May;87(5):1498–1505. doi: 10.1161/01.cir.87.5.1498. [DOI] [PubMed] [Google Scholar]
  18. Krupski W. C., Bass A., Cadroy Y., Kelly A. B., Harker L. A., Hanson S. R. Antihemostatic and antithrombotic effects of monoclonal antibodies against von Willebrand factor in nonhuman primates. Surgery. 1992 Aug;112(2):433–440. [PubMed] [Google Scholar]
  19. Landolfi R., De Candia E., Rocca B., Ciabattoni G., Antinori A., Masetti R., Patrono C. Effects of unfractionated and low molecular weight heparins on platelet thromboxane biosynthesis "in vivo". Thromb Haemost. 1994 Dec;72(6):942–946. [PubMed] [Google Scholar]
  20. Leung L., Nachman R. Molecular mechanisms of platelet aggregation. Annu Rev Med. 1986;37:179–186. doi: 10.1146/annurev.me.37.020186.001143. [DOI] [PubMed] [Google Scholar]
  21. McEver R. P. The clinical significance of platelet membrane glycoproteins. Hematol Oncol Clin North Am. 1990 Feb;4(1):87–105. [PubMed] [Google Scholar]
  22. Neumann F. J., Ott I., Gawaz M., Puchner G., Schömig A. Neutrophil and platelet activation at balloon-injured coronary artery plaque in patients undergoing angioplasty. J Am Coll Cardiol. 1996 Mar 15;27(4):819–824. doi: 10.1016/0735-1097(95)00563-3. [DOI] [PubMed] [Google Scholar]
  23. Nurden A. T., Macchi L., Bihour C., Durrieu C., Besse P., Nurden P. Markers of platelet activation in coronary heart disease patients. Eur J Clin Invest. 1994 Feb;24 (Suppl 1):42–45. doi: 10.1111/j.1365-2362.1994.tb02426.x. [DOI] [PubMed] [Google Scholar]
  24. Phillips D. R., Charo I. F., Parise L. V., Fitzgerald L. A. The platelet membrane glycoprotein IIb-IIIa complex. Blood. 1988 Apr;71(4):831–843. [PubMed] [Google Scholar]
  25. Plow E. F., Ginsberg M. H. Cellular adhesion: GPIIb-IIIa as a prototypic adhesion receptor. Prog Hemost Thromb. 1989;9:117–156. [PubMed] [Google Scholar]
  26. Rinder C. S., Mathew J. P., Rinder H. M., Bonan J., Ault K. A., Smith B. R. Modulation of platelet surface adhesion receptors during cardiopulmonary bypass. Anesthesiology. 1991 Oct;75(4):563–570. doi: 10.1097/00000542-199110000-00004. [DOI] [PubMed] [Google Scholar]
  27. Ruggeri Z. M. New insights into the mechanisms of platelet adhesion and aggregation. Semin Hematol. 1994 Jul;31(3):229–239. [PubMed] [Google Scholar]
  28. Salzman E. W., Rosenberg R. D., Smith M. H., Lindon J. N., Favreau L. Effect of heparin and heparin fractions on platelet aggregation. J Clin Invest. 1980 Jan;65(1):64–73. doi: 10.1172/JCI109661. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Scharf R. E., Tomer A., Marzec U. M., Teirstein P. S., Ruggeri Z. M., Harker L. A. Activation of platelets in blood perfusing angioplasty-damaged coronary arteries. Flow cytometric detection. Arterioscler Thromb. 1992 Dec;12(12):1475–1487. doi: 10.1161/01.atv.12.12.1475. [DOI] [PubMed] [Google Scholar]
  30. Schatz R. A., Baim D. S., Leon M., Ellis S. G., Goldberg S., Hirshfeld J. W., Cleman M. W., Cabin H. S., Walker C., Stagg J. Clinical experience with the Palmaz-Schatz coronary stent. Initial results of a multicenter study. Circulation. 1991 Jan;83(1):148–161. doi: 10.1161/01.cir.83.1.148. [DOI] [PubMed] [Google Scholar]
  31. Schatz R. A., Baim D. S., Leon M., Ellis S. G., Goldberg S., Hirshfeld J. W., Cleman M. W., Cabin H. S., Walker C., Stagg J. Clinical experience with the Palmaz-Schatz coronary stent. Initial results of a multicenter study. Circulation. 1991 Jan;83(1):148–161. doi: 10.1161/01.cir.83.1.148. [DOI] [PubMed] [Google Scholar]
  32. Schömig A., Kastrati A., Dietz R., Rauch B., Neumann F. J., Katus H. H., Busch U. Emergency coronary stenting for dissection during percutaneous transluminal coronary angioplasty: angiographic follow-up after stenting and after repeat angioplasty of the stented segment. J Am Coll Cardiol. 1994 Apr;23(5):1053–1060. doi: 10.1016/0735-1097(94)90589-4. [DOI] [PubMed] [Google Scholar]
  33. Schömig A., Kastrati A., Mudra H., Blasini R., Schühlen H., Klauss V., Richardt G., Neumann F. J. Four-year experience with Palmaz-Schatz stenting in coronary angioplasty complicated by dissection with threatened or present vessel closure. Circulation. 1994 Dec;90(6):2716–2724. doi: 10.1161/01.cir.90.6.2716. [DOI] [PubMed] [Google Scholar]
  34. Serruys P. W., de Jaegere P., Kiemeneij F., Macaya C., Rutsch W., Heyndrickx G., Emanuelsson H., Marco J., Legrand V., Materne P. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med. 1994 Aug 25;331(8):489–495. doi: 10.1056/NEJM199408253310801. [DOI] [PubMed] [Google Scholar]
  35. Shattil S. J., Cunningham M., Hoxie J. A. Detection of activated platelets in whole blood using activation-dependent monoclonal antibodies and flow cytometry. Blood. 1987 Jul;70(1):307–315. [PubMed] [Google Scholar]
  36. Sigwart U., Urban P., Golf S., Kaufmann U., Imbert C., Fischer A., Kappenberger L. Emergency stenting for acute occlusion after coronary balloon angioplasty. Circulation. 1988 Nov;78(5 Pt 1):1121–1127. doi: 10.1161/01.cir.78.5.1121. [DOI] [PubMed] [Google Scholar]
  37. Topol E. J. Caveats about elective coronary stenting. N Engl J Med. 1994 Aug 25;331(8):539–541. doi: 10.1056/NEJM199408253310811. [DOI] [PubMed] [Google Scholar]
  38. Tschoepe D., Schultheiss H. P., Kolarov P., Schwippert B., Dannehl K., Nieuwenhuis H. K., Kehrel B., Strauer B., Gries F. A. Platelet membrane activation markers are predictive for increased risk of acute ischemic events after PTCA. Circulation. 1993 Jul;88(1):37–42. doi: 10.1161/01.cir.88.1.37. [DOI] [PubMed] [Google Scholar]

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