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Plasminogen activator inhibitor-1 (PAI-1), a serine protease inhibitor, is the major regulator of the fibrinolytic system and is implicated in the pathogenesis of atherosclerosis. PAI-1 is synthesized and stored in platelets. Despite the prevalent use of antiplatelet therapy in patients with coronary artery disease (CAD), the effect of antiplatelet therapy on PAI-1 levels has not been clearly defined. Therefore, we sought to investigate the relationship between dual antiplatelet therapy (DAPT) and plasma PAI-1 levels.
We recruited 22 patients between the ages of 18 and 80 who underwent coronary angiogram and had obstructive CAD at our institution. Plasma PAI-1 total antigen levels were measured (Molecular Innovations ELISA, USA). Multivariable linear regression was performed to examine the association of DAPT and PAI-1.
Of the 22 patients recruited, the mean age was 60±14 years, 7 (32%) were women, 8 (36%) were diabetic, and mean body-mass index (BMI) was 28±4.8 kg/m2. 6 patients (27.3%) presented to the hospital with a myocardial infarction and 3 (14%) had a history of stroke or transient ischemic attack. 14 patients were on DAPT, with 10 patients (71.4%) on clopidogrel, 3 (21.4%) on ticagrelor, and 1 (7.1%) on prasugrel. Unadjusted PAI-1 levels were lower in patients on DAPT compared to those not on DAPT (53.3 vs. 12.3 ng/mL). DAPT was significantly associated with lower PAI-1 levels in patients with obstructive CAD after adjustment for age, sex, BMI, and diabetes (p=0.036).
Use of DAPT is associated with significantly lower PAI-1 levels in patients with obstructive CAD. These findings suggest that DAPT may enhance fibrinolysis and offers a novel mechanism via PAI-1 by which DAPT may confer protective antithrombotic effects.