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Anti-platelet therapy is given to patients with acute coronary syndrome to reduce the risk for thrombotic events but may increase the risk for bleeding. If severe bleeding occurs in a patient on anti-platelet treatment, transfusion of platelets is often used in an attempt to restore platelet function. However, the efficacy of platelet transfusions in patients on anti-platelet therapy is not well documented. This in vitro study was conducted to predict the effect of platelet transfusion in ticagrelor treated patients.
Nearly complete P2Y12 inhibition was induced by the addition of 1μM ticagrelor to human platelet rich plasma (PRP). Human platelet aggregation was evaluated in PRP after addition of 20μM ADP by light transmission aggregometry before and after an “in vitro transfusion” equal to the addition of 25 or 75% un-inhibited platelets from the same blood donor. In addition, the effect of an “in vitro transfusion” equal to the addition of 40% un-inhibited platelets was evaluated when different levels of P2Y12 inhibition were induced by ticagrelor (0.3, 0.7 and 2.1μM).
In the setting of nearly complete P2Y12 inhibition, corresponding to a reduction in ADP-induced aggregation from 82% to 12%, by ticagrelor, an “in vitro transfusion” of 25% and 75% reversed aggregation to 16% (p<0.01) and 45% (p<0.01), respectively. When ADP-induced aggregation (control level 73%) was inhibited to different levels by ticagrelor, an “in vitro transfusion” of 40% reversed aggregation from/to; 60%/71% (p<0.01), 34%/60% (p<0.05) and 6%/16% (p<0.05).
It is concluded that in vitro the platelet inhibition achieved by ticagrelor can be partly reversed by un-inhibited platelets.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Acute Coronary Syndromes: Basic V
Abstract Category: 2. Acute Coronary Syndromes: Basic
Presentation Number: 1300-190
- 2013 American College of Cardiology Foundation