Comparison of Platelet Function and Morphology in Patients Undergoing Percutaneous Coronary Intervention Receiving Bivalirudin Versus Unfractionated Heparin Versus Clopidogrel Pretreatment and Bivalirudin

Sunil X. Anand, Michael C. Kim, Mazullah Kamran, Samin K. Sharma, Annapoorna S. Kini, Jawed Fareed, Debra A. Hoppensteadt, Frank Carbon, Erdal Cavusoglu, David Varon, Juan Viles Gonzalez, Juan J. Badimon, Jonathan D. Marmur

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Abstract

We hypothesized that direct thrombin inhibition could attenuate platelet activation and release of soluble CD40 ligand (sCD40L), a marker of inflammation, during percutaneous coronary intervention (PCI). To assess platelet function under flow conditions with bivalirudin versus unfractionated heparin (UFH), we employed the cone and plate(let) analyzer (CPA) assay in drug-spiked blood samples from volunteers (n = 3) in vitro, and then in PCI patients who received bivalirudin alone (n = 20), UFH alone (n = 15), and clopidogrel pretreatment plus bivalirudin (n = 15). Scanning electron microscopy was employed to image bivalirudin or UFH-treated platelets to determine whether platelet function observations had a morphologic explanation. Enzyme immunoassay was used to measure sCD40L levels in PCI patients. In vitro, bivalirudin decreased platelet surface coverage; UFH increased platelet surface coverage. In PCI patients, bivalirudin alone decreased platelet surface coverage, UFH alone increased platelet surface coverage, and clopidogrel pretreatment plus bivalirudin additively reduced platelet surface coverage. Unlike UFH, bivalirudin did not activate platelets in SEM studies. Bivalirudin alone or coupled with clopidogrel significantly reduced plasma sCD40L in PCI patients. In conclusion, our findings suggest that under flow conditions, bivalirudin alone or coupled with clopidogrel may have an antiplatelet effect versus UFH alone during PCI. These data suggest that bivalirudin and UFH may confer an anti-inflammatory effect by reducing sCD40L during PCI.

Original languageEnglish
Pages (from-to)417-424
Number of pages8
JournalAmerican Journal of Cardiology
Volume100
Issue number3
DOIs
StatePublished - Aug 1 2007
Externally publishedYes

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clopidogrel
Percutaneous Coronary Intervention
Heparin
Blood Platelets
CD40 Ligand
bivalirudin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of Platelet Function and Morphology in Patients Undergoing Percutaneous Coronary Intervention Receiving Bivalirudin Versus Unfractionated Heparin Versus Clopidogrel Pretreatment and Bivalirudin. / Anand, Sunil X.; Kim, Michael C.; Kamran, Mazullah; Sharma, Samin K.; Kini, Annapoorna S.; Fareed, Jawed; Hoppensteadt, Debra A.; Carbon, Frank; Cavusoglu, Erdal; Varon, David; Viles Gonzalez, Juan; Badimon, Juan J.; Marmur, Jonathan D.

In: American Journal of Cardiology, Vol. 100, No. 3, 01.08.2007, p. 417-424.

Research output: Contribution to journalArticle

Anand, SX, Kim, MC, Kamran, M, Sharma, SK, Kini, AS, Fareed, J, Hoppensteadt, DA, Carbon, F, Cavusoglu, E, Varon, D, Viles Gonzalez, J, Badimon, JJ & Marmur, JD 2007, 'Comparison of Platelet Function and Morphology in Patients Undergoing Percutaneous Coronary Intervention Receiving Bivalirudin Versus Unfractionated Heparin Versus Clopidogrel Pretreatment and Bivalirudin', American Journal of Cardiology, vol. 100, no. 3, pp. 417-424. https://doi.org/10.1016/j.amjcard.2007.02.106
Anand, Sunil X. ; Kim, Michael C. ; Kamran, Mazullah ; Sharma, Samin K. ; Kini, Annapoorna S. ; Fareed, Jawed ; Hoppensteadt, Debra A. ; Carbon, Frank ; Cavusoglu, Erdal ; Varon, David ; Viles Gonzalez, Juan ; Badimon, Juan J. ; Marmur, Jonathan D. / Comparison of Platelet Function and Morphology in Patients Undergoing Percutaneous Coronary Intervention Receiving Bivalirudin Versus Unfractionated Heparin Versus Clopidogrel Pretreatment and Bivalirudin. In: American Journal of Cardiology. 2007 ; Vol. 100, No. 3. pp. 417-424.
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AU - Anand, Sunil X.

AU - Kim, Michael C.

AU - Kamran, Mazullah

AU - Sharma, Samin K.

AU - Kini, Annapoorna S.

AU - Fareed, Jawed

AU - Hoppensteadt, Debra A.

AU - Carbon, Frank

AU - Cavusoglu, Erdal

AU - Varon, David

AU - Viles Gonzalez, Juan

AU - Badimon, Juan J.

AU - Marmur, Jonathan D.

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