INFLUENCE OF ANTIPLATELET THERAPY RESISTANCE ON PROGNOSIS OF THROMBOTIC COMPLICATIONS IN PATIENTS WITH CORONARY HEART DISEASE

Liakhotska A. V., Netiazhenko V. Z., Melnyk V. S., Plenova O. N. INFLUENCE OF ANTIPLATELET THERAPY RESISTANCE ON PROGNOSIS OF THROMBOTIC COMPLICATIONS IN PATIENTS WITH CORONARY HEART DISEASE. ВІСНИК МОРСЬКОЇ МЕДИЦИНИ. 2018;1(78):21-29. ISSN 0049-6804. DOI http://dx.doi.org/10.5281/zenodo.1230274

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УДК 612.12-008:616-08-039.71:616-005.6

DOI http://dx.doi.org/10.5281/zenodo.1230274

А. В. Ляхоцька, В. З. Нетяженко, В. С. Мельник, О. М. Плєнова

ВПЛИВ РЕЗИСТЕНТНОСТІ ДО АНТИТРОМБОЦИТАРНОЇ ТЕРАПІЇ НА ПРОГНОЗ РОЗВИТКУ ТРОМБОТИЧНИХ УСКЛАДНЕНЬ У ХВОРИХ З ІШЕМІЧНОЮ ХВОРОБОЮ СЕРЦЯ

Національний медичний університет імені О.О. Богомольця, м. Київ

Summary. Liakhotska A. V., Netiazhenko V. Z., Melnyk V. S., Plenova O. N. INFLUENCE OF ANTIPLATELET THERAPY RESISTANCE ON PROGNOSIS OF THROMBOTIC COMPLICATIONS IN PATIENTS WITH CORONARY HEART DISEASE. - Bogomolets National Medical University. – e-mail: a.liakhotska@gmail.com. In recent years, the incidence of acute cardiovascular events associated with thrombosis in patients with coronary heart disease (CHD) has increased in Ukraine. According to the current international recommendations for prevention, the antithrombotic agents (prophylaxis of platelet aggregation and benign thrombotic formation): acetylsalicylicacid (ASA), thienopyridines (clopidogrel, ticagrelor, ticlopidine), etc., are widely used to influence the main pathogenesis of various forms of CHD. As a result of annual prospective monitoring, the role of antiplatelet resistance in the development of thrombotic complications in patients with st able and unstable forms of coronary heart disease and associated hypertension was determined, depending on genetic fact or sand thrombosis. The study included 167 patients with an average age of 67,09±9.08 years. Duration of observation is 1 year. The combine dend point included cases of non-fatal thrombotic complications: ischemic stroke, acute coronary syndrome and pulmonary embolism. Determination of antiplateletres istance was carried out with Aggredynetest, modern laser lights cattering technique that detects platelet aggregation induced by the arachidonic acidagon istandadenosinediphosphate when the whole blood is added to the test cartridge-AA / ADP. The resultis recorded by the platelet activity index (PAI). The prevalence and influence on the prediction of the  mutation and polymorphism of gene ITGA2 C807T, also known as GPIa. It was found that the total frequency of thrombotic complications was 10.2%. The highest risk of thrombotic complications was observed in patients with varying degrees of non-sensitivity to antiplatelet therapy (OR 3.8; 95% CI 1.1 to 12). The effect on the prediction of genetic variants of ITGA2 T/CT was manifested in the presence of concomitantanti platelet resistance, which was observed in 82.3% of the examined patients with complications. According to this conclusions detection of resistance to antiplatelet therapy, as well as an accompanying determination of carriers of genotype T ITGA2, may be recommended  to patients with CHD in order to  clarify the risk of adverse cardiovascular events.

Key words: coronary heart disease, angina pectoris, antiplatelet therapy, resistance, prognosis