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Observational Study
. 2022 Dec 30;59(1):84.
doi: 10.3390/medicina59010084.

The Effectiveness of Antiplatelet Therapy and the Factors Influencing It in Patients with Acute Coronary Syndrome before and during the COVID-19 Pandemic

Ovidiu-Ionut Anchidin  1   2 , Stefan Horia Rosianu  1   2 , Ancuta Nemes  2 , Mihai Aldica  2 , Dan Blendea  1   2 , Adrian Molnar  1   2 , Horatiu Moldovan  3   4 , Dana Pop  1   5
Affiliations
Observational Study

The Effectiveness of Antiplatelet Therapy and the Factors Influencing It in Patients with Acute Coronary Syndrome before and during the COVID-19 Pandemic

Ovidiu-Ionut Anchidin et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Dual antiplatelet therapy (DAPT) is essential in the treatment of patients with acute coronary syndrome (ACS). The objective of this study was to evaluate the effectiveness of antiplatelet medication in our practice and to investigate the factors that influence it. Materials and Methods: A prospective cohort observational study was conducted, in which 193 patients with ACS were enrolled. The patients were stented in the catheterization laboratory between May 2019 and October 2020, before and during the COVID-19 pandemic, and were receiving DAPT. Their platelet functions were tested using a Multiplate Analyzer. In addition to this, clinical data, demographics, laboratory tests, and cardiovascular risk factors were also analyzed. Results: 43.46% of the patients treated with aspirin were found to be resistant to it. This phenomenon was more common in men (48.17% vs. 31.48%, p = 0.036), and it was associated with being under the age of 50 (OR: 2.08; 95% CI: 1.11-3.90) and weighing over 70 kg (OR: 3.00; 95% CI: 1.21-7.40). Most of the patients treated with clopidogrel were in the optimal treatment window, while about half of the patients treated with ticagrelor had an exaggerated pharmacological response. Among the laboratory parameters, leukocytosis and platelet count were found to be determinants of platelet reactivity for both the aspirin and ticagrelor treatments. Conclusions: Many patients treated with antiplatelet agents are outside of the treatment window. The results obtained showed that low doses of gastro-resistant aspirin tablets are ineffective, and their efficacy can be influenced by various clinical and laboratory factors. Patients receiving ticagrelor have significantly reduced platelet reactivity, influenced only by certain laboratory indicators. The pandemic significantly influenced the results of the platelet aggregation tests only in patients treated with clopidogrel.

Keywords: COVID-19; HTPR; LTPR; acute coronary syndrome; antiplatelet agents; platelet reactivity.

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Conflict of interest statement

Ovidiu Anchidin has received speaker fees from AstraZeneca not related to the topic of this study. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Response to antiplatelet therapy. (a) Response to aspirin treatment—the red line is drawn at 20, and the curve represents the normal distribution curve. (b) Response to P2Y12 inhibitor treatment, ticagrelor vs. clopidogrel—the red line is drawn at 18 and the black at 46, and the curve represents the distribution curve.
Figure 2
Figure 2
Risk factors for aspirin resistance.
Figure 3
Figure 3
Risk factors for an elevated hemorrhagic risk in patients receiving ticagrelor.
See this image and copyright information in PMC

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