Thrombin generation test in the estimation of effects of antiplatelet agents in patients with coronary heart disease after percutaneous coronary intervention
Aim: To explore the possibilities of using thrombin generation test in platelet-rich and platelet-poor plasma to assess the impact of dual antiplatelet therapy in patients with CHD after percutaneous coronary intervention. Material and methods: The material for the study was venous blood of 54 patients with CHD aged 53 to 77 years after percutaneous coronary intervention with stent placing within a year and receiving clopidogrel and aspirin in standard doses (75 and 75-100 mg daily, respectively), and of 40 people comparable by age and sex, without clinical manifestations of CHD and not receiving the drugs for any other purpose. Thrombin generation test was performed in platelet-rich and platelet-poor plasma. Intravascular activation and induced platelet aggregation, as well as routine coagulation indicators, were evaluated. Results: Administration of antiplatelet agents did not affect the results of routine coagulation tests or intravas-cular platelet activation. The evaluation of induced platelet aggregation demonstrated that antiplatelet agents had the most significant impact on collagen-induced platelet aggregationim: To explore the possibilities of using thrombin generation test in platelet-rich and platelet-poor plasma to assess the impact of dual antiplatelet therapy in patients with CHD after percutaneous coronary intervention. Material and methods: The material for the study was venous blood of 54 patients with CHD aged 53 to 77 years after percutaneous coronary intervention with stent placing within a year and receiving clopidogrel and aspirin in standard doses (75 and 75-100 mg daily, respectively), and of 40 people comparable by age and sex, without clinical manifestations of CHD and not receiving the drugs for any other purpose. Thrombin generation test was performed in platelet-rich and platelet-poor plasma. Intravascular activation and induced platelet aggregation, as well as routine coagulation indicators, were evaluated. Results: Administration of antiplatelet agents did not affect the results of routine coagulation tests or intravas-cular platelet activation. The evaluation of induced platelet aggregation demonstrated that antiplatelet agents had the most significant impact on collagen-induced platelet aggregation (p = 10<sup>-7)</sup>. The thrombogram showed that in platelet-rich plasma the most significant impact of antiaggregants was in a decrease in endogenous thrombin potential (ETP; P = 0,0045) and peak thrombin concentration (PT; P = 4^10<sup>-6</sup>), and an increase in the time to peak of the thrombin concentration (TTP; P = 0,0012). Decreased velocity of thrombin generation (VI; P = 10<sup>-8) </sup>was the most statistically relevant indicator. Administration of antiplatelet agents had no effect on thrombograms of thrombin generation tests performed in platelet-poor plasma. Conclusion: Thrombin generation tests in platelet-rich plasma can be used to evaluate the effect of dual antiplatelet therapy. The most relevant indicator is velocity of thrombin generation.