Article Text
Abstract
Objective: To study the effect of unfractionated heparin (UFH) versus low molecular weight heparin (LMWH) in combination with glycoprotein (Gp) IIb/IIIa blockers on platelet activation and aggregation.
Methods: Washed platelets were stimulated with thrombin in the presence or absence of UFH (monoparin), LMWH (enoxaparin), and a Gp IIb/IIIa blocker (abciximab, eptifibatide, or tirofiban).
Results: Although Gp IIb/IIIa antagonists blocked the final common pathway of thrombin induced platelet aggregation, UFH and LMWH were better at blocking upstream platelet activation. UFH was significantly more effective than LMWH at inhibiting P selectin expression (p = 0.001) and platelet derived growth factor release from thrombin activated platelets (p = 0.012).
Conclusions: UFH and LMWH exert complementary effects to Gp IIb/IIIa blockers by inhibiting afferent pathways of platelet activation. Coadministration of heparin with Gp IIb/IIIa blockers provides improved protection against persistent platelet activation, thereby improving outcome after percutaneous coronary intervention. Judging from these data, UFH may be more effective in this regard than LMWH, at least in vitro. The use of LMWH in preference to UFH during percutaneous coronary intervention, although initially attractive, may inadequately protect against platelet activation despite the presence of Gp IIb/IIIa blockers.
- ACS, acute coronary syndromes
- ELISA, enzyme linked immunosorbent assay
- ESSENCE, efficacy and safety of subcutaneous enoxaparin in non-Q wave coronary events
- Gp, glycoprotein
- LMWH, low molecular weight heparin
- PAR, protease activated receptor
- PCI, percutaneous coronary intervention
- PDGF, platelet derived growth factor
- POLONIA, Polish-American local Lovenox NIR assessment
- PSGL, P selectin glycoprotein ligand
- SYNERGY, superior yield of the new strategy of enoxaparin, revascularisation and glycoprotein IIb/IIIa inhibitors
- TRAP, thrombin receptor activating peptide
- UFH, unfractionated heparin
Statistics from Altmetric.com
- ACS, acute coronary syndromes
- ELISA, enzyme linked immunosorbent assay
- ESSENCE, efficacy and safety of subcutaneous enoxaparin in non-Q wave coronary events
- Gp, glycoprotein
- LMWH, low molecular weight heparin
- PAR, protease activated receptor
- PCI, percutaneous coronary intervention
- PDGF, platelet derived growth factor
- POLONIA, Polish-American local Lovenox NIR assessment
- PSGL, P selectin glycoprotein ligand
- SYNERGY, superior yield of the new strategy of enoxaparin, revascularisation and glycoprotein IIb/IIIa inhibitors
- TRAP, thrombin receptor activating peptide
- UFH, unfractionated heparin
Footnotes
-
↵* These authors contributed equally to the work