The influence of different beta-blockers on platelet aggregation in patients with coronary heart disease оn dual antiplatelet therapy

Primena beta blokatora u lečenju pacijenata sa koronarnom bolešću srca povezana je sa smanjenjem učestalosti anginoznih tegoba i mortaliteta pacijenata. Zbog same težine bolesti i prethodnih kardiovaskularnih intervencija mnogi pacijenti sa koronarnom bolešću koriste dvojnu antiagregacionu terapiju u cilju postizanja veće inhibicije agregabilnosti trombocita. Uticaj beta blokatora na agregabilnost trombocita kod pacijenata koji koriste antiagregacionu terapiju je nedovoljno ispitan. Cilj: Ispitati uticaj različitih beta blokatora na agregabilnost trombocita kod pacijenata koji koriste dvojnu antiagregacionu terapiju. Metodologija: Istraživanje je obuhvatilo 331 pacijenta, lečenih na Klinici za kardiologiju KC Kragujevac u toku 2011. godine. Pacijenti su podeljeni u četiri grupe u zavisnosti od vrste beta blokatora koji su koristili (bisoprolol, nebivolol, metoprolol, karvedilol). Agregabilnost trombocita je merena primenom multiplate analizatora i izražena kroz vrednost ADP testa (za procenu efekta klopidogrela), ASPI testa (za procenu efekta ASK), TRAP testa (za procenu bazalne agregabilnosti trombocita) kao i odnos ADP/TRAP i ASPI/TRAP koji predstavljaju stepen inhibicije agregabilnosti trombocita u odnosu na bazalnu vrednost. U obzir je uzeta i zastupljenost demografskih, kliničkih parametara, vrednosti laboratorijski parametara i zastupljenost grupa kardivaskularnih lekova između poređenih grupa. Rezultat: Pacijeneti koji su koristili nebivolol imali su značajno nižu vrednost odnosa ADP/TRAP testa (0,39 ± 0,30) u odnosu na pacijente koji su koristili bisoprolol (0,48 ± 0,26; p=0,038), kao i trend ka nižoj vrednosti ADP testa (328,0 ± 197,3 prema 403,7 ± 213,2; p=0.059) dok nije bilo statistički značajne razlike u vrednosti laboratorijskih parametara funkcije trombocita između ostalih poređenih grupa. Zaključak: Pacijenti sa koronarnom bolešću srca na dvojnoj antiagregacionoj terapiji koji su koristili nebivolol imali su statistički značajno niži nivo rezidualne, ADP indukovane agregabilnosti trombocita u odnosu na bazalnu vrednost od pacijenata koji su koristili bisoprolol.The use of beta-blockers in the treatment of patients with coronary heart disease is associated with a decrease in the frequency of angina pectoris and mortality of patients. Due to the severity of the disease and previous cardiovascular interventionс, many patients with coronary artery disease usе dual antiplatelet therapy to achieve greater inhibition of platelet aggregation. The influence of beta blockers on platelet aggregation in patients using antiplatelet therapy is not well understood. Objective: To examine the effect of different beta-blockers on platelet aggregation in patients on dual antiplatelet therapy . Methodology: The study included 331 patients 122 who were treated at the Department of Cardiology, Clinical Center Kragujevac during the 2011th year. Patients were divided into four groups depending on the type of betablockers that are used ( bisoprolol, nebivolol, metoprolol, carvedilol ). Platelet aggregation was measured using the multiplate analyzer and expressed through the value of ADP test (to assess the effect of clopidogrel), ASPI test (to assess the effect of ASA) TRAP test ( to assess baseline platelet aggregation ) and the ratio of ADP/TRAP and ASPI/TRAP representing the degree of inhibition of platelet aggregation compared to the basal value. In consideration was taken the representation of demographic, clinical characteristics, laboratory parameters and cardiovascular medications between the groups. The result : patients which used by nebivolol had a significantly lower value of the ratio of ADP/TRAP (0.39±0.30) compared to patients who used bisoprolol (0.48 ±0.26, p =0.038), and trend toward lower values ADP test ( 328.0±197.3 vs 403.7 ± 213.2, p =0.059) while there was no statistically significant difference in values of other laboratory parameters of platelet function between other groups. Conclusion : Patients with coronary artery disease on dual antiplatelet therapy who used nebivolol had significantly lower levels of residual ADP-induced platelet aggregation compared to baseline than patients who used bisoprolol