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It is known that feasible regular muscle training of an aerobic nature helps to reduce platelet activity of people with high normal blood pressure. At the same time, the physiological reaction of platelets to regular physical activity of the second mature age people with already formed arterial hypertension remains not entirely clear. Purpose of the study is to find out the possibilities of regular moderate aerobic physical activity of the second mature age people with newly developed arterial hypertension. The platelets functional activity of physically exercising and avoiding physical exercises people of the second mature age with arterial hypertension was traced by using optical aggregatometry and cytometry with an assessment of P-selectin level and GP IIb-IIIa on the platelet surface. The platelet aggregation activity and the number of GP IIb-IIIa molecules and P-selectin on platelet membranes of patients who took aspirin and had low physical activity and under the control were comparatively high. Platelet aggregation of patients, who trained physically, was not expressed, and under the ADP action on platelet membranes, the amount of GP IIb-IIIa and P-selectin did not change significantly. The paper shows the possibility of weakening the platelets activity of patients with recent arterial hypertension under the influence of regular physical activity. The results obtained give a reason to consider regular dosed physical activity as an obligatory component of the treatment of this category of patients to minimize the development of their thrombotic manifestations. [ABSTRACT FROM AUTHOR]

The aim of this work was a simultaneous analysis of functional platelet activity using both standard optical aggregometry and flow cytometry, by means of measuring P-selectin and GP IIb-IIIa glycoprotein receptor contents on the surface of ADP-induced platelets. GP IIb-IIIa amounts and P-selectin expression on cell surface are significantly increased on platelets after activation with 10 mcM ADP, both in normal donors and in aspirin-treated patients. In clopidogrel-treated patients, the amounts of expressed P-selectin and GP IIb-IIIa did not change after ADP induction, thus suggesting absence of detectable ADP-induced platelet activation in this group. By means of Spearman criterion, a distinct correlation was found between the P-selectin expression, GP IIb-IIIa contents, and rates of standard ADP-induced aggregation. A combination of standard ADP-induced aggregation/activation of platelets with flow cytometry using FITC or PE-labeled antibodies to P-selectin and GP IIb-IIIa, allowed us to apply immunological approaches to analysis of platelet hemostasis, to propose novel laboratory criteria for evaluation of platelet hyperaggregation, and to detect differential effects of clopidogrel and aspirin.

Abstract: Introduction: Previous studies demonstrated that cell-permeable αIIb cytoplasmic peptides can modulate the activation of αIIbβ3. An integrin activation motif was mapped to its membrane proximal region and a double proline mutant peptide and receptor indicated that its central turn motif had inhibitory capacity. However, the residues critical for inhibition of αIIbβ3 activation were not identified. Using central turn peptides derived from αIIb and αV, residues critical for suppression of integrin activation were identified and the importance of these residues in protein–protein interactions was assessed. Materials and methods: Cell-permeable peptides were used to determine the capacity of the central turn peptides to suppress αIIbβ3 and αVβ3 activation. Far Western analysis was used to characterize the capacity of the peptides to interact with CIB1 and surface plasmon resonance was used to characterize the binding of an antibody to the cytoplasmic tails of αIIb and αV. Results and conclusions: The central turn peptide from αV, αV(993–1001), has full inhibitory capacity while that derived from αIIb requires additional residues located adjacent to αIIb(995–1003). Within these two sequences there is a switch in the position of an asparaginine and leucine residue for a valine and glutamine (αIIb, RNRPPLEED; αV, RVRPPQEEQ). This switch had a dramatic effect on their inhibitory capacity and on protein–protein interactions. The two arginine and glutamic residues, juxtapositioned at identical locations in both subunits, appeared to be important in specifying the orientation by which proteins can dock to this region in αIIb and αV. [Copyright &y& Elsevier]

Evidence-based clinical practice guidelines encapsulate current knowledge to guide health care professionals in the treatment of patients with unstable angina or non-ST-segment-elevation myocardial infarction (NSTEMI), yet adherence to guideline recommendations is suboptimal. Guideline adherence may be improved by quality improvement programs such as the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation?) National Quality Improvement Initiative of the American College of Cardiology-American Heart Association Guidelines. The CRUSADE data have been analyzed to demonstrate that overall guideline adherence is directly associated with mortality and that improvement in guideline adherence saves lives. Also, the CRUSADE data have determined that the real-life mortality risk associated with unstable angina and NSTEMI is greater than suggested by clinical trials. The newer antiplatelet drugs recommended in early intervention and discharge treatment strategies are underused across many segments of the unstable angina-NSTEMI population. Glycoprotein IIb-IIIa inhibitors are underused in high-risk populations, and clopidogrel is markedly underused in patients who are medically managed rather than undergoing percutaneous coronary intervention or coronary artery bypass graft surgery. In addition, often the specialty of the treating physician and the status of the hospital influence the use of antiplatelet therapy. The reasons for underprescribing of antiplatelet drugs by physicians are not entirely clear but may be related to a lack of guideline familiarity and understanding, as well as factors such as drug novelty, safety, and cost. Continued education and data dissemination are therefore vital in promoting the prescription of guideline-recommended drugs, both in the early hospitalization phase and as patients transition to community-based care. The role of the pharmacist is pivotal in ensuring adherence to clinical guidelines by interacting with both the physician and patient. [ABSTRACT FROM AUTHOR]

Objective. To compare clinical outcomes and glycoprotein IIb-IIIa inhibitor use in patients undergoing percutaneous coronary intervention (PCI) who received bivalirudin or unfractionated heparin (UFH) in a real-world setting. Design. Retrospective cohort analysis. Setting. University-affiliated medical center. Patients. One thousand seventy-five adult patients who underwent PCI and received either bivalirudin (539 patients) or UFH (536 patients) from April 1, 2003-April 1, 2004. Measurement and Main Results. Patient data on demographics, comorbidities, laboratory values, and reports of radiologic examinations, cardiac catheterizations, and discharge summaries were obtained. Outcomes evaluated included rates of in-hospital mortality, myocardial infarction, revascularization, and length of stay (LOS), as well as Randomized Evaluation of PCI Linking Angiomax to Reduced Clinical Events (REPLACE-2) and Thrombosis in Myocardial Infarction (TIMI) bleeding categorization. Bivalirudin use was associated with a significant reduction in TIMI major (5.0% vs 9.7%, p=0.003), REPLACE-2 major (5.4% vs 12.9%, p<0.001), and TIMI minor (1.7% vs 6%, p<0.001) bleeding complications compared with UFH use. Significantly fewer patients in the bivalirudin group received glycoprotein IIb-IIIa inhibitors (27.3% vs 62.7%, p<0.001). Patients receiving bivalirudin had significantly fewer myocardial infarctions after catheterization (10.7% [40/375] vs 18.0% [51/284], p=0.007). No differences were noted in mortality and revascularization rates between groups. A shortened LOS was observed in the bivalirudin group. Conclusions. This real-world analysis that included high-risk patients provides further evidence that bivalirudin is an attractive alternative to UFH because of a decrease in bleeding events without compromising efficacy. [ABSTRACT FROM AUTHOR]

Study Objective. To perform a cost-effectiveness analysis comparing three treatment approaches during nonurgent percutaneous coronary intervention (PCI): bivalirudin with provisional glycoprotein (GP) IIb-IIIa inhibitor therapy, unfractionated heparin (UFH) with eptifibatide, and UFH with abciximab. Design. Literature-based decision model from an institutional perspective. Data Source. Patient data from the Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE)-2 study and three other randomized controlled trials that included UFH and routine GP IIb-IIIa inhibitor (eptifibatide or abciximab) therapy. All included studies were comparable based on patient population, procedural techniques, and general treatment approaches. Measurements and Main Results. We included patient populations undergoing contemporary nonurgent PCI to identify probabilities of success or complications (myocardial infarction, urgent revascularization, thrombocytopenia, and major or minor bleeding at 30 days). Costs were assigned to each outcome by incorporating diagnosis-related group- and/or Current Procedural Terminology-associated costs, institutional drug acquisition costs, and unit replacement costs of platelets and red blood cells. In the base-case analysis, the use of bivalirudin with provisional GP IIb-IIIa inhibitor therapy dominated the UFH and planned GP IIb-IIIa inhibitor approach: UFH with eptifibatide was $74 more expensive and 1.2% less effective, and UFH with abciximab was $777 more expensive and 2.3% less effective. Sensitivity analyses indicated that the model results were robust, but also revealed that bivalirudin lost its cost-effectiveness, resulting in UFH with eptifibatide becoming more cost-effective, when two or more vials of bivalirudin were necessary in greater than 27% of cases or when the use of provisional GP IIb-IIIa inhibitor therapy exceeded 20%. Conclusion. This analysis indicates that bivalirudin with provisional GP IIb- IIIa inhibitor therapy is the most cost-effective antithrombotic treatment strategy in nonurgent PCI when its use and dosing are consistent with the REPLACE-2 trial. [ABSTRACT FROM AUTHOR]

Introduction: We examined the potential role of polymorphisms of the platelet genes GP1BA (rs2243093, rs6065 and VNTR), ITGB3 (rs5918), ITGA2 (rs938043469) and P2RY12 (rs2046934, rs6801273 and rs6798347) as risk factors for myocardial infarction (MI)., Methods: The study population was divided into three groups: controls (n=235), MI at age ≤45 years (MI ≤45, n=44), and MI at age >45 years (MI >45, n=78). The control group was further divided into two subgroups (control ≤45 and >45), and subgroups including only men were also considered for statistical analysis. Polymorphisms were detected by polymerase chain reaction and restriction fragment length polymorphism analysis., Results: Regarding non-genetic risk factors, the control group differed statistically from the MI ≤45 group (p<00.5) in terms of smoking, hypertension, diabetes and obesity, and from the MI >45 group (p<0.05) in terms of hypertension, diabetes, obesity, family history of thrombosis and high cholesterol. For the studied ITGA2 polymorphism, a statistical difference was found when MI >45 was compared with the control group, with a higher risk of MI in the TT genotype (OR 2.852; 95% CI: 1.092-7.451; p=0.032). In the GP1BA rs6065 polymorphism, a statistically significant difference was found between control ≤45 only men and MI ≤45 only men, with a higher risk in the CT genotype (OR 5.568; 95% CI: 1.421-21.822; p=0.016), despite the low numbers included. The other polymorphisms studied did not show any statistically significant correlations., Conclusion: There is a statistically significant association between the TT genotype of the ITGA2 rs938043469 polymorphism and increased risk for MI >45., (Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)