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Inicio Revista Colombiana de Cardiología Diferencias en la agregación plaquetaria de sangre coronaria y periférica de p...
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Vol. 17. Núm. 6.
Páginas 255-264 (Noviembre - Diciembre 2010)
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Vol. 17. Núm. 6.
Páginas 255-264 (Noviembre - Diciembre 2010)
DOI: 10.1016/S0120-5633(10)70250-3
Open Access
Diferencias en la agregación plaquetaria de sangre coronaria y periférica de pacientes con enfermedad coronaria. Implicaciones clínicas
Differences in platelet aggregation in coronary and peripheral blood of patients with coronary disease. Clinical implications
Visitas
1581
Jaime Cabrales1,
Autor para correspondencia
jcabrales@cardioinfantil.org

Correspondencia: Calle 163A # 13B - 60, Fundacion Cardioinfantil, primer piso, Hemodinamia, Bogotá, Colombia.
, Darío Echeverri1, Orlando Corzo1, Mauricio Pineda1
1 Fundación Cardioinfantil- Instituto de Cardiología, Bogotá, Colombia
Este artículo ha recibido
1581
Visitas

Under a Creative Commons license
Información del artículo
Introducción

Los fenómenos trombóticos son más frecuentes en las coronarias y, al parecer, los cambios que produce la enfermedad aterosclerótica en la reología y en la superficie endotelial son los responsables de este fenómeno.

Objetivo

Cuantificar la diferencia en la agregación plaquetaria de sangre venosa coronaria y sangre venosa periférica en pacientes con enfermedad coronaria severa.

Metodología

Se seleccionaron pacientes mayores de treinta años, con enfermedad coronaria severa, de quienes se obtuvieron muestras de sangre periférica y del seno coronario, y se realizaron agregaciones plaquetarias por el método de absorbancia con ADP 10μmol, ácido araquidónico (AA), epinefrina (Epi) 300μmol y colágeno 10μg/mL.

Resultados

Se incluyeron en total 32 pacientes con edad promedio de 65±10 años, 22 hombres, 10 (31%) pacientes con enfermedad estable y 22 (69%) con inestable. La agregación plaquetaria en sangre del seno coronario fue mayor con todos los agonistas usados, así: ADP 61,8% vs. 53,4% (p=0,001), AA 15,1% vs. 13,8% (p=0,48), colágeno 72,6% vs. 69,2% (p=0,048) y Epi 58% vs. 51,6% (p=0,01). Los pacientes con enfermedad inestable muestran una mayor agregación con ADP en el seno coronario: 58,5% vs. 49,2% (p=0,001) y no hay diferencias en los inestables. La resistencia a la Aspirina fue similar (p=1), sin embargo la resistencia al clopidogrel fue mayor en el seno coronario: 56% vs. 48% (p=0,24).

Conclusión

Se describe la presencia de mayor agregación plaquetaria en el seno coronario de pacientes con enfermedad aterosclerótica, la cual es significativa para ADP, colágeno y epinefrina. Se sugiere la aparición de factores locales asociados con la enfermedad coronaria que aumentan la agregación plaquetaria. La agregación plaquetaria periférica no refleja el comportamiento local en pacientes con aterosclerosis coronaria.

Palabras clave:
agregometría plaquetaria
clopidogrel
antiagregantes
seno coronario
enfermedad coronaria
Introduction

Thrombotic events are more frequent in the coronary arteries and apparently the changes in rheology and endothelial surface produced by atheroesclerotic disease are responsible for this phenomenon.

Objective

Quantify the difference in platelet aggregation of coronary venous blood and peripheral venous blood in patients with severe coronary disease.

Methodology

We selected patients older than 30 years with severe coronary disease and obtained samples of peripheral and coronary sinus blood. Platelet aggregation was realized by the absorbance method with ADP 10μmol, arachidonic acid (AA), epinephrine (Epi) 300μmol and collagen 10μg/mL.

Results

We included a total of 32 patients with mean age 65±10 years. 22 were men; 10 patients (31%) had stable disease and 22 (69%) unstable disease. Platelet aggregation in coronary sinus blood was higher with all agonists used as follows: ADP 61.8% vs. 53.4% (p=0.001), AA 15.1% vs.13.8% (p=0.48), collagen 72.6% vs. 69.2% (p=0.048) and Epi 58% vs. 51.6% (p=0.01). Patients with unstable disease show increased aggregation with ADP in the coronary sinus 58.5% vs. 49.2% (p=0.001) and there are no differences in the unstable. Aspirin resistance was similar (p=1); however, clopidogrel resistance was higher in the coronary sinus 56% vs. 48% (p=0.24).

Conclusion

We describe the presence of higher platelet aggregation in the coronary sinus of patients with atheroesclerotic disease that is significant for ADP, collagen and epinephrine, and suggest the appearance of local factors associated with the coronary disease that increase platelet aggregation. Peripheral platelet aggregation doesn’t reflect the local behavior in patients with coronary atheroesclerosis.

Key words:
platelet aggregometry
clopidogrel
coronary sinus
coronary disease
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Copyright © 2010. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular
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