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CC BY 4.0 · TH Open 2021; 05(03): e230-e238
DOI: 10.1055/s-0041-1731309
Original Article

Lower Antiplatelet Effect of Aspirin in Essential Thrombocythemia than in Coronary Artery Disease

Oliver Buchhave Pedersen 
1   Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
2   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Anne-Mette Hvas
1   Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
3   Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
,
Hans Beier Ommen
4   Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
,
Steen Dalby Kristensen
2   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
3   Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
,
Erik Lerkevang Grove 
2   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
3   Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Abstract

Background Patients with essential thrombocythemia (ET) and coronary artery disease (CAD) have increased risk of thromboembolic complications. In addition, a reduced antiplatelet effect of aspirin has been demonstrated in both patient groups. As ET is a platelet disorder, platelets may be more important for the thromboembolic risk in ET than in CAD. We aimed to investigate the antiplatelet effect of aspirin and platelet turnover in ET versus CAD patients.

Methods We included 48 ET patients and an age-matched group of 48 CAD patients. The effect of aspirin was evaluated by thromboxane B2 (TXB2) levels and platelet aggregation. Platelet turnover was assessed by immature platelet count (IPC) and immature platelet fraction (IPF).

Results ET patients had reduced effect of aspirin compared with CAD patients, demonstrated by significantly higher TXB2 levels (median of differences = 22.3 ng/mL, p < 0.0001) and platelet aggregation (median of differences = 131.0 AU*min, p = 0.0003). Furthermore, ET patients had significantly higher IPC (p < 0.0001) and IPF (p = 0.0004) than CAD patients.

Conclusion ET patients have lower 24-hour antiplatelet effect of aspirin than CAD patients. This may be explained by an increased platelet production and turnover counteracting the antiplatelet effect of aspirin. These findings strengthen the rationale for exploring novel antiplatelet regimens in ET patients to reduce the risk of cardiovascular events.

Keywords

aspirin - essential thrombocythemia - platelet aggregation - thromboxane B2 - platelet activation - platelet function test - coronary artery disease

Competing Interests

None related to this manuscript. The authors report the following general conflicts:


ELG has received speaker honoraria or consultancy fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, MSD, Mundipharma, Portola Pharmaceuticals, and Roche. He is an investigator in the SATELLITE, FLAVOUR, and ETESIAN studies (AstraZeneca) and has received unrestricted research grants from Boehringer Ingelheim. SDK has received lecture fees from Aspen and AstraZeneca. AMH has received speaker's fees from CSL Behring, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, and Leo Pharma and unrestricted research support from Octapharma, and CSL Behring. OBP and HBO have no conflicts to declare.




Publication History

Received: 02 February 2021

Accepted: 16 April 2021

Article published online:
04 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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