Resumen

CABRALES, Jaime; ECHEVERRI, Darío; CORZO, Orlando  y  PINEDA, Mauricio. Differences in platelet aggregation in coronary and peripheral blood of patients with coronary disease: Clinical implications. Rev. Colom. Cardiol. [online]. 2010, vol.17, n.6, pp.255-264. ISSN 0120-5633.

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. OBJETIVE: 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 10 mmol, arachidonic acid (AA), epinephrine (Epi) 300 mmol and collagen 10 ug/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.

Palabras clave : platelet aggregometry; clopidogrel; coronary sinus; coronary disease.

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