Effects of intravenous lysine acetylsalicylate versus oral aspirin on platelet responsiveness in patients with ST‐segment elevation myocardial infarction: the ECCLIPSE‐STEMI trial

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dc.contributor.authorVivas Balcones, Luis David
dc.contributor.authorJiménez, José Julio
dc.contributor.authorMartín Asenjo, Roberto
dc.contributor.authorBernardo, Esther
dc.contributor.authorOrtega Pozzi, María Aranzazu
dc.contributor.authorGómez Polo, Juan Carlos
dc.contributor.authorMoreno Muñoz, Guillermo
dc.contributor.authorVilacosta, Isidre
dc.contributor.authorPérez Villacastín Domínguez, Julián
dc.contributor.authorFernández Ortiz, Antonio Ignacio
dc.date.accessioned2024-02-07T10:24:52Z
dc.date.available2024-02-07T10:24:52Z
dc.date.issued2023-02-01
dc.description.abstractEnsayo clínico aleatorizado multicéntrico que evaluó en 32 pacientes con infarto agudo de miocardio el efecto de la administración intravenosa de acetilsalicilato de lisina frente a aspirina oral. El estudio objetivó una inhibición plaquetaria más potente y precoz en los pacientes que recibieron acetilsalicilato de lisina intravenosa. Prasugrel and ticagrelor, new P2Y12-ADP receptor antagonists, are associated with greater pharmacodynamic inhibition and reduction of cardiovascular events in patients with an acute coronary syndrome. However, evidence is lacked about the effects of achieving faster and stronger cyclooxygenase inhibition with intravenous lysine acetylsalicylate (LA) compared to oral aspirin. Recently, we demonstrated in healthy volunteers that the administration of intravenous LA resulted in a significantly reduction of platelet reactivity compared to oral aspirin. Loading dose of LA achieves platelet inhibition faster, and with less variability than aspirin. However, there are no data of this issue in patients with an ST-segment elevation myocardial infarction (STEMI). This is a prospective, randomized, multicenter, open platelet function study conducted in STEMI patients. Subjects were randomly assigned to receive a loading dose (LD) of intravenous LA 450 mg plus oral ticagrelor 180 mg, or LD of aspirin 300 mg plus ticagrelor 180 mg orally. Platelet function was evaluated at baseline, 30 min, 1 h, 4 h and 24 h using multiple electrode aggregometry and vasodilator-stimulated phosphoprotein phosphorylation (VASP). The primary endpoint of the study is the inhibition of platelet aggregation (IPA) after arachidonic acid (AA) 0.5 mM at 30 min. Secondary endpoints were the IPA at 1, 4, and 24 h after AA, and non-AA pathways through the sequence (ADP and TRAP). A total of 32 STEMI patients were randomized (16 LA, 16 aspirin). The inhibition of platelet aggregation after AA 0.5 mM at 30 min was greater in subjects treated with LA compared with aspirin: 166 vs. 412 respectively (p = 0.001). This differential effect was observed at 1 h (p = 0.01), but not at 4 and 24 h. Subjects treated with LA presented less variability and faster inhibition of platelet aggregation wit AA compared with aspirin. The administration of intravenous LA resulted in a significantly reduction of platelet reactivity compared to oral aspirin on ticagrelor inhibited platelets in patients with STEMI. Loading dose of LA achieves an earlier platelet inhibition, and with less variability tan aspirin.es
dc.description.departmentDepto. de Medicina
dc.description.facultyFac. de Medicina
dc.description.refereedTRUE
dc.description.sponsorshipHospital San Carlos
dc.description.sponsorshipInstituto de Salud Carlos III
dc.description.statuspub
dc.identifier.citationVivas D, Jimenez JJ, Marttón-Asenjo R, Bernardo E, Ortega-Pozzi MA, Gómez-Polo JC, et al. Effects of intravenous lysine acetylsalicylate versus oral aspirin on platelet responsiveness in patients with ST-segment elevation myocardial infarction: the ECCLIPSE-STEMI trial. J Thromb Thrombolysis. 2023;55:203-210
dc.identifier.doi10.1007/s11239-022-02737-y
dc.identifier.essn1573-742X
dc.identifier.issn0929-5305
dc.identifier.officialurlhttps://onlinelibrary.wiley.com/doi/10.1111/eci.13436
dc.identifier.pmid36480147
dc.identifier.relatedurlhttps://pubmed.ncbi.nlm.nih.gov/36480147/
dc.identifier.urihttps://hdl.handle.net/20.500.14352/99866
dc.issue.number2
dc.journal.titleJournal of Thrombosis and Thrombolysis
dc.language.isoeng
dc.page.final210
dc.page.initial203
dc.relation.projectIDinfo:eu-repo/grantAgreement/MINECO//PI16%2F00191/ES/Efectos de la Administración Intravenosa de Acetilsalicilato de Lisina versus Aspirina Oral sobre la Respuesta Plaquetaria en Pacientes con un Infarto Agudo de Miocardio con Elevación del Segmento ST: un estudio farmacodinámico/
dc.rights.accessRightsrestricted access
dc.subject.keywordPlatelets
dc.subject.keywordLysine acetylsalicylate
dc.subject.keywordAspirin
dc.subject.keywordAcute coronary syndrome
dc.subject.ucmCiencias Biomédicas
dc.subject.unesco32 Ciencias Médicas
dc.titleEffects of intravenous lysine acetylsalicylate versus oral aspirin on platelet responsiveness in patients with ST‐segment elevation myocardial infarction: the ECCLIPSE‐STEMI trialen
dc.typejournal article
dc.type.hasVersionVoR
dc.volume.number55
dspace.entity.typePublication
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