The Impact of Patient Characteristics and Antiplatelet Regimes on Clot Microstructure in Patients Treated for ST Elevation Myocardial Infarction: Clot Microstructure can Evaluate Therapeutic Efficacy
Background Unfavourable clot microstructure is associated with adverse outcomes in ST elevation myocardial infarction (STEMI). We investigated the effect of comorbidities and anti-platelet treatment on clot microstructure in STEMI patients using fractal dimension (d f ), a novel biomarker of clot mi...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-03-01
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| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/10760296221131563 |
| _version_ | 1827976463114043392 |
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| author | Matthew J. Lawrence PhD Daniel R. Obaid PhD Ahmed Sabra PhD Janet Whitley BA Rhianwen Quarry MBBch Suresh Pillai MSc Alexander J. Chase PhD David Smith MD Phylip R. Williams PhD Karl Hawkins PhD Roger H.K. Morris PhD Phillip A. Evans MD |
| author_facet | Matthew J. Lawrence PhD Daniel R. Obaid PhD Ahmed Sabra PhD Janet Whitley BA Rhianwen Quarry MBBch Suresh Pillai MSc Alexander J. Chase PhD David Smith MD Phylip R. Williams PhD Karl Hawkins PhD Roger H.K. Morris PhD Phillip A. Evans MD |
| author_sort | Matthew J. Lawrence PhD |
| collection | DOAJ |
| description | Background Unfavourable clot microstructure is associated with adverse outcomes in ST elevation myocardial infarction (STEMI). We investigated the effect of comorbidities and anti-platelet treatment on clot microstructure in STEMI patients using fractal dimension (d f ), a novel biomarker of clot microstructure derived from the visco-elastic properties of whole blood. Methods Patients with STEMI (n = 187) were recruited sequentially receiving aspirin with Clopidogrel (n = 157) then Ticagrelor (n = 30). Patient characteristics and blood for rheological analysis obtained. We quantified d f using sequential frequency sweep tests to obtain the phase angle of the Gel Point which is synonymous with the clot microstructure. Results Higher d f was observed in males (1.755 ± 0.068) versus females (1.719 ± 0.061, p = .001), in patients with diabetes (1.786 ± 0.067 vs 1.743 ± 0.046, p < .001), hypertension (1.760 ± 0.065 vs 1.738 ± 0.069, p = .03) and previous MI (1.787 ± 0.073 vs 1.744 ± 0.066, p = .011) compared to without. Patients receiving Ticagrelor had lower d f than those receiving Clopidogrel (1.708 ± 0.060 vs 1.755 ± 0.067, p < .001). Significant correlation with d f was found with haematocrit (r = 0.331, p < .0001), low-density lipoprotein (LDL) (r = 0.155, p = .046) and fibrinogen (r = 0.182, p = .014). Following multiple regression analysis, diabetes, LDL, fibrinogen and haematocrit remained associated with higher d f while treatment with Ticagrelor remained associated with lower d f . Conclusions The biomarker d f uniquely evaluates the effect of interactions between treatment and underlying disease on clot microstructure. STEMI patients with diabetes and elevated LDL had higher d f, indicating denser clot. Ticagrelor resulted in a lower d f than Clopidogrel signifying a less compact clot. |
| first_indexed | 2024-04-09T20:35:51Z |
| format | Article |
| id | doaj.art-8eb367a08997456997c917b8e19aaa48 |
| institution | Directory Open Access Journal |
| issn | 1938-2723 |
| language | English |
| last_indexed | 2024-04-09T20:35:51Z |
| publishDate | 2023-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj.art-8eb367a08997456997c917b8e19aaa482023-03-30T10:03:29ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232023-03-012910.1177/10760296221131563The Impact of Patient Characteristics and Antiplatelet Regimes on Clot Microstructure in Patients Treated for ST Elevation Myocardial Infarction: Clot Microstructure can Evaluate Therapeutic EfficacyMatthew J. Lawrence PhD0Daniel R. Obaid PhD1Ahmed Sabra PhD2Janet Whitley BA3Rhianwen Quarry MBBch4Suresh Pillai MSc5Alexander J. Chase PhD6David Smith MD7Phylip R. Williams PhD8Karl Hawkins PhD9Roger H.K. Morris PhD10Phillip A. Evans MD11 Welsh Centre for Emergency Medicine Research, , Swansea, UK Medical School, , Swansea, UK Morriston Regional Heart Centre, , Swansea, UK Medical School, , Swansea, UK Morriston Regional Heart Centre, , Swansea, UK Medical School, , Swansea, UK Morriston Regional Heart Centre, , Swansea, UK Morriston Regional Heart Centre, , Swansea, UK College of Engineering, , Swansea, UK Medical School, , Swansea, UK School of Applied Science, , Cardiff, UK Medical School, , Swansea, UKBackground Unfavourable clot microstructure is associated with adverse outcomes in ST elevation myocardial infarction (STEMI). We investigated the effect of comorbidities and anti-platelet treatment on clot microstructure in STEMI patients using fractal dimension (d f ), a novel biomarker of clot microstructure derived from the visco-elastic properties of whole blood. Methods Patients with STEMI (n = 187) were recruited sequentially receiving aspirin with Clopidogrel (n = 157) then Ticagrelor (n = 30). Patient characteristics and blood for rheological analysis obtained. We quantified d f using sequential frequency sweep tests to obtain the phase angle of the Gel Point which is synonymous with the clot microstructure. Results Higher d f was observed in males (1.755 ± 0.068) versus females (1.719 ± 0.061, p = .001), in patients with diabetes (1.786 ± 0.067 vs 1.743 ± 0.046, p < .001), hypertension (1.760 ± 0.065 vs 1.738 ± 0.069, p = .03) and previous MI (1.787 ± 0.073 vs 1.744 ± 0.066, p = .011) compared to without. Patients receiving Ticagrelor had lower d f than those receiving Clopidogrel (1.708 ± 0.060 vs 1.755 ± 0.067, p < .001). Significant correlation with d f was found with haematocrit (r = 0.331, p < .0001), low-density lipoprotein (LDL) (r = 0.155, p = .046) and fibrinogen (r = 0.182, p = .014). Following multiple regression analysis, diabetes, LDL, fibrinogen and haematocrit remained associated with higher d f while treatment with Ticagrelor remained associated with lower d f . Conclusions The biomarker d f uniquely evaluates the effect of interactions between treatment and underlying disease on clot microstructure. STEMI patients with diabetes and elevated LDL had higher d f, indicating denser clot. Ticagrelor resulted in a lower d f than Clopidogrel signifying a less compact clot.https://doi.org/10.1177/10760296221131563 |
| spellingShingle | Matthew J. Lawrence PhD Daniel R. Obaid PhD Ahmed Sabra PhD Janet Whitley BA Rhianwen Quarry MBBch Suresh Pillai MSc Alexander J. Chase PhD David Smith MD Phylip R. Williams PhD Karl Hawkins PhD Roger H.K. Morris PhD Phillip A. Evans MD The Impact of Patient Characteristics and Antiplatelet Regimes on Clot Microstructure in Patients Treated for ST Elevation Myocardial Infarction: Clot Microstructure can Evaluate Therapeutic Efficacy Clinical and Applied Thrombosis/Hemostasis |
| title | The Impact of Patient Characteristics and Antiplatelet Regimes on Clot Microstructure in Patients Treated for ST Elevation Myocardial Infarction: Clot Microstructure can Evaluate Therapeutic Efficacy |
| title_full | The Impact of Patient Characteristics and Antiplatelet Regimes on Clot Microstructure in Patients Treated for ST Elevation Myocardial Infarction: Clot Microstructure can Evaluate Therapeutic Efficacy |
| title_fullStr | The Impact of Patient Characteristics and Antiplatelet Regimes on Clot Microstructure in Patients Treated for ST Elevation Myocardial Infarction: Clot Microstructure can Evaluate Therapeutic Efficacy |
| title_full_unstemmed | The Impact of Patient Characteristics and Antiplatelet Regimes on Clot Microstructure in Patients Treated for ST Elevation Myocardial Infarction: Clot Microstructure can Evaluate Therapeutic Efficacy |
| title_short | The Impact of Patient Characteristics and Antiplatelet Regimes on Clot Microstructure in Patients Treated for ST Elevation Myocardial Infarction: Clot Microstructure can Evaluate Therapeutic Efficacy |
| title_sort | impact of patient characteristics and antiplatelet regimes on clot microstructure in patients treated for st elevation myocardial infarction clot microstructure can evaluate therapeutic efficacy |
| url | https://doi.org/10.1177/10760296221131563 |
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