Platelet aggregation plays a pivotal role in acute coronary syndrome (ACS). In this
setting, β-blockers (BBs) are used to counteract the effects of catecholamines on
heart. Circulating catecholamines can also potentiate platelet reactivity, mainly
through α2- and β2-adrenoceptors on human platelets' surface, thus BB may affect platelet aggregation;
however, the effects of different BBs on platelet aggregation in contemporary-treated
patients with ACS have been poorly investigated. One hundred patients with ACS on
dual antiplatelet therapy with aspirin and ticagrelor were randomized to receive treatment
with carvedilol, a nonselective BB (n = 50), or metoprolol, a selective β1-blocker (n = 50), at maximum tolerated dose. Light transmission aggregometry was
performed at randomization (T0) and at 30-day follow-up (T30), and the results were
expressed as a percentage of maximum platelet aggregation (MPA). The primary end point
was epinephrine-induced MPA at 30 days. Patients were predominantly men (80%), and
mean age was 57.3 ± 9.7 years. The 2 randomized groups were well balanced for baseline
characteristics. At T0, mean MPA was similar between the groups (18.96 ± 9.05 vs 18.32 ± 9.21
with 10 µM epinephrine, 14.42 ± 9.43 vs 15.98 ± 10.08 with 20 µM adenosine diphophate
(ADP), and 13.26 ± 9.83 vs 14.30 ± 9.40 with 10 µM ADP for carvedilol and metoprolol,
respectively, all p = NS). At 30 days, platelet aggregation induced by epinephrine
was significantly lower in the carvedilol group than in the metoprolol group (23.52 ± 10.25
vs 28.72 ± 14.37, p = 0.04), with a trend toward the lower values of ADP-induced MPA
(20 µM ADP 19.42 ± 13.84 vs 24.16 ± 13.62, p = 0.09; 10 µM ADP 19.12 ± 12.40 vs 22.57 ± 13.59,
p = 0.19). In conclusion, carvedilol, a nonselective BB, reduces residual platelet
reactivity in patients with ACS compared with the selective BB, metoprolol.
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Article info
Publication history
Published online: April 03, 2018
Accepted:
March 13,
2018
Received:
February 9,
2018
Footnotes
This study was supported by internal funds.
See page 10 for disclosure information.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
