Effects of carvedilol versus metoprolol on platelet aggregation in patients with acute coronary syndrome: the PLATE-BLOCK study

Item Type:	Article
Title:	Effects of carvedilol versus metoprolol on platelet aggregation in patients with acute coronary syndrome: the PLATE-BLOCK study
Creators Name:	Ilardi, F. and Gargiulo, G. and Schiattarella, G.G. and Giugliano, G. and Paolillo, R. and Menafra, G. and De Angelis, E. and Scudiero, L. and Franzone, A. and Stabile, E. and Perrino, C. and Cirillo, P. and Morisco, C. and Izzo, R. and Trimarco, V. and Esposito, G.
Abstract:	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 α(2)- and β(2)-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 β(1)-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.
Keywords:	Acute Coronary Syndrome, Adrenergic alpha-1 Receptor Antagonists, Adrenergic beta-1 Receptor Antagonists, Blood Platelets, Carvedilol, Drug Dose-Response Relationship, Follow-Up Studies, Metoprolol, Platelet Aggregation, Platelet Function Tests, Prospective Studies, Treatment Outcome
Source:	American Journal of Cardiology
ISSN:	0002-9149
Publisher:	Elsevier
Volume:	122
Number:	1
Page Range:	6-11
Date:	1 July 2018
Official Publication:	https://doi.org/10.1016/j.amjcard.2018.03.004
PubMed:	View item in PubMed

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