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

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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., Gargiulo, G., Schiattarella, G.G., Giugliano, G., Paolillo, R., Menafra, G., De Angelis, E., Scudiero, L., Franzone, A., Stabile, E., Perrino, C., Cirillo, P., Morisco, C., Izzo, R., 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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