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Adrenaline enhances in vitro platelet activation and aggregation in blood samples from ticagrelor-treated patients
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Örebro University, School of Medical Sciences. Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.ORCID iD: 0000-0002-1920-3962
Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Regional Blood Bank, Sahlgrenska University Hospital, Gothenburg, Sweden .
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2018 (English)In: Research and Practice in Thrombosis and Haemostasis, E-ISSN 2475-0379, Vol. 2, no 4, p. 718-725Article in journal (Refereed) Published
Abstract [en]

Background: Temporarily improved platelet reactivity may reduce the bleeding in patients on antiplatelet therapy who have ongoing bleeding or who are in need of acute surgery. Adrenaline can bind to adrenergic alpha(2A)-receptors on platelets and potentially enhance platelet reactivity.

Objective: To assess if adrenaline can improve adenosine diphosphate (ADP)-induced platelet aggregation and activation in blood samples from patients on dual antiplatelet therapy with acetylsalicylic acid (ASA) and the ADP-receptor antagonist ticagrelor.

Methods: Blood samples were collected from a total of forty acute coronary syndrome patients on dual antiplatelet therapy with ASA and ticagrelor. ADP-induced platelet aggregation (by impedance aggregometry) and activation (by flow cytometry) were assessed before and after supplementation with adrenaline and/or platelet concentrate.

Results: Adrenaline supplementation (770 nmol L-1) increased median ADP-induced aggregation from 15 (25-75th percentiles: 10-20) to 26 (18-38) aggregation units. The effect was independent of concomitant platelet supplementation. Adrenaline also increased ADP-induced platelet activation: from 40% (36-54%) to 83% (74-88%) platelets with active fibrinogen receptor (binding PAC-1) and from 13% (7-21%) to 35% (18-50%) P-selectin-expressing platelets.

Conclusions: Adrenaline potentiated ADP-induced platelet aggregation and activation in blood samples from ticagrelor-treated patients. Adrenaline infusion may be a new method to enhance platelet function in ticagrelor-treated patients who are in need of acute surgery or have ongoing bleeding. In vivo studies are needed to confirm the present results.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018. Vol. 2, no 4, p. 718-725
Keywords [en]
adrenaline, flow cytometry, platelet aggregation, platelet aggregation inhibitors, platelet function tests
National Category
Hematology
Identifiers
URN: urn:nbn:se:oru:diva-70871DOI: 10.1002/rth2.12149ISI: 000452490400014PubMedID: 30349891OAI: oai:DiVA.org:oru-70871DiVA, id: diva2:1275824
Funder
Swedish Heart Lung Foundation, 20150587
Note

Funding Agency:

Västra Götaland Region ALFGBG-146281  ALFGBG-725131

Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved

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Ramström, Sofia

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