High concentration of symmetric dimethylarginine is associated with low platelet reactivity and increased bleeding risk in patients with acute coronary syndrome. Issue 213 (May 2022)

• Record Type: Journal Article
• Authors: Eyileten, Ceren; Gasecka, Aleksandra; Nowak, Anna; Jarosz-Popek, Joanna; Wolska, Marta; Dizdarevic, Al-Medina; Lang, Irene M.; Postula, Marek; Ufnal, Marcin; Siller-Matula, Jolanta M.
• Is Part Of: Thrombosis research. Issue 213(2022)
• Page Start: 195
• Page End: 202
• Publication Date: 2022-05
• Subjects: AA arachidonic acid -- ADP adenosine diphosphate -- AMI acute myocardial infarction -- ACS acute coronary syndrome -- ADMA asymmetric dimethylarginine -- ASA acetylsalicylic acid -- AF atrial fibrillation -- CAD coronary artery disease -- CI confidence interval -- CKD chronic kidney disease -- hsCRP high-sensitivity C-reactive protein -- CV cardiovascular -- CVD cardiovascular diseases -- DAPT dual antiplatelet therapy -- eGFR estimated glomerular filtration rate -- ESC European Society of Cardiology -- ISTH International Society on Thrombosis and Haemostasis -- GFR glomerular filtration rate -- HDL high-density lipoprotein -- Hb haemoglobin -- MACE major adverse cardiac events -- MEA multiple electrode aggregometry -- MI myocardial infarction -- NF-κβ nuclear factor kappa-light-chain-enhancer of activated B cells -- NSTEMI non ST-elevation myocardial infarction, -- NO nitric oxide -- OR odds ratio -- PAD peripheral artery disease -- PGE1 prostaglandin E1 -- PCI percutaneous coronary intervention -- ROS reactive oxygen species -- SDMA symmetric dimethylarginine -- STEMI ST elevation myocardial infarction -- TIMI Thrombolysis in Myocardial Infarction -- TLR-2 Toll-like receptor 2 -- TnT Troponin T -- U units -- WBC white blood cells; SDMA -- Nitric oxide -- L-arginine -- Acute coronary syndrome -- Bleeding; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2022.03.025
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: Dual antiplatelet therapy (DAPT) prevents ischemic events in patients with acute coronary syndrome (ACS), but is associated with increased risk of bleeding events. Symmetric dimethylarginine (SDMA) is one of nitric oxide (NO)-related pathway metabolites and stands as a promising biomarker of early chronic kidney disease (CKD) and cardiovascular diseases (CVDs). Objectives: Our study evaluated the role of SDMA in predicting bleeding events in patients after ACS treated with DAPT. Methods: We compared plasma concentrations of NO-related pathway metabolites in patients with ACS ( n = 291) and investigated the prognostic value of SDMA as a bleeding predictor during 1-year follow-up. We measured the metabolites concentration using ultra performance liquid chromatography. Platelet reactivity was determined using impedance aggregometry. Results: Patients with the highest quartile (4th) of SDMA concentration had significantly lower platelet aggregation compared to those in the 1st-3rd quartiles of SDMA, based on ADP + PGE1-, AA-, and ADP-induced platelet reactivity tests ( p = 0.0004, p = 0.002, p = 0.014, respectively). Patients with major or minor bleeding events had significantly higher concentrations of SDMA as compared to those without bleeding events or to those with minimal bleeding events ( p = 0.019, p = 0.019, respectively). Conclusion: Higher SDMA concentration is associated with lower platelet reactivity and is associated with major and minor bleeding events in patients with ACS on DAPT. Therefore, SDMA stands as a potential biomarker for individualization of duration and potency of antiplatelet therapies in the ACS population at high risk of bleeding complications. Highlights: Dual antiplatelet therapy is a risk factor for major and minor bleeding events. Higher SDMA concentration is associated with cardiovascular and chronic kidney disease. We present association between SDMA and platelet reactivity. Higher concentrations of SDMA were in patients with major or minor bleeding events. SDMA is a potential biomarker of bleeding risk in patients on dual antiplatelet therapy.