vWF/ADAMTS13 is associated with on-aspirin residual platelet reactivity and clinical outcome in patients with stable coronary artery disease

• Published in: Thrombosis journal 2017-11, Vol.15 (1), p.28-28, Article 28
• Main Authors: Warlo, Ellen M K, Pettersen, Alf-Åge R, Arnesen, Harald, Seljeflot, Ingebjørg
• Format: Article
• Language: English
• Subjects: ADAMTS13; Antigens; Aspirin; Cardiac patients; Cardiovascular disease; Care and treatment; Coronary heart disease; Patient outcomes; Residual platelet reactivity; Stroke; Von Willebrand factor
• ISSN: 1477-9560; 1477-9560
• DOI: 10.1186/s12959-017-0151-3

The mechanisms behind residual platelet reactivity (RPR) despite aspirin treatment are not established. It has been shown that coronary artery disease (CAD) patients with high on-aspirin RPR have elevated levels of von Willebrand factor (vWF). ADAMTS13 is a metalloprotease cleaving ultra large vWF multimers into less active fragments.Our aim was to investigate whether ADAMTS13 and vWF/ADAMTS13 ratio were associated with high RPR, and further with clinical endpoints after 2 years. Stable aspirin-treated CAD patients (  = 999) from the ASCET trial. RPR was assessed by PFA-100. ADAMTS13 antigen and activity were analysed using chromogenic assays. Endpoints were a composite of acute myocardial infarction, stroke and death. The number of patients with high RPR was 258 (25.8%). Their serum thromboxane B (TxB ) levels were low, indicating inhibition of COX-1. They had significantly lower levels of ADAMTS13 antigen compared to patients with low RPR (517 vs 544 ng/mL,  = 0.001) and significantly lower ADAMTS13 activity (0.99 vs 1.04 IU/mL,  = 0.020). The differences were more pronounced when relating RPR to ratios of vWF/ADAMTS13 antigen and vWF/ADAMTS13 activity (