Thromb Haemost 2007; 98(03): 662-669
DOI: 10.1160/TH07-04-0272
Animal Models
Schattauer GmbH

A thromboxane A2/prostaglandin H2 receptor antagonist (S18886) shows high antithrombotic efficacy in an experimental model of stent-induced thrombosis

Gemma Vilahur
1   Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau (UAB), Barcelona, Spain
,
Laura Casaní
1   Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau (UAB), Barcelona, Spain
,
Lina Badimon
1   Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau (UAB), Barcelona, Spain
› Author Affiliations
Financial support:This study was supported by funds provided by Servier (Paris, France), CB06/03 and Plan Nacional SAF 2006/10091.
Further Information

Publication History

Received 13 April 2007

Accepted after resubmission 29 May 2007

Publication Date:
28 November 2017 (online)

Summary

Acute thrombosis is a threat in patients undergoing percutaneous coronary intervention with stent implantation. Our objective was to determine if stent-induced thrombus formation could be inhibited by oral treatment with a thromboxane A2/prostaglandin H2 receptor antagonist (TPr; S18886) as an alternative to standard therapy. Pigs were allocated in the following treatment (p.o) groups: I) clopidogrel (CLOP); II) ASA; III) S18886; IV) ASA+CLOP; and V) placebo-control. Damaged vessel was placed in the Badimon chamber containing a stent and perfused at 212/s.Antithrombotic effects were assessed as 111In-platelet deposition (PD) in two series (60 and 180 min after drug intake). Fibrin(ogen) deposition, light transmittance aggregometry (LTA; collagen, U46619, and ADP), and bleeding time (BT) were also evaluated. After 60 min S18886 reduced PD ≤48%, 40%, and 35% vs placebo, CLOP-, and ASA-treated ani mals, respectively (P<0.05), while ASA+CLOP showed a 58% reduction versus placebo (P<0.01).After 3 hours, ASA+CLOP decreased PD by 55%, S18886 by 40%, CLOP alone by 28% (P>0.05), and ASA showed no inhibition versus placebo. Similar effects were found in S18886– and ASA+CLOP-treated animals at both times. Fibrin(ogen) deposition followed the same pattern. Collagen-induced LTA was significantly reduced by ASA, ASA+CLOP, and S18886; S18886 abolished U46619-induced LTA; and, CLOP±ASA reduced ADP-induced LTA in a time-dependent manner. TPr blockade did not prolong BT, whereas CLOP±ASA significantly did (P<0.0001). In conclusion, blockade of theTPr provided a fast and potent platelet inhibitory effect in a porcine model of in-stent thrombosis comparable to that of blocking both the ADP receptor and cyclooxygenase activation; in addition,TPr provided a more favorable bleeding risk profile.

 
  • References

  • 1 Schomig A, Kastrati A, Mudra H. et al. Four-year experience with Palmaz-Schatz stenting in coronary angioplasty complicated by dissection with threatened or present vessel closure. Circulation 1994; 90: 2716-2724.
  • 2 Lau KW, Hung JS, Sigwart U. The current status of stent placement in small coronary arteries < 3.0 mm in diameter. J Invasive Cardiol 2004; 16: 411-416.
  • 3 Baigent C, Collins R, Appleby P. et al. ISIS-2: 10 year survival among patients with suspected acute myocardial infarction in randomised comparison of intravenous streptokinase, oral aspirin, both, or neither. The ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Br Med J 1998; 316: 1337-1343.
  • 4 Maree AO, Fitzgerald DJ. Aspirin and coronary artery disease. Thromb Haemost 2004; 92: 1175-1181.
  • 5 Sabatine MS, Cannon CP, Gibson CM. et al. Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCICLARITY study. J Am Med Assoc 2005; 294: 1224-1232.
  • 6 Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Br Med J 2002; 324: 71-86.
  • 7 A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996; 348: 1329-1339.
  • 8 Yusuf S, Zhao F, Mehta SR. et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494-502.
  • 9 Steinhubl SR, Berger PB, Mann JT. 3rd, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. J Am Med Assoc 2002; 288: 2411-2420.
  • 10 Diener HC, Bogousslavsky J, Brass LM. et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004; 364: 331-337.
  • 11 Chen ZM, Jiang LX, Chen YP. et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005; 366: 1607-1621.
  • 12 Moussa I, Oetgen M, Roubin G. et al. Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. Circulation 1999; 99: 2364-2366.
  • 13 Bhatt DL, Bertrand ME, Berger PB. et al. Metaanalysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting. J Am Coll Cardiol 2002; 39: 9-14.
  • 14 Hongo RH, Ley J, Dick SE. et al. The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting. J Am Coll Cardiol 2002; 40: 231-237.
  • 15 Harrington RA, Becker RC, Ezekowitz M. et al. Antithrombotic therapy for coronary artery disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 513S-548S.
  • 16 Montalescot G, Sideris G, Meuleman C. et al. A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial. J Am Coll Cardiol 2006; 48: 931-938.
  • 17 Gurbel P, Malinin A, Callahan K. et al. Effect of loading with clopidogrel at the time of coronary stenting on platelet aggregation and glycoprotein IIb/IIIa expression and platelet-leukocyte aggregate formation. Am J Cardiol 2002; 90: 312-315.
  • 18 Kakkos SK, Nicolaides AN. S-18886 Servier. Curr Opin Investig Drugs 2002; 3: 1324-1327.
  • 19 Cayatte AJ, Du Y, Oliver-Krasinski J. et al. The thromboxane receptor antagonist S18886 but not aspirin inhibits atherogenesis in apo E-deficient mice: evidence that eicosanoids other than thromboxane contribute to atherosclerosis. Arterioscler Thromb Vasc Biol 2000; 20: 1724-1728.
  • 20 Osende JI, Shimbo D, Fuster V. et al. Antithrombotic effects of S 18886, a novel orally active thromboxane A2 receptor antagonist. J Thromb Haemost 2004; 2: 492-498.
  • 21 Maalej N, Osman HE, Shanmuganayagam D. et al. Antithrombotic properties of the thromboxane A2/prostaglandin H2 receptor antagonist S18886 on prevention of platelet-dependent cyclic flow reductions in dogs. J Cardiovasc Pharmacol 2005; 45: 389-395.
  • 22 Gaussem P, Reny JL, Thalamas C. et al. The specific thromboxane receptor antagonist S18886: pharmacokinetic and pharmacodynamic studies. J Thromb Haemost 2005; 3: 1437-1445.
  • 23 Belhassen L, Pelle G, Dubois-Rande JL. et al. Improved endothelial function by the thromboxane A2 receptor antagonist S 18886 in patients with coronary artery disease treated with aspirin. J Am Coll Cardiol 2003; 41: 1198-1204.
  • 24 Verbeuren TJ, Vallez MO, Lavielle G. et al. Activation of thromboxane receptors and the induction of vasomotion in the hamster cheek pouch microcirculation. Br J Pharmacol 1997; 122: 859-866.
  • 25 Rukshin V, Azarbal B, Finkelstein A. et al. Effects of GP IIb/IIIa receptor inhibitor tirofiban (aggrastat) in ex vivo canine arteriovenous shunt model of stent thrombosis. J Cardiovasc Pharmacol 2003; 41: 615-624.
  • 26 Badimon L, Turitto V, Rosemark JA. et al. Characterization of a tubular flow chamber for studying platelet interaction with biologic and prosthetic materials: deposition of indium 111-labeled platelets on collagen, subendothelium, and expanded polytetrafluoroethylene. J Lab Clin Med 1987; 110: 706-718.
  • 27 Meyer BJ, Badimon JJ, Chesebro JH. et al. Dissolution of mural thrombus by specific thrombin inhibition with r-hirudin: comparison with heparin and aspirin. Circulation 1998; 97: 681-685.
  • 28 Badimon L, Badimon JJ, Galvez A. et al. Influence of arterial damage and wall shear rate on platelet deposition. Ex vivo study in a swine model. Arteriosclerosis 1986; 6: 312-320.
  • 29 Merrill E. Rheology of blood. Physiol Rev 1969; 49: 863-888.
  • 30 Jeremias A, Sylvia B, Bridges J. et al. Stent thrombosis after successful sirolimus-eluting stent implantation. Circulation 2004; 109: 1930-1932.
  • 31 Makkar RR, Eigler NL, Kaul S. et al. Effects of clopidogrel, aspirin and combined therapy in a porcine ex vivo model of high-shear induced stent thrombosis. Eur Heart J 1998; 19: 1538-1546.
  • 32 Galvez A, Badimon L, Badimon JJ. et al. Electrical aggregometry in whole blood from human, pig and rabbit. Thromb Haemost 1986; 56: 128-132.
  • 33 Mertz E. The anomaly of a normal Duke’s and a very prolonged saline bleeding time in swine suffering from an inherited bleeding disease. Am J Physiol 1942; 136: 360-362.
  • 34 Moses JW, Leon MB, Popma JJ. et al. Sirolimuseluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003; 349: 1315-1323.
  • 35 Lemos PA, Lee CH, Degertekin M. et al. Early outcome after sirolimus-eluting stent implantation in patients with acute coronary syndromes: insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. J Am Coll Cardiol 2003; 41: 2093-2099.
  • 36 Gurbel PA, Bliden KP, Hiatt BL. et al. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation 2003; 107: 2908-2913.
  • 37 Grossmann R, Sokolova O, Schnurr A. et al. Variable extent of clopidogrel responsiveness in patients after coronary stenting. Thromb Haemost 2004; 92: 1201-1206.
  • 38 Angiolillo DJ, Fernandez-Ortiz A, Bernardo E. et al. High clopidogrel loading dose during coronary stenting: effects on drug response and interindividual variability. Eur Heart J 2004; 25: 1903-1910.
  • 39 Patti G, Colonna G, Pasceri V. et al. Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA- 2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study. Circulation 2005; 111: 2099-2106.
  • 40 Morawietz H, Breier G. Endothelial cell biology: an update. 5th International Symposium on the Biology of Endothelial Cells. Thromb Haemost 2006; 95: 1025-1030.
  • 41 Penglis PS, Cleland LG, Demasi M. et al. Differential regulation of prostaglandin E2 and thromboxane A2 production in human monocytes: implications for the use of cyclooxygenase inhibitors. J Immunol 2000; 165: 1605-1611.
  • 42 Vejar M, Fragasso G, Hackett D. et al. Dissociation of platelet activation and spontaneous myocardial ischemia in unstable angina. Thromb Haemost 1990; 63: 163-168.
  • 43 Schror K, Weber AA, Hohlfeld T. Clopidogrel "resistance". Thromb Haemost 2004; 92: 229-231.