Background: Takotsubo syndrome (TTS) is a reversible form of ventricular dysfunction mimicking many clinical features of acute coronary syndrome (ACS) without coronary artery occlusion. The underlying pathophysiological mechanisms of TTS are not fully understood, as yet, even if a strong association to stressful conditions and secretion of catecholamines has been observed in post-menopausal women.
Aims: In this study we tested the hypotheses that TTS patients display abnormalities in platelet and fibrin clotting function.
Methods: Forty-five age-matched women with ACS were enrolled at the index event and, after a differential diagnosis, divided in TTS(N=26;< 50% stenosis) and with obstructive coronary disease (CAD)(N=19;≥50% stenosis). After a 6 months follow-up, platelet aggregation induced by different stimuli was performed in platelet rich plasma. Functional fibrinogen and polymerization of fibrin clot were assessed in plasma by Clauss method and by spectrophotometric analysis, respectively. Twenty-four healthy post-menopausal women were recruited as reference group (CTRL). TTS and CAD patients were all on aspirin treatment. The study complies with the Declaration of Helsinki and was approved by the Hospital Institutional Review Board and Ethical Committee. All participants provided written informed consent.
Results: Despite aspirin treatment, an enhanced platelet activation was recorded in TTS patients as shown by increased slope aggregation in response to ADP, epinephrine and norepinephrine vs CAD and CTRL (p< 0.004). In particular, the maximum platelet aggregation induced by both ADP and norepinephrine was higher in TTS than in CAD patients (p=0.04 and p=0.003, respectively).
No significant differences were observed in response to TRAP-6. TTS patients have both lower functional fibrinogen level and percentage of fiber clot polymerization than CAD patients
(p< 0.0001 and p< 0.012, respectively), being however comparable to CTRL.
Conclusions: The data here reported show for the first time an increased residual platelet activation in TTS patients, which however is associated with no change in fibrin clotting ability.
To cite this abstract in AMA style:Amadio P, Barbieri SS, Porro B, Eligini S, Cavalca V, Barbieri S, Werba PJ, Olivares P, Veglia F, Tremoli E, Trabattoni D. Evaluation of Platelets Activation and Fibrin Clotting in Post-Menopausal Women with Takotsubo Syndrome [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/evaluation-of-platelets-activation-and-fibrin-clotting-in-post-menopausal-women-with-takotsubo-syndrome/. Accessed March 3, 2021.
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