Prevalence of and risk factors for aspirin resistance in elderly patients with coronary artery disease

Objective To assess the prevalence of and related risk factors for aspirin resistance in elderly patients with coronary artery disease (CAD). Methods Two hundred and forty-six elderly patients (75.9 ± 7.4 years) with CAD who received daily aspirin therapy (≥ 75 mg) over one month were recruited. The effect of aspirin was assessed using light transmission aggregometry (LTA) and thrombelastography platelet mapping assay (TEG). Aspirin resistance was defined as ≥ 20% arachidonic acid (AA)-induced aggregation and ≥ 70% adenosine diphosphate (ADP)-induced aggregation in the LTA assay. An aspirin semi-responder was defined as meeting one (but not both) of the criteria described above. Based on the results of TEG, aspirin resistance was defined as ≥ 50% aggregation induced by AA. Results As determined by LTA, 23 (9.3%) of the elderly CAD patients were resistant to aspirin therapy; 91 (37.0%) were semi-responders. As determined by TEG, 61 patients (24.8%) were aspirin resistant. Of the 61 patients who were aspirin resistant by TEG, 19 were aspirin resistant according to LTA results. Twenty-four of 91 semi-responders by LTA were aspirin resistant by TEG. Multivariate logistic regression analysis revealed that elevated fasting serum glucose level (Odds ratio: 1.517; 95% CI: 1.176–1.957; P = 0.001) was a significant risk factor for aspirin resistance as determined by TEG. Conclusions A significant number of elderly patients with CAD are resistant to aspirin therapy. Fasting blood glucose level is closely associated with aspirin resistance in elderly CAD patients.     

阿司匹林抵抗对冠状动脉介入术后病人的远期影响

目的了解冠状动脉支架术后冠心病患者阿司匹林抵抗（AR）的状况及其远期影响。方法选择经皮冠状动脉介入术（PCI）后不稳定性心绞痛患者118例,在体外应用ADP诱导的血小板最大聚集率≥70％和0．5％花生四烯酸诱导血小板最大聚集率≥20％者为AR患者,并设立复合终点,随访12个月以上。结果有26例被判断为AR,两组患者除性别以外在年龄、冠心病相关危险因素和药物治疗等方面比较差异无统计学意义（P〉0．05）。平均随访期（18．51±7．65）个月,13例发生了终点事件（11．02％）,AR患者中6例（23．08％）,非AR患者中7例（7．61％）,P=0．05;多因素分析提示AR仍是远期不良事件的独立预测因素（HR2．31;95％CI1．23—5．37;P〈0．05）。结论冠状动脉支架术后的冠心病患者中AR发生率22．03％,AR是发生远期不良事件的重要危险因素。     

老年冠心病患者阿司匹林抵抗的临床研究

目的：探讨老年冠心病患者阿可匹林抵抗（AR）的发生率及其临床特征,评价AR的相关危险因素。方法：对135例患老年冠心病,口服阿司匹林≥100mg超过7d的患者,采用血小板聚集仪分别测定花生四烯酸、二磷酸腺苷（ADP）诱导的血小板聚集率（PAR）。AR的定义：用0．5mmol／L花生四烯酸诱导,平均PAR≥20％,用10μmol／L的ADP诱导,平均PAR≥70％。阿司匹林半抵抗（ASR）即符合上述AR两条件之一者,均不满足者为阿司匹林敏感（AS）。用统计学方法分析各组间各项临床特征差异及影响AR与ASR的独立危险因素。结果：AR、ASR及AS发生率分别为13．3%（18／135）、28．9％（39／135）及57．8％（78／135）。与AS者相比,AR组中糖尿病患者明显增多,且该组患者纤维蛋白原（Fb）水平明显高于AS组[（4．21±1．09）g／L：（3．58±0．80）g／L,P〈0．05]。Logistic回归分析表明,糖尿病[相对比值比（OR）=7．402,95％可信区间（CI）3．110～17．620,P〈0．01]是发生AR与ASR的独立危险因素。结论：研究人群中阿司匹林抵抗的发生率为13．3％,发生AR与ASR可能与糖尿病有关,高Fb患者发生AR的危险性升高。     

冠心病患者阿司匹林抵抗及其影响因素

目的探讨冠心病患者阿司匹林抵抗（Aspirin resistance,AR）现象及其影响因素。方法入选1 731例入院诊断为冠心病（急性冠状动脉综合征和稳定型心绞痛）的患者。采用血小板聚集仪分别测定花生四烯酸（AA）、腺苷二磷酸（二磷酸腺苷,ADP）诱导的血小板聚集率。AR定义为0.5 mmol/L花生四烯酸时血小板平均聚集率≥20%,用10μmol/L ADP时血小板平均聚集率≥70%。阿司匹林半抵抗（Aspirin semiresistance,ASR）即符合上述两个条件之一者。均不符合者为阿司匹林敏感（Aspirin sensitive,AS）。用统计学方法分析各组间各项临床特征差异及影响AR与ASR的危险因素。结果1 731例患者中AR的发生率3.58%（62/1 731）,ASR的发生率20.34%（352/1 731）。与AS相比,AR＋ASR中以女性、高龄、高脂血症患者较多,吸烟者较少。而且AS患者的血小板计数偏高,总胆固醇水平偏低。Logistic回归分析表明,女性[相对比值比（OR）=1.377,95%可信区间（CI）1.084～1.751,P=0.009〗、老年（OR=1.504,95%CI1.005～2.253,P=0.047）、总胆固醇（TCHO）（OR=1.249,95%CI1.114～1.401,P=0.000）升高是发生AR与ASR的危险因素。结论服用阿司匹林的冠心病患者中AR发生率为3.58%,ASR发生率为20.34%。发生AR与ASR危险因素有女性、高龄、高血脂。     

阿托伐他汀及阿司匹林对冠心病患者C-反应蛋白的影响

目的 探讨阿托伐他汀及阿司匹林时冠心病患者C-反应蛋白的影响。方法观察109例冠心病患者的C-反应蛋白在用药前后的变化。其中阿托伐他汀组37例，阿司匹林组29例，阿托伐他汀和阿司匹林联用组43例。结果3组患抒用药前后C-反应蛋白的改变差异均有统计学意义（P〈O.05），而阿托伐他汀及阿司匹林联用组用药后C-反应蛋白的浓度与另两组用药后C-反应蛋白的浓度比较差异办有统计学意义（P〈O.01）。结论阿托伐他汀和阿司匹林联刚对C-反应蛋白的降低优于单一的阿托伐他汀或阿司匹林。     

Aspirin resistance and adverse clinical events in patients with coronary artery disease

Purpose

We sought to determine the clinical significance of aspirin resistance measured by a point-of-care assay in stable patients with coronary artery disease (CAD).

Methods

We used the VerifyNow Aspirin (Accumetrics Inc, San Diego, Calif) to determine aspirin responsiveness of 468 stable CAD patients on aspirin 80 to 325 mg daily for ≥4 weeks. Aspirin resistance was defined as an Aspirin Reaction Unit ≥550. The primary outcome was the composite of cardiovascular death, myocardial infarction (MI), unstable angina requiring hospitalization, stroke, and transient ischemic attack.

Results

Aspirin resistance was noted in 128 (27.4%) patients. After a mean follow-up of 379 ± 200 days, patients with aspirin resistance were at increased risk of the composite outcome compared to patients who were aspirin-sensitive (15.6% vs 5.3%, hazard ratio [HR] 3.12, 95% confidence intervals [CI], 1.65-5.91, P < .001). Cox proportional hazard regression modeling identified aspirin resistance, diabetes, prior MI, and a low hemoglobin to be independently associated with major adverse long-term outcomes (HR for aspirin resistance 2.46, 95% CI, 1.27-4.76, P = .007).

Conclusions

Aspirin resistance, defined by an aggregation-based rapid platelet function assay, is associated with an increased risk of adverse clinical outcomes in stable patients with CAD.     

联合治疗对冠脉综合征患者阿司匹林抵抗的疗效

目的：探讨联合治疗对冠脉综合征（ACS）患者阿司匹林抵抗（AR）的疗效。方法：168例有AR的ACS患者随机被分为三组：一组为对照组（阿司匹林剂量维持不变），一组为阿斯匹林加量组，一组为联合治疗组（在阿司匹林基础上加服双嘧达莫）。于入院时及两周后分别检查血小板聚集率、尿11-脱氢-血栓素（11-DH—TxB2）等项指标。结果：上述三组于入院当日上述两项指标，均高于正常值。至二周后阿斯匹林加量组有下降趋势．但无显著性差异（P〉0．05）；联合治疗组上述两项指标均明显下降，与对照组相比有显著差异（P〈0．05）。结论：在阿司匹林的基础上联合双嘧达莫，能更有效地降低急性冠脉综合征患者的阿司匹林抵抗。     

冠心病患者C反应蛋白的临床意义及阿司匹林的影响

目的 :探讨 C反应蛋白 (CRP)与冠心病 (CHD)的关系及阿司匹林对其的影响。方法 :观察 6 9例冠状动脉单支狭窄 >6 0 %的 CHD患者 ,35例正常对照者及 31例病例对照者的 CRP浓度及不同剂量的阿司匹林对CRP浓度的影响 ,及 CRP浓度的高低与冠状动脉狭窄程度的关系。结果 :CHD患者的 CRP浓度较正常对照组显著增高 (P <0 .0 5 ) ,大剂量的阿司匹林可降低 CHD患者的 CRP浓度 (P <0 .0 5 ) ,CRP浓度与冠状动脉狭窄程度正相关 (r =0 .5 3,P <0 .0 5 )。结论 :CRP浓度可作为评价冠状动脉病变严重程度的一个参考指标     

阿司匹林和西洛他唑对冠心病合并糖尿病患者血小板聚集活性的影响

目的:探讨阿司匹林对冠心病合并糖尿病患者血小板聚集活性的影响;西洛他唑对血小板聚集活性作用是否有类似改变。方法:入选的冠心病患者中合并与合并2型糖尿病患者各45例。根据其口服药物又分为阿司匹林组、西洛他唑组和联合用药组,每组各15例。记录患者基本情况并测定血小板聚集活性、血浆血栓素(TX)B2、6-K-前列腺素(PG)F1a和髓过氧化物酶(MPO)水平,并进行统计分析。结果:(1)多元逐步回归分析显示血糖是影响血小板聚集的独立因素(R=0.914,P<0.01);(2)方差分析显示糖尿病患者血小板聚集活性、血浆TXB2、MPO水平较非糖尿病患者明显增高,6-K-PGF1a水平降低(P<0.001);(3)非糖尿病患者阿司匹林组和西洛他唑组血小板聚集活性和TXB2没有明显差异,西洛他唑组血浆6-K-PGF1a水平高于阿司匹林组,而MPO水平低于阿司匹林组(P<0.001);糖尿病患者西洛他唑组血小板聚集活性、TXB2和MPO水平低于阿司匹林组,而6-K-PGF1a水平高于阿司匹林组(P<0.05~0.001)。结论:对冠心病合并糖尿病患者西洛他唑较阿司匹林可以更有效地抑制血小板聚集。     

Incidence and predictors of upper gastrointestinal bleeding in patients receiving low-dose aspirin for secondary prevention of cardiovascular events in patients with coronary artery disease

AIM: The use of low-dose aspirin to prevent cardiovascular disease events is well established. However, the incidence and predictors of upper gastrointestinal bleeding (UGIB) with its use are unknown. We studied prospectively the incidence and outcome of peptic ulceration in low-dose aspirin users. METHODS: A total of 991 patients with coronary artery disease (CAD) on low-dose aspirin were prospectively followed-up for two years for the occurrence and clinical features of first hospitalized episode of UGIB. RESULTS: UGIB had a bimodal presentation with 45% occurring within four months of aspirin initiation and had an overall prevalence of 1.5% per year. There was no UGIB-related death. Hypertension (OR = 4.6, 95%CI 1.5 - 14.7, P = 0.009), history of peptic ulceration (OR = 3.1, 95%CI 1.1 - 9.0, P = 0.039), tertiary education (OR = 3.08, 95%CI 1.1 - 9.0, P = 0.039) and higher lean body mass (P = 0.016) were independent factors associated with UGIB. Use of nitrate did not reduce UGIB. CONCLUSION: The incidence of UGIB in patients with CAD on long-term low-dose aspirin is low, but is accompanied with significant morbidity. With prolonged use of aspirin, UGIB continues to be a problem for those with risk factors and especially in patients with a history of peptic ulcers, in which UGIB tends to occur early after aspirin therapy.     

Determinants of aspirin resistance in patients with type 2 diabetes

BackgroundCardiovascular disease is a leading cause of mortality among patients with type 2 diabetes mellitus (T2DM). Numerous patients with T2DM show resistance to aspirin treatment, which may explain the higher rate of major adverse cardiovascular events observed compared with non-diabetes patients, and it has recently been shown that aspirin resistance is mainly related to accelerated platelet turnover with persistent high platelet reactivity (HPR) 24 h after last aspirin intake. The mechanism behind HPR is unknown. The aim of this study was to investigate the precise rate and mechanisms associated with HPR in a population of T2DM patients treated with aspirin.MethodsIncluded were 116 consecutive stable T2DM patients who had attended our hospital for their yearly check-up. HPR was assessed 24 h after aspirin intake using light transmission aggregometry (LTA) with arachidonic acid (AA) and serum thromboxane B2 (TXB2) measurement. Its relationship with diabetes status, insulin resistance, inflammatory markers and coronary artery disease (CAD) severity, using calcium scores, were investigated.ResultsUsing LTA, HPR was found in 27 (23%) patients. There was no significant difference in mean age, gender ratio or cardiovascular risk factors in patients with or without HPR. HPR was significantly related to duration of diabetes and higher fasting glucose levels (but not consistently with HbA_1c), and strongly related to all markers of insulin resistance, especially waist circumference, HOMA-IR, QUICKI and leptin. There was no association between HPR and thrombopoietin or inflammatory markers (IL-6, IL-10, indoleamine 2,3-dioxygenase activity, TNF-α, C-reactive protein), whereas HPR was associated with more severe CAD. Similar results were found with TXB2.ConclusionOur results reveal that ‘aspirin resistance’ is frequently found in T2DM, and is strongly related to insulin resistance and severity of CAD, but weakly related to HbA_1c and not at all to inflammatory parameters. This may help to identify those T2DM patients who might benefit from alternative antiplatelet treatments such as twice-daily aspirin and thienopyridines.     

不同剂量阿司匹林对冠心病患者胃黏膜损伤的临床研究

目的了解不同剂量阿司匹林对冠心病患者胃黏膜的损伤。方法对每日服用肠溶阿司匹林５０ｍｇ（２６例）、１５０ｍｇ（３０例）和３００ｍｇ（３０例）冠心病患者，观察了服药前和服药７天后临床症状、大便潜血试验、胃镜下胃黏膜表现及胃黏膜病理学变化，采用放免法测定了胃液前列腺素Ｅ２（ＰＧＥ２）和血浆血栓素Ｂ２（ＴＸＢ２）水平。结果阿司匹林每日３００ｍｇ剂量组治疗后，胃镜下胃黏膜病变程度及胃黏膜病理学指标均显著高于另两组（Ｐ值均＜０．０１），而胃液ＰＧＥ２水平较另两组显著降低（Ｐ值均＜０．００１），另两组之间差异无显著性。结论冠心病患者每日服用阿司匹林１５０ｍｇ既能显著降低血浆ＴＸＢ２水平，对胃黏膜近期又无明显损伤。     

老年2型糖尿病合并冠心病患者阿司匹林抵抗的危险因素分析

目的 研究老年T2DM合并冠心病患者对阿司匹林的反应性及其危险因素. 方法 选择我院老年科住院的T2DM合并冠心病患者147例,根据血栓弹力图（TEG）结果将其分为阿司匹林抵抗组（AR,抑制率≤50％）和阿司匹林非抵抗组（N-AR）,并分析两组临床数据. 结果 AR组30例,N-AR组117例.AR发生率为20％.AR组同型半胱氨酸（Hcy）、FPG、TG、LDL-C及HbA1c分别为（16.43±4.77）mmol/L,（7.73±0.16）mmol/L,（1.70±0.60） mmol/L,（2.60±0.55） mmol/L,（7.79±0.58）％,均明显高于N-AR组,而视黄醇结合蛋白（RBP）为（34.17±9.30） mmol/L,低于NAR组（P＜0.05）.Logistic回归分析结果显示,FPG、TC、LDL-C和Hcy是AR的影响因素,使患者AR的危险性分别提高1.9倍,0.1倍,13.1倍和1.1倍.血糖不达标者、糖尿病病程较长者AR发生率增高（P＜0.05）.结论 T2DM合并冠心病患者存在一定的AR现象,有效地控制血糖,减低血脂,降低Hcy,可降低AR发生率.     

阿司匹林静脉给药在急性冠状动脉综合征中的可行性研究

目的 比较静脉与口服阿司匹林给药在急性冠状动脉综合征(ACS)急性期治疗的临床效果,观察静脉阿司匹林的不良反应及6个月临床事件.方法 符合诊断标准如不稳定性心绞痛或急性心肌梗死的患者99例,入院前均服用口服阿司匹林100 mg/d至少1周以上.采用随机前瞻性对照研究,按随机区组设计方法将符合入选标准的患者随机分到三组,排除自动转院及失访者,最后静脉(300 mg/d)组30例,口服(100 mg/d)组32例、口服(300 mg/d)组33例.对照组20例为无器质性心脏病及血液病从未服用过阿司匹林及氯吡格雷的患者.结果 静脉组二磷酸腺苷(ADP)诱导血小板聚集率降低幅度为(12.0±10.4)%,与口服(100 mg/d)组的(6.0±14.6)%及口服(300 mg/d)组的(9.4±16.6)%比较差异无统计学意义;静脉组花生四烯酸(AA)诱导血小板聚集率降低幅度为(6.7±11.2)%,与口服(100 mg/d)组的(6.9±12.3)%及口服(300 mg/d)组的(7.3±13.0)%比较,差异无统计学意义.静脉组CD62p水平降低幅度(10.9±18.6)%,与口服(100 mg/d)组的(9.0±11.8)%及口服(300 mg/d)组的(7.1±15.7)%比较差异无统计学意义.6个月随访结果:静脉组出现临床终点事件3例(10.0%),口服(100 mg/d)组和口服(300 mg/d)组分别为3例(9.4%)和4例(12.1%),三组比较差异无统计学意义.结论 阿司匹林静脉(300 mg/d)与口服(100 mg/d,300 mg/d)途径在ACS急性期1周应用对ADP、AA诱导的血小板聚集率及血小板CD62p水平降低幅度的影响无明显差异.静脉用药可减少消化道黏膜的直接刺激,能够替代不能口服阿司匹林的ACS患者的抗血小板治疗.     

阿司匹林在冠心病二级预防中的应用现况

目的 了解中国多省市冠心病患者阿司匹林应用现况.方法 以2781例既往曾确诊患有冠心病的门诊患者为研究对象.2006年在中国内地31个省市自治区选择32家三级医院和32家二级医院,每家医院以研究启动时点起连续选择既往曾确诊冠心病的门诊患者50例.采用访谈形式收集患者信息,填写统一表格.主要分析患者阿司匹林的应用及医生处方情况.结果 (1)在2781例门诊冠心病患者中,男性1914例,女性867例,年龄(65±10)岁;(2)门诊冠心病患者阿司匹林的服用率为83.6%,男性(85.1%)高于女性(80.4%,P<0.01),随着年龄的增加,阿司匹林的服用率呈下降趋势(P<0.05),不同省市协作医院间阿司匹林的服用率存在差异(P<0.01),其中贵州省患者阿司匹林的服用率最低(64.2%),浙江省最高(97.8%);(3)门诊冠心病患者阿司匹林的处方率为90.4%,总计93.0%的医生处方剂量符合<阿司匹林在动脉硬化性心血管疾病中临床应用:中国专家共识(2005)>中建议使用的剂量(75～150 mg/d),不同省市协作医院医生处方剂量存在差异,个别医院1/3的处方剂量低于75 mg/d;(4)女性、高龄、月收入低、既往无经皮冠状动脉介入治疗史及冠心病病程长的门诊冠心病患者,阿司匹林的服用率低.结论 我国内地门诊冠心病患者阿司匹林的总服用率为83.6%,但31个省市、64家医院间差异较大;各医院医生阿司匹林处方剂量间也存在很大差异,应在冠心病二级预防中引起足够重视.     

不同剂量阿司匹林对冠心病患者C反应蛋白的影响

目的探讨不同剂量阿司匹林(ASP)对冠心病(CHD)患者血浆C反应蛋白(CRP)的影响。方法120例CHD患者根据ASP用量随机分为50mg、100mg、300mgASP治疗组。观察在ASP治疗后1周、2周、4周及12周CRP浓度的变化。结果CHD患者血浆CRP水平明显增高,与正常对照组相比,差异有统计学意义(P<0.01)。ASP100和300mg组用药2周和1周后,CRP浓度有明显下降,与治疗前相比,差异有统计学意义(P<0.01,P<0.05)。结论ASP可显著降低CHD患者血浆CRP含量。     

心血管病患者中的阿司匹林抵抗

目的　前瞻性地评价心血管病患者发生阿司匹林抵抗 (AR)的流行病学概况 ,并探讨其预测因子。方法　 35 2例病情稳定的心血管病住院患者 ,每日服用阿司匹林 10 0mg ,连服 7天 ,服用最后一剂后 2 4h内抽取的空腹静脉血为血样 ,分别用二磷酸腺苷 (ADP)、花生四烯酸 (AA)诱导血小板凝集试验 (PAgT) ,检测血小板聚集率。结果　患者中AR发生率为 3.98% ,阿司匹林半敏感 (ASR)者占 2 5 .9% ,且AR或ASR患者中的女性较AS者多(35 .2 %vs 18.2 % ,P =0 .0 0 1) ,而AS者中吸烟者较AR或ASR者多 (0 %vs 9.5 % ,P =0 .0 0 2 )。结论　阿司匹林用于抗血小板治疗及预防动脉硬化事件的心血管病患者 ,若有AR存在可选择其他安全有效的抗血小板制剂长期服用 ,预测AR及抗血小板治疗个体化 ,将是抗血小板治疗未来的方向     

不同剂量阿司匹林对冠心病患者血清C－反应蛋白水平的影响

目的探讨不同剂量阿司匹林对冠心病患者血清C－反应蛋白水平的影响。 方法选取2017年1月至2018年3月青岛市城阳区人民医院收治的120例冠心病患者作为观察组,将所有患者按随机数表法分为甲组、乙组、丙组,各40例,选取40例同期健康体检者作为对照组。甲、乙、丙组患者均接受阿司匹林口服治疗,甲组用药剂量为50 mg/d,乙组用药剂量为150 mg/d,丙组用药剂量为300 mg/d,用药时长为1个月。对比治疗前后各组对象血清C－反应蛋白水平。 结果观察组冠心病患者血清C－反应蛋白水平均为(4.75±0.18)mg/L,对照组健康体检者血清C－反应蛋白水平为(2.82±1.09)mg/L。观察组血清C－反应蛋白水平高于对照组,差异有统计学意义(P<0.05)。治疗前,甲、乙、丙3组患者血清C－反应蛋白水平差异无统计学意义(P>0.05)。甲、乙两组患者治疗后血清C－反应蛋白水平与治疗前比较,差异无统计学意义(P>0.05),丙组患者治疗后C－反应蛋白水平低于治疗前(P<0.05),且低于甲、乙两组治疗后水平(P<0.05)。 结论冠心病患者血清C－反应蛋白水平高于健康人群,大剂量(300 mg/d)阿司匹林能够能够有效降低C－反应蛋白水平。     

Thrombopoietin and platelet aggregation in patients with stable coronary artery disease

Thrombopoietin (TPO) may facilitate platelet activation and aggregation. However, data on the impact of TPO on platelet aggregation in patients with stable coronary artery disease (CAD) are scarce. We aimed to investigate associations between TPO and platelet aggregation and activation in patients with stable coronary artery disease (CAD). We studied 900 stable CAD patients. Serum TPO was assessed by ELISA. Platelet aggregation was evaluated using the Multiplate Analyzer (agonists: arachidonic acid [AA] and collagen) and the VerifyNow Aspirin Assay. Platelet activation was evaluated by soluble (s)P-selectin. Cyclooxygenase-1 inhibition was evaluated by serum thromboxane B₂ (TXB₂). We found that TPO correlated weakly with platelet aggregation evaluated by Multiplate using AA (r = ?0.09, p = 0.01) and collagen as agonists (r = ?0.03, p = 0.43) and by VerifyNow (r = 0.07, p = 0.03). We found no correlation between TPO and sP-selectin (r = ?0.01, p = 0.70). Independent predictors of AA-induced platelet aggregation by Multiplate included high levels of sP-selectin and serum TXB₂, high platelet count, increasing age and body mass index, female sex, and active smoking. Independent predictors of TPO included low AA-induced platelet aggregation by Multiplate, high levels of hs-CRP, active smoking, and high platelet aggregation evaluated by VerifyNow. In conclusion, TPO levels did not correlate with platelet activation and only weak associations were found between TPO and platelet aggregation, suggesting that TPO did not substantially facilitate platelet aggregation in stable CAD patients.