Ovrakh T. Prognostic significance of the platelets reactivity in patients with ischemic heart disease and type 2 diabetes mellitus in the dynamics of therapy

The Dissertation is dedicated to improving the effectiveness of treatment and prediction of secondary cardiovascular events in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (DM) after acute coronary syndrome (ACS) on the basis of morph functional properties of platelets study in the dynamics of dual antiplatelet therapy (DAT). The conducted research shows more intensive accelerated circulation of platelets, high activity of adenosine diphosphate (ADP) - and arachidonic acid (AA) - induced platelet aggregation, increased levels of circulating immature platelets and thromboxane synthesis in diabetic patients with CAD 4-6 weeks after ACS. In the study the importance of metabolic factors in the activation of platelet hemostasis in patients with type 2 DM after ACS was demonstrated and the more intensive influence of hyperglycemia, insulin resistance and dyslipidemia on platelet hemostasis comparing with the stable types of CAD was found. Hypercholesterolemia, hyperglycemia and insulin resistance in the case of controlled glycaemia lead to increased circulation of platelets. Disorders of carbohydrate and lipid metabolism also impact on platelet aggregation properties: hyperglycemia and increased insulin resistance contribute to increased AA - induced platelet aggregation and thromboxane synthesis. The increase of LDL cholesterol level is associated only with the growth of AA-induced platelet aggregation and the HDL cholesterol reduction is accompanied by an increase of thromboxane synthesis alone. It has been proved that metabolic factors don't influence on ADP- induced platelet aggregation in patients with type 2 DM after ACS. The obtained results of the residual platelet reactivity (RPR) assessment in patients with type 2 DM after ACS in the dynamics of DAT demonstrate a high RPR on acetylsalicylic acid and clopidogrel use as monotherapy or in combination. The advantages of atorvastatin over rosuvastatin in the first 4-6 weeks after ACS using DAT on the basis of RTR ADP and the prevalence of high RTR-ADP have been demonstrated in this paper. It was shown that the replacement of one statin to another six months after ACS in diabetic patients with CAD taking clopidogrel within 12 months prevents RTR increase. It was shown that 4-6 weeks after ACS the level of cystatin C is elevated and interrelated with the morphofunctional properties of platelets in patients with type 2 DM. It has been proven that the platelet count, the MPV, maximum platelet aggregation (MPA)-ADP, MPA-AA, 11 dТхВ2 in urine and cystatin C are independent high risk predictors of secondary cardiovascular events in patients with type 2 diabetes after ACS, and the increase throughout the first 6 to 8 weeks after ACS platelet count ? 274?109 / l, MPV ? 8.1 fL, MPA-ADP ? 60.71 %, MPA-AA ? 15.13 %, levels 11 dTxB2 in urine ? 79.70 ng/mmol creatinine and cystatin С more than 1942.62 ng/ml was associated with an increase in the development of cardiovascular events reoccurrence within 12 months in 7.09 times, 9.26 times, 3.10 times, 6.43 times, 3.44 times and 3, 78 times, respectively.