Zaprovalna O. Antiplatelet therapy in patients with ischemic heart disease: pathogenetic aspects, risks and diagnostic-therapeutic strategy.

A new solution of the modern cardiology problem is presented in the thesis: a strategy to predict the risk of unfavorable outcomes of ischemic heart disease is developed and new approaches are proposed to select the most effective and safe antiplatelet therapy regime in stable forms of ischemic heart disease on the basis of the study of the relationship between the features of the disease and the parameters of atherothrombotic complications morphofunctional characteristics of platelets functional state and their morphology, clinical and demographic, metabolic and genetic factors). The influence of such pathogenetic factors of ischemic heart disease (dyslipidemia, endothelial dysfunction, immune activating activity, oxidative stress) on the morphofunctional characteristics of platelets during prolonged intake of acetylsalicylic acid has been investigated. The relation between metabolic disturbances and variability of the response to acetylsalicylic acid was determined and the new scheme to use antiplatelet drugs in case of ischemic heart disease in combination with type 2 diabetes mellitus has been developed. It was fond that that high platelet activation is observed in patients with ischemic heart disease and high weight and/or abdominal obesity, regardless of the presence of diabetes and is associated with a high risk of adverse cardiovascular events. The influence of polymorphisms of the gene of cycloxygenase-1 C50T PTGS1 and platelet genes: T1565C of the platelet receptor gene ITGB3, T924C of the thromboxane receptor TBXA2R, C807T of the glycoprotein Ia strain ITGA2 on the outcomes of ischemic heart disease and its correlation with the morphofunctional characteristics of the platelets. The thesis represents the new personalised approach to the prescription of antiplatelet therapy based on cardiovascular risk factors is proposed.