Platelet Activation Determined by Flow Cytometry Persists Despite Antithrombotic Therapy in Patients with Unstable Angina and Non-Q-Wave Myocardial Infarction.

Background: Current strategies in the treatment of patients with acute coronary syndromes include antiplatelet agents and thrombin antagonists, most commonly aspirin and heparin, respectively. Cardiac events, however, occur despite what is considered to be maximal medical treatment. Methods: We determined the percentage of activated platelets in whole blood samples taken from 22 patients with unstable angina and non-Q-wave myocardial infarection participating in the TIMI III B trial. Platelet activation was assessed using a monoclonal antibody to the surface-expressed alpha-granule protein, P-selectin, and flow cytometry. All patients received a full complement of antiischemic medications as well as intravenous heparin and oral aspirin, and were then randomized to tissue plasminogen activator or placebo. Results: Platelet activation prior to randomization was increased threefold to fourfold compared with healthy volunteers (11.4 +/- 11.4% vs. 2.0%; p < 0.01). Serial measurements performed 12, 24, 48, and 96 hours after treatment initiation revealed that platelet activation persisted. No differences in patients experiencing recurrent ischomic events (n = 9) or those randomized to a 90-minute, accelerated infusion of tissue plasminogen activator (n = 12) were observed. Conclusions: A modest degree of platelet activation is seen for at least 96 hours and possibly longer in patients with unstable angina and non-Q-wave myocardial infarction, despite being treated with intravenous heparin and oral aspirin. These findings support current efforts to identify more potent and selective antithrombotic treatment strategies.