New Research Suggests Platelet 'Stickiness' May be the Single Most Important Risk Factor in Patients Treated with Coronary Stents

BALTIMORE, Jan. 27 /PRNewswire/ -- Most Americans know their cholesterol level, but do they know how "sticky" their platelets are? Research findings from Dr. Paul A. Gurbel, an interventional cardiologist and Director of the Sinai Center for Thrombosis Research based at Sinai Hospital of Baltimore, indicate that platelet aggregation or "stickiness" may be the single largest factor in determining the likelihood of developing serious complications, including heart attack, in patients treated with coronary artery stents.

"We currently measure the cholesterol level in everyone with vascular disease, yet the pivotal event that kills the patient - platelet aggregation isn't being assessed in any way," said Dr. Gurbel.

Dr. Gurbel's findings may explain why someone with no cardiac history could die suddenly of a massive heart attack, while an individual with high blood pressure, high cholesterol and plaque-filled arteries may never have a cardiac event because they had low platelet aggregation.

Along with his team at Sinai, Dr. Gurbel demonstrated that patients with platelets most prone to aggregate had the highest prevalence of complications, including heart attack, after coronary artery stenting.

Their work is helping to revolutionize the testing and treatment of patients with coronary artery disease, offering further evidence that a more personalized approach to anti-platelet therapy needs to be established.

Dr. Gurbel was one of the first researchers in the world to discover that up to 30 percent of patients taking clopidogrel, a drug designed to decrease platelet aggregation, do not respond to treatment.

"Of the millions of cardiac patients treated with clopidogrel, a significant percentage are non-responsive and remain at high risk for a major cardiac event," said Dr. Gurbel. "The platelet aggregation of each patient needs to be precisely measured to determine how well the drug is working. The blind administration of anti-platelet drugs without confirming a good response, in our opinion, will soon be reaching an end."

Click here for a recent story on Dr. Gurbel's research - http://www.wbaltv.com/video/17929792/index.html

Thrombosis Research at Sinai Hospital

Researchers at Sinai Hospital of Baltimore are studying a very small part of the human body with a very big impact.

The Center for Thrombosis Research, part of the Heart Center at Sinai, is conducting groundbreaking research in the area of platelet aggregation, or stickiness. The clumping together of platelets, also referred to as aggregation, is the main reason blood clots develop, causing heart attacks, strokes and the blocking of new coronary artery stents.

Currently, aspirin and PLAVIX are the two major, approved conventional
medications to prevent blood clot formation in people who have coronary artery disease. The Sinai Center for Thrombosis Research, led by Paul A. Gurbel, M.D., questions why some patients continue to form deadly blood clots despite being on these conventional medications. Gurbel, also a member of Hagerstown Heart with a practice at the Heart Center at Sinai, is the hospital’s busiest interventional cardiologist.

In the most recent study performed at the Center for Thrombosis Research, Gurbel and his team found that current aspirin therapy successfully blocks its target at all dosage levels, including 81 mg, 162 mg and 325 mg, in patients with a history of heart disease. The research also showed that aspirin might be just as effective at a lower dose as it is at the maximum dosage in some patients.

As well as studying the effects of aspirin, Gurbel has been leading research on PLAVIX, a commonly prescribed anti-clotting medication. After significant research, Gurbel uncovered that PLAVIX does not work the same in all patients. In fact, up to 30 percent were non-responsive to the standard dose of the drug.

In recent investigations, Gurbel established that patients who did not respond to PLAVIX optimally, frequently had an adverse outcome. In this landmark study, Gurbel and his team clearly demonstrated that high platelet aggregation and less response to PLAVIX after coronary stenting are associated with poor outcomes.

“We are now conducting further research to better understand additional reasons why these deadly blood clots form in some patients, in an effort to continue to improve patient outcomes,”
says Gurbel.

The groundbreaking research being conducted at the Sinai Center for Thrombosis Research may change the current dosing strategy for aspirin and PLAVIX and has had far-reaching effects for patients being treated with coronary stents worldwide. The American Heart Association and the American College of Cardiology have altered some of their practice guidelines as a result of the center’s research findings.

Currently, investigators at the Center for Thrombosis Research are recruiting patients with stable coronary artery disease to measure their platelet reactivity and response to conventional medications, such as aspirin and PLAVIX. Patients who have a poor response to these medications may be asked to participate in studies investigating new anti-clotting medications.

The Center’s research will strongly influence the way doctors treat cardiovascular disease in the future and will likely mandate the universal measurement of the degree of platelet stickiness to ensure that the drugs given are actually doing their job.

For more information about the Center for Thrombosis Research and the Heart Center at Sinai, please call 410-601-WELL (9355).

Straight to the Heart - Sinai’s Heart Center Offers Comprehensive Care

It pays to know your numbers. To take a free online heart risk assessment and enter a drawing to receive one of 500 free Omron pedometers*, visit KnowYourNumbersBaltimore.com.

*While supplies last.



The Heart Center at Sinai Hospital is one of the most comprehensive cardiac care centers in the region. Using advanced heart care methods and an Emergency Chest Pain Evaluation Unit located in Sinai ER-7, physicians diagnose and begin treatment at the earliest possible moment.

The Cardiac Catheterization Laboratory at Sinai is a fully digital system that provides the utmost on heart visualization. The full-service facility offers patients the advantage of diagnostic testing, coronary stent placement and recovery in one convenient setting. An ultra modern and expanded cardiac catheterization laboratory with 24 preparatory and recovery beds opened last year.

The Schapiro Cardiac Diagnostic Center merges the latest in medical technology and patient comfort. Sinai is the first hospital in the greater Baltimore area to offer a flat-panel, biplane X-ray machine. This revolutionary technology takes simultaneous images of the heart at two different angles, providing physicians and technicians with crisper, cleaner and fully digital images of a patient’s arteries and veins.

The Heart Center at Sinai excels in the field of cardiac surgery. The most skilled heart surgeons perform bypass procedures and valve surgery in state-of-the-art operating rooms. A recovery area with 10 coronary care beds, a 35-bed progressive care unit, and 14 post-cardiac surgery step-down beds further enhances patient care.

The Heart Center at Sinai treats patients and patients’ family’s needs with compassion and understanding. Through its Tender Touch program, all Heart Center patients receive special services to make their hospital stay as comfortable and stress free as possible.

Patients at the Heart Center at Sinai also may be referred to the new LifeBridge Health Cardiac Rehabilitation Program, which is designed to help improve cardiovascular well-being. Cardiologists, cardiac rehabilitation specialists, nutritionists, exercise physiologists and behavioral psychologists help patients maintain a healthy heart.

Advancing heart surgery
Recent technological advances have made it possible for heart surgeons at Sinai to perform heart valve procedures without fully dividing the breastbone (“sternotomy”). Mitral valve procedures are especially well suited for less invasive techniques, in which the operation is performed without stopping the heart from beating.

Minimally invasive surgery is shorter, leaves smaller scars and reduces the trauma and pain associated with conventional open-chest surgery. A patient’s recovery time is greatly reduced, as are the amount of blood loss, the likely need for blood transfusions and the risk of developing infections. Patients who undergo minimally invasive surgery often heal faster and are able to resume normal activities sooner.

Cardiovascular research
Cardiovascular research conducted at Sinai Hospital has benefited the lives of countless patients. Physician pioneers at Sinai developed the first implantable cardioverter-defibrillator, a life-saving device now used to treat patients around the world.

Sinai’s commitment to cardiovascular research is ongoing in the Center for Thrombosis Research. Under the direction of Paul A. Gurbel, M.D., a team investigating blood clot formation – the major cause of heart attack and stroke – is changing the way doctors treat patients with heart disease.

For more information about the Heart Center at Sinai, call 410-601-WELL (9355).