Pulmonary Hypertension Clinical Trial
Official title:
Platelet Reactivity and Treatment With Prostacyclin Analogues in Pulmonary Arterial Hypertension
Background: Prostacyclin analogues (epoprostenol, treprostinil and iloprost) induce
vasodilation in advanced pulmonary arterial hypertension (PAH) but also inhibit platelets,
increasing patients' bleeding risk. The antiplatelet effects of different prostacyclin
analogues have never been compared head-to-head. The goal of the PAPAYA (Platelet Reactivity
and Treatment With Prostacyclin Analogues in Pulmonary Arterial Hypertension) trial is(i) to
compare platelet function (platelet reactivity, extracellular vesicles concentration and
thrombus formation) in patients with PAH treated with prostacyclin analogues on top of
endothelin receptor antagonists (ERA) and/or phosphodiesterase type 5 inhibitors (PDE5i) and
patients treated only with ERA and PDE5i, and (ii) to compare the antiplatelet effect of
different prostacyclin analogues.
Venous blood will be collected from patients treated with prostacyclin analogues (study
group; n=40) and patients treated with ERA or PDE5i (control group; n=40). Platelet
reactivity will be analysed in whole blood by impedance aggregometry using arachidonic acid,
adenosine diphosphate and thrombin receptor-activating peptide as agonists. Concentrations of
extracellular vesicles from all platelets (CD61+), activated platelets (CD62P+), leukocytes
(CD45+) and endothelial cells (CD146+) will be analysed in platelet-depleted plasma using
flow cytometry (A-60 Micro). Platelet-rich thrombus formation will be measured using whole
blood perfusion system. The study will determine the antiplatelet effect of prostacyclin
analogues and compare different prostacyclin analogues head-to-head to identify the best
drugs to use in case of thrombosis or bleeding.
n/a
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