In vitro-inhibition of shear-induced platelet aggregation by verapamil

1 ＩｎｔｒｏｄｕｃｔｉｏｎＲｅｃｅｎｔｅｖｉｄｅｎｃｅｓｕｇｇｅｓｔｓｔｈａｔｓｈｅａｒｉｎｄｕｃｅｄｐｌａｔｅｌｅｔａｇｇｒｅｇａｔｉｏｎ (ＳＩＰＡ)ｉｓａｎｉｍｍｐｏｒｔａｎｔｍｅｃｈａｎｉｓｍｏｆｔｈｒｏｍｂｏｓｉｓａｔａｒｔｅｒｉａｌｓｔｅｎｏｓｉｓ[2 ] .ＯｕｒｐｒｅｖｉｏｕｓｓｔｕｄｙｓｈｏｗｅｄｔｈａｔｓｏｍｅｏｆｔｈｅＣｈｉｎｅｓｅｈｅｒｂａｌｍａｔｅｒｉａｌｓｅｘｈｉｂｉｔｅｄｉｎｈｉｂｉｔｉｏｎｔｏＳＩＰＡ ,ｓｕｃｈａｓｌｉｇｕｓｔｒａｚｉｎｅ[6 ] .Ｏｕｒｓｔｕｄｙａｌｓｏｓｈｏｗｅｄｔｈａｔｌｉｇｕｓｔｒａｚｉｎｅｈａｄｅｆｆｅｃｔｏｆｉｎｈｉｂｉｔｉｎｇｉｎｔｒａｃｅｌｌｕｌａｒｃａｌｃｉｕｍｔｏｐｌａｔｅｌｅｔ[5 ] .Ｔｈｅｒｅｆｏｒｅ ,ｔｏｉｎｖｅｓｔｉｇａｔｅｔｈｅｅｆｆｅｃｔｏｆｖｅｒａｐａｍｉｌ,ａｔｙｐｉｃａｌｃａｌｃｉｕｍａｎｔａｇｏｎｉｓｔ,ｉｓｔｈｅｐｕｒｐｏｓｅｏｆｔｈｉｓｓｔｕｄｙ .2 Ｍａｔｅｒｉａｌｓａｎｄｍｅｔｈｏｄｓ2 1 ＡｎｉｍａｌｓＭａｌｅＮｅｗＺｅａｌａｎｄｒａｂｂｉｔｓｗｅｉｇｈｉｎｇ 2 .0— 2 .5ｋｇｗｅｒｅｓ...

Studies on the Basic Principles for the Processing of Rhizoma Cibotii Part Ⅰ Influence of Rhizoma Cibotii and Its Processed Samples on Thrombin Induced Rabbit Platelet Aggregation

比较研究了狗脊及其不同炮制品对凝血酶诱导的兔血小板聚集作用的影响 ,各炮制品均有抑制血小板聚集作用 ,抗血小板聚集作用砂烫品 >盐制品 >酒蒸品 >单蒸品 >

Inhibitory Effect of β-Elemene Emulsion on Platelet Aggregation and its Mechanism

为阐明β榄香烯的抗血小板作用，本文分别采用比浊法和放免法测定大鼠连续ｉｐ７ｄβ榄香烯乳６．２５～１２．５ｍｇ·ｋｇ－１·ｄ－１后对血小板聚集、血浆ｋｅｔｏＰＧＦ１α和ＴＸＢ２水平的影响。结果表明，本品分别使凝血酶、花生四烯酸和ＡＤＰ诱导血小板最大聚集率下降３８．３％～４２．６％，１４．７％～１９．１％和７．２％～１０．８％，血浆ＴＸＢ２从８８ｎｇ·Ｌ－１下降至７２ｎｇ·Ｌ－１，ｋｅｔｏＰＧＦ１α从１７．５ｎｇ·Ｌ－１增加至２０．９ｎｇ·Ｌ－１。提示ＴＸＢ２降低和ｋｅｔｏＰＧＦ１α值增加是其抑制血小板聚集的作用机制之一。

EFFECTS OF NIMODIPINE ON PLATELET AGGREGATION AND THE ACTIVITY OF ENZYMES IN ARACHIDONIC ACID METABOLISM

The effects of nimodipine on platelet aggregation and arachidonic acid(AA)metabolism were studied in order to explore its effect on patients with thrombosis or cardiovas- cular disease.The results indicate that nimodipine(50-350μmol/L)significantly inhibits platelet aggregation induced by ADP,AA,and ionophore A23187 in a dose dependent manner.The inhibitory effects induced by ionophore A23187 could be partially antagonized by calcium(1 mmol/L).When the substrate was AA and the enzyme was supplied by pig lung microsomes,nimodipine(50-400μmol/L)significantly reduced the generation of TXB_2 and 6-keto-PGF_(1a) in parallel.When the substrate was prostaglandin endoperoxide, however,the levels of TXB_2 and 6-keto-PGF_(1a)were not significantly altered in the same concentration range.The results suggest that nimodipine is a cyclooxygenase inhibitor,and its ability to inhibit platelet aggregation is related to its calcium blocking effect.

Plasma pharmacological study on Da Huang Zhe Chong capsule on platelet aggregation of normal person

Objective To develop a plasma pharmacological method evaluates the effect of Da Huang Zhe Chong capsule on platelet aggregation and its mechanism, which is a representative Traditional Chinese Medicine Patent Prescription Promoting blood circulation by removing blood stasis. Methods Platelets specimens from healthy volunteers made serum and plasma with medicine, while platelet PRP were separated, which were divided into 8groups,i.e. auto-serum, allo-serum, serum with Da Huang Zhe Chong capsule , serum with aspirin, auto-plasma, plasma with Da Huang Zhe Chong capsule, plasma with aspirin, every group added to serum and plasma to hatch. After ADP and adrenalin were added into the specimens and hatched, the effects of specimens on platelet aggregation were observed. Results After ADP adrenalin were added, all the serum groups did not present platelet aggregation,while all the plasma group presented platelet aggregation. P1, P5, Pmax, t and TM have no significant difference (P＞0. 05) between auto-plasma group and allo-plasma group induced by ADP and adrenalin. P1, P5, t and Pmax have significant differences (P＜0. 01) and TM decreased significantly (P＜0. 05) comparing plasma group with Da Huang Zhe Chong capsule and plasma group of aspirin to allo-plasma group. P1, t and Pmax have significant difference (P＜0.05), and P5 and TM are simulate comparing plasma group with Da Huang Zhe Chong capsule to plasma group of aspirin. P1, P5, t and Pmax have significant differences (P＜0. 01), P1, TM have also significant(P＜0. 05), comparing plasma group of Da Huang Zhe Chong capsule with plasma of aspirin to allo-plasma group induced by adrenalin. P1 ,P5 and Pmax have significant differences (P＜0.05), and t and Pmax are simulate comparing plasma group with Da Huang Zhe Chong capsule with plasma group of aspirin. Conclusion The serum pharmacological study is inappropriate to study platelet aggregation in vitro. The plasma pharmacological study is inappropriate to study platelet aggregation in vitro. The plasma pharmacological study could reflect the pharmacological effect produced in vivo. Da Huang Zhe Chong capsule has better anti artery thrombosis effect than aspirin, and it is an ideal medicine for anti artery thrombosis.

Components of traditional Chinese medicine inhibit platelet aggregation by blocking ADP receptor subtypes P2Y1 and P2Y12

Platelets aggregation and thrombosis formation are major reasons of cardiovascular and cerebral vascular diseases.To develop new generative,potent and safe agents for inhibiting platelet aggregation and preventing above diseases are urgently required.Some traditional Chinese medicines of″Houxue Huayu″have been shown to inhibit platelet aggregation potently.In the present study the mechanisms and the molecular targets of puerarin,salvianolic acid B and the analogue of 3-n-butylphthalide,dl-PHPB were investigated and compared with ticlopidine.Four platelet aggregation inducers,ADP,arachidonic acid,collagen and thrombin were used in the study.It was found that puerarin and dl-PHPB specifically inhibited ADP induced platelet aggregation like ticlopidine did.However,salvianolic acid B inhibited both ADP and collagen induced platelet aggregations with similar potency.Due to existing two ADP receptor subtypes on platelets,P2Y1 and P2Y12,we studied the action of above compounds on the receptors and the signaling pathways.It was found that dl-PHPB decreased IP1 accumulation produced by ADP,but had no effect on IP1 level induced by m-3M3 FBS,an activator of PLC.M-3M3 FBS might attenuate the inhibitory effect of dl-PHPB on ADP-induced platelet aggregation.In addition,dl-PHPB did not affect cyclic AMP formation in platelets by ADP,which is different from P2Y12 antagonist ticlopidine.Puerarin showed the similar effects of dl-PHPB.Therefore,the actions of dl-PHPB and puerarin might be through P2Y1receptor-PLC-βpathway.Salvianolic acid B did not reduce the IP1 accumulation stimulated by ADP.It might act on the receptor subtype P2Y12.Our results suggest that components of Chinese herb medicine might be a resource for development of novel anti-platelet drugs.

Synthesis of Novel Ligustrazine Derivatives as Potential Platelet Aggregation Inhibitors

A series of novel ligustrazine derivatives were synthesized. These compounds have not been reported in literature, and their chemical structures were confirmed by IR, ^1H NMR and ESI-MS. The preliminary antiplatelet aggregation screening results demonstrated that the compounds 7a, 7b and 7c showed higher potency than ligustrazine.

A practical synthesis of sarpogrelate hydrochloride and in vitro platelet aggregation inhibitory activities of its analogues

A convenient approach for the preparation of sarpogrelate hydrochloride was developed.Two series of sarpogrelate hydrochloride analogues were designed and synthesized in order to improve their platelet aggregation inhibitory activities, biological tests suggested that these compounds have platelet aggregation inhibitory activities to some extent.

Time-effect and dose-effect of prasugrel hydrobromide acetic acid compound inhibiting platelet aggregation

Aim To evaluate the time-effect and dose-effect of prasugrel hydrobromide acetic acid compound （PHAAC） inhibiting platelet aggregation. Methods For the time-effect study, 190 Sprague-Dawley （SD） rats were devided into 19 groups （n- 10）： the vehicle control group, the PHAAC groups （0.5, 1, 2, 4, 6, 24, 48, 72, 96 h） and the prasugrel hydrochloride groups （0.5, 1, 2, 4, 6, 24, 48, 72, 96 h）. Rats were singly intra- gastic administration of the vehicle, the PHAAC （5 mg·kg^-1） or the prasugrel hydrochloride （5 mg · kg^-1 ）, re- spectively. Blood samples were taken at each time point for the determination of platelet aggregation rate （PAR）. For the dose-effect study, 110 SD rats were devided into 11 groups （n= 10）： the vehicle control group, the PHAAC groups （10, 5, 2.5, 1, 0.5 mg · kg^-1, dosage of prasugrel） and the prasugrel hydrochloride groups （ 10, 5, 2.5, 1, 0.5 mg · kg^-1, dosage of prasugrel） . Blood samples were taken at 4 h after drug administration for the determination of PAR. Results Compared with the vehicle group, PHAAC has significant anti-platelet ag- gregative effects （P 〈 0.05） at the time of 0.5, 1, 2, 4, 6, 24, 48 h, and the effect at the time of 4 h was the strongest. There were no obvious differences between the effect of PHAAC （5 mg · kg^-1） and prasugrel hydrochlo- ride （5 mg · kg^-1） at each time point. Compared with the vehicle group, intragastic administration of PHAAC at the doses of 10, 5, 2.5, 1, 0.5 mg · kg^-1 could obviously inhibite the platelet aggregation, and showed a dose- dependent manner. There were no significant differences between the effect of PHAAC and prasugrel hydrochloride at the same dose. Conclusion PHAAC can inhibit platelet aggregation in a dose-dependent manner, and the effect at 4 h after drug administration is the strongest. The action strength and duration of PHAAC are similar with that of the prasugrel hydrochloride.

Effect of adjuvant therapy with ginkgo-damole on apoptosis, nerve injury and platelet aggregation of patients with acute cerebral infarction

Objective:To investigate the effect of adjuvant therapy with ginkgo-damole on apoptosis, nerve injury and platelet aggregation of patients with acute cerebral infarction. Methods:A total of 74 patients with acute cerebral infarction treated in our hospital from March 2014 to December 2015 were retrospectively analyzed, and they were divided into ginkgo-damole group and conventional treatment group according to a therapeutic schedule that whether ginkgo-diyidamolum were included. At Week 2 and Week 4 after treatment, contents of apoptosis molecule, nerve injury molecule and index of platelet aggregation in serum were detected. Results:At Week 2 after treatment, contents of soluble Fas, soluble Fas ligand, soluble tumor necrosis factor related apoptosis inducing ligand, S100β, neuron specific enolase, glial fibrillary acidic protein, myelin basic protein, malonaldehyde, endothelin-1, fibrinogen and D-dimer in patients' sera of ginkgo-damole group were significantly lower than those of conventional treatment group. Contents of nitric oxide in sera were obviously higher than that of conventional treatment group. At Week 4 after treatment, contents of soluble Fas, soluble Fas ligand, soluble tumor necrosis factor related apoptosis inducing ligand, S100β, neuron specific enolase, glial fibrillary acidic protein, myelin basic protein, malonaldehyde, endothelin-1, fibrinogen and D-dimer in patients' sera of ginkgo-damole group were significantly lower than those of conventional treatment group. Contents of nitric oxide in sera were obviously higher than that of conventional treatment group. Conclusions:Adjuvant therapy with ginkgo-damole can inhibit the apoptosis of neuron cells and neurogliocyte and reduce the neural function injury and the situation of platelet aggregation.

Evaluation of the Effect of Aspirin on Platelet Aggregation: Methodological Recommendations for Aspirin-Drug Interaction Studies

Given the broad application of aspirin as antiplatelet drug, availability of standardized methodology to assess potential interaction with any co-medication on platelet aggregation is desired. We characterized the effect of aspirin (ASA) therapy on collagen-induced platelet aggregation in whole blood to define such methodology. Collagen-induced platelet whole blood aggregation was assessed in 6 healthy male volunteers on 2 occasions (Day 1, Day 7) using the Chronolog aggregometer. From Day 2 up to Day 7, subjects received a daily oral dose of 75 mg ASA. The relationship between collagen dose and platelet aggregation response was assessed. On Day 1, maximal aggregation was observed at 1 μg/mL collagen (15.3 ± 4.6 Ω) and higher. Reproducible results were obtained without any indication of intra-subject fluctuations. ASA treatment decreased maximal aggregation by 80% and 38% at 0.5 and 2.0 μg/mL collagen, respectively. Power calculations were performed based on the observed intra-subject variability and demonstrated minimal sample sizes of 9 - 11 subjects for future cross-over ASA-drug interaction studies exploring effects on platelet aggregation, which demonstrates that the proposed collagen-induced ex vivo whole blood platelet aggregation is a feasible methodology to evaluate ASA-drug interactions in healthy volunteers.

Inhibitory effects and mechanisms of high molecular-weight phlorotannins from Sargassum thunbergii on ADP-induced platelet aggregation

We evaluated the effects of high molecular-weight phlorotannins from Sargassum thunbergii(STP) on ADP-induced platelet aggregation and arachidonic acid(AA) metabolism in New Zealand white rabbits and Wistar rats.The inhibition of STP on platelet aggregation was investigated using a turbidimetric method,and the levels of the terminal products of AA metabolism were measured using the corresponding kits for maleic dialdehyde(MDA),thromboxane B2(TXB2) and 6-keto-prostaglandin F1α(6-keto-PGF1α) by colorimetry and radioimmunoassay,as appropriate.We found that STP could inhibit ADP-induced platelet aggregation,and the inhibitory ratio was 91.50% at the STP concentration of 4.0 mg/mL.Furthermore,STP markedly affected AA metabolism by decreasing the synthesis of MDA(P<0.01) and increasing the synthesis of 6-keto-PGF1α,thus changing the plasma TXB2/6-keto-PGF1α balance when the platelets were activated(P<0.01).Therefore,STP altered AA metabolism and these findings partly revealed the molecular mechanism by which STP inhibits ADP-induced platelet aggregation.

Study on the targets and mechanisms of traditional Chinese medicine in inhibiting platelet aggregation

Platelets aggregation and thrombosis formation are major reasons of cardiovascular and cerebral vascular diseases.To develop novel,effective and safe agents for inhibiting platelet aggregation and preventing above diseases is urgently needed.Some traditional Chinese medicines for“Houxue Huayu”have been shown to inhibit platelet aggregation potently.They are used frequently in China and also in Asian countries.Recently,the major effective components of Pueraria lobata,Salvia miltiorrhiza Bunge,Apium graveolens L.and so on were studied.The mechanisms and the molecular targets of puerarin,salvianolic acid B and the analogue of 3-n-butylphthalide,dl-PHPB were investigated.Four platelet aggregation inducers,ADP,arachidonic acid(AA),collagen(Col)and thrombin,were used in the study.

Effects of procainamide on adenosine diphosphate-induced platelet aggregation and thromboxane B_2 production in rabbits in vitro

Turbidimetry and radioimmunoassay were used to study the effects of procainamide (PA ) onadenosine diphosphate (ADP)-induced rabbit platelet aggregation and thromboxane B2 (TXB2) production invitro. PA 8. 5--544. 0 μmol L-1 inhibited ADP-induced platelet aggregation and TXB2 production, and theinhibition rates were 26. 7% -- 66. 7 % and 21. 4 % -- 70. 1 %, respectively. There was positive correlation between PA concentration and its efficiency in inhibiting the platelet aggregation and TXB2 production, and alsobetween the inhibition rates of platelet aggregation and that of TXB2 production. The three linear equationsand main parameters were The results indicate that PA could significantly inhibit ADP--induced platelet aggregation and TXB2 production in rabbits.

Effects of Berbamine on PAF Production in Human Neutrophils and on Platelet Aggregation

The effects of berbamine, an alkaloid of dibenzylisoquinoline, on PAF produc tion in human neutrophils and on platelet aggregation induced by PAF were studied and compared with those of the calcium antagonist verapamil. Preincubation with berbamine (50 mmol / L, 100 mmol / L) or verapamil (10 mmol / L, 100 mmol / L) was shown to significantly inhibit A 23187 stimulated PAF synthesis. Berbamine and verapamil were found to inhibit platelet aggregation induced by PAF 70 pmol / L in a dose dependent manner. These results suggest that the inhibitory effects of berbamine and verapamil on A 23187 stimulated PAF synthesis in human neutrophils and PAF induced platelet aggregation are possibly brought about by inhibiting cellular calcium influx.

Effect of resveratrol on platelet aggregation in vivo and in vitro

OBJECTIVE: Low or moderate consumption of red wine has a greater benefit than the consumption of other beverages in the prevention of atherosclerosis and coronary heart disease and this is increasingly attributed to the polyphenol compounds in red wine, such as resveratrol. In the present study, we investigated the effect of resveratrol on platelet aggregation in vitro and in vivo. METHODS: Platelet aggregation in rabbits and normal subjects was measured using Born's method. RESULTS: Resveratrol, at 10 - 1000 micromol/L, significantly inhibited platelet aggregation in vitro induced by collagen, thrombin, and ADP in healthy subjects. The inhibitory effect was concentration-dependent. Hypercholesterolemia induced by high-cholesterol diet enhanced ADP-induced platelet aggregation. Resveratrol 4 mg x kg(-1) x d(-1) inhibited ADP-induced platelet aggregation in vivo despite no changes in serum lipid levels. CONCLUSIONS: Resveratrol inhibits platelet aggregation both in vitro and in vivo. This may be one of the mechanisms by which resveratrol prevents atherosclerosis.

Iridoid glycosides extracted from Zhizi(Fructus Gardeniae)decrease collagen-induced platelet aggregation and reduce carotid artery thrombosis in an invivo rat model

OBJECTIVE: To investigate the anti-platelet aggregation and antithrombotic effects in rats of iridoid glycosides extracted from Zhizi (FructusGardeniae). METHODS: The present study evaluated the antithrombotic activity of iridoid glycosides (IGs) in a rat model of carotid artery thrombosis. The effects on coagulation, such as thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT), and the effect on collagen-induced platelet aggregation in vivo were investigated. Rats were intragastrically administered IGs (50, 100 or 200 mg/ kg) twice daily for 3 days. RESULTS: IGs were shown for the first time to have an antithrombotic action through the inhibition of platelet aggregation, with little effect on the coagulation time of peripheral blood. Our results also showed that IGs may significantly and dose-dependently reduce arterial thrombus load in a model of carotid artery thrombosis and inhibit collagen-induced platelet aggregation in rats. IGs (100or 200 mg/kg) had no significant effect on APTT and PT, but did lengthenTT at a higher dose. CONCLUSION: These data, together with the previously reported neuroprotective effects of IGs in rats with cerebral ischemia, suggest that the antithrombotic action of IGs may potentially contribute to the treatment of cerebral ischemic diseases, including cerebral apoplexy.

Correlation study between pre-operative platelet aggregation rate and peri-operative blood product application in patients with off-pump coronary artery bypass grafting

Objective To explore the impact of pre-operative platelet aggregation rate(PAR)on off-pump coronary artery bypass grafting(OPCABG),meanwhile to study the relationship between platelet function and blood product application during peri-operative period in relevant patients.Methods A total of 172 patients receiving OPCABG in our hospita from 2014-01 to 2015-09 were en-

Effect of Aqueous Extracts of Several Kinds of Herbs on Human Platelet Aggregation and Expression of P-Selectin in Vitro

Objective： To study the effect of aqueous extract of several kinds of herbs on human platelet aggregation and expression of P-selectin in vitro. Methods： Blood was collected from volunteers. Effects of the prepared water extracts of herbs on platelet aggregation were monitored on a Packs-4 aggregometer. The fluorescence intensity of water extracts of Caulis Spatholobi, Flos Carthami and Rhizoma Curcumae on the expression of P-selectin in human platelets of healthy persons was measured with flow cytometry. Results： Out of several herbs investigated, Flos Carthami and Rhizoma Curcumae potently inhibited platelet aggregation after incubation with platelet-rich plasma （PRP） for 15 min. Caulis Spatholobi, Flos Carthami and Rhizoma Curcumae inhibited adenosine-5＇-diphosphate （ADP） or platelet activating factor （PAF）-induced platelet aggregation in PRP in a dose-dependent manner. In contrast to Flos Carthami and Rhizoma Curcumae, Caulis Spatholobi could not inhibit thrombin-induced platelet aggregation. Despite its inability to inhibit thrombin-induced platelet aggregation in PRP, Caulis Spatholobi had a greater anti-aggregating activity in PRP induced by ADP or PAF. Caulis Spatholobi and Flos Carthami showed significant inhibitory effects on the expression of P-selectin. Conclusions： Caulis Spatholobi, Flos Carthami and Rhizoma Curcumae have potent anti-platelet properties, and their inhibitory actions are mediated via different mechanisms. Caulis Spatholobi inhibited ADP-induced platelet aggregation but not by thrombin, indicating that its mechanism of action might be independent of the thromboxane pathway. The effect of Caulis Spatholobi and Flos Carthami were associated with suppressing the expression of P-selectin.

Use of tailored loading-dose clopidogrel in patients undergoing selected percutaneous coronary intervention based on adenosine diphosphate-mediated platelet aggregation

Background Adenosine phosphate-mediated platelet aggregation is a prognostic factor for major adverse cardiac events in patients who have undergone selective percutaneous coronary interventions. This study aimed to assess whether an adjusted loading dose of clopidogrel could more effectively inhibit platelet aggregation in patients undergoing selected percutaneous coronary intervention.Methods A total of 205 patients undergoing selected percutaneous coronary intervention were enrolled in this multicenter, prospective, randomized study. Patients receiving domestic clopidogrel （n=104） served as the Talcom （Taijia）group; others （n=101） received Plavix, the Plavix group, Patients received up to 3 additional 300-mg loading doses of clopidogrel to decrease the adenosine phosphate-mediated platelet aggregation index by more than 50% （the primary endpoint） compared with the baseline. The secondary endpoint was major adverse cardiovascular events at 12 months.Results Compared with the rational loading dosage, the tailored loading dosage better inhibited platelet aggregation based on a ＞50% decrease in adenosine phosphate-mediated platelet aggregation （rational loading dosage vs. tailored loading dosage, 48% vs. 73%, P=0.028）. There was no significant difference in the eligible index between the Talcom and Plavix groups （47% vs. 49% at 300 mg; 62% vs. 59% at 600 mg; 74% vs. 72% at 900 mg; P ＞0.05） based on a standard adenosine diphosphate-mediated platelet aggregation decrease of ＞50%. After 12 months of follow-up, there were no significant differences in major adverse cardiac events （2.5% vs. 2.9%, P=5.43）. No acute or subacute stent thrombosis events occurred.Conclusion An adjusted loading dose of clopidogrel could have significant effects on antiplatelet aggregation compared with a rational dose, decreasing 1-year major adverse cardiac events in patients undergoing percutaneous coronary interventions based on adenosine phosphate-mediated platelet aggregation with no increase in bleeding.