Davidson, Jack Gorman, Valentin Fuster, Juan Badimon, Mount Sinai School of Medicine, New York,. NY, Columbia University College of Physicians and ...
Platelet Reactivity in Coronary Artery Disease Patients with Depression: Are All Anti-Depressants Equal? M. Urooj Zafar, Karen Hiensch, Gemma Vilahur, Constantin Novoselsky, Daniel Yadagar, Karina Davidson, Jack Gorman, Valentin Fuster, Juan Badimon, Mount Sinai School of Medicine, New York, NY, Columbia University College of Physicians and Surgeons, New York, NY
Background: A strong relationship exists between coronary artery disease [CAD] and depression. Depressed CAD patients [pt] have more coronary events presumably due to higher serotonin [5HT] mediated platelet reactivity. Anti-depressive therapy has been shown to help reduce coronary events but the mechanism is unknown. We compared platelet reactivity in depressed vs. non-depressed CAD pt and assessed the effect of 4 commonly used antidepressants on platelets. Methods: Depressed (13) and non-depressed (15) pt with stable CAD matched for age and sex were enrolled. Blood from each pt was mixed in vitro with saline (control), nefazodone, duloxetine, escitalopram and sertraline. Platelet reactivity was assessed by optical aggregometry in response to ADP (5µM) and 5HT (10µM). Effect of each drug on platelet aggregation was compared with control. Results: Depressed CAD pt had higher platelet reactivity vs non-depressed. Except nefazodone, each drug significantly reduced 5HT-mediated platelet aggregation, with sertraline being the most potent. No effect on ADP mediated aggregation was seen. Conclusions: Depressed CAD pt have increased platelet reactivity which plays an important role in the higher event rate seen in these pts. Different antidepressants inhibit 5HT-mediated platelet reactivity to varying degrees. This highlights the importance of selecting the proper antidepressant in CAD pt, due to the dual effect of improving depressive symptomatology and directly inhibiting platelet reactivity.
