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Thromb Haemost 2020; 120(09): 1282-1290
DOI: 10.1055/s-0040-1713888
Cellular Haemostasis and Platelets

von Willebrand Factor Predicts Mortality in ACS Patients Treated with Potent P2Y12 Antagonists and is Inhibited by Aptamer BT200 Ex Vivo

Katarina D. Kovacevic
1   Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
,
Bernd Jilma
1   Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
,
Shuhao Zhu
2   Guardian Therapeutics, Lexington, Massachusetts, United States
,
James C. Gilbert
2   Guardian Therapeutics, Lexington, Massachusetts, United States
,
Max-Paul Winter
3   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Aurel Toma
3   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Christian Hengstenberg
3   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Irene Lang
3   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Jacek Kubica
4   Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Toruń, Poland
,
Jolanta M. Siller-Matula
3   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
5   Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Warsaw, Poland
› Author Affiliations Funding This trial was funded by the Austrian Science Fund, grant number: SFB54-P04.
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Abstract

Background von Willebrand factor (VWF) is crucial for arterial thrombosis and its plasma levels are increased in acute coronary syndromes (ACSs). The effects of conventional platelet inhibitors are compromised by elevated VWF under high shear rates. BT200 is a third-generation aptamer that binds and inhibits the A1 domain of human VWF. This article aims to study whether VWF is a predictor of mortality in ACS patients under potent P2Y12 blocker therapy and to examine the effects of a VWF inhibiting aptamer BT200 and its concentrations required to inhibit VWF in plasma samples of patients with ACS.

Methods VWF activity was measured in 320 patients with ACS, and concentration effect curves of BT200 were established in plasma pools containing different VWF concentrations.

Results Median VWF activity in patients was 170% (interquartile range % confidence interval [CI]: 85–255) and 44% of patients had elevated (> 180%) VWF activity. Plasma levels of VWF activity predicted 1-year (hazard ratio [HR]: 2.68; 95% CI: 1.14–6.31; p < 0.024) and long-term (HR: 2.59; 95% CI: 1.10–6.09) mortality despite treatment with potent platelet inhibitors (dual-antiplatelet therapy with aspirin and prasugrel or ticagrelor). Although half-maximal concentrations were 0.1 to 0.2 µg/mL irrespective of baseline VWF levels, increasing concentrations (0.42–2.13 µg/mL) of BT200 were needed to lower VWF activity to < 20% of normal in plasma pools containing increasing VWF activity (p < 0.001).

Conclusion VWF is a predictor of all-cause mortality in ACS patients under contemporary potent P2Y12 inhibitor therapy. BT200 effectively inhibited VWF activity in a target concentration-dependent manner.

Keywords

VWF - mortality - predictor - BT200 - ACS - prasugrel - ticagrelor

Supplementary Material



Publication History

Received: 02 March 2020

Accepted: 26 May 2020

Article published online:
17 July 2020

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