Hyperproduction of von Willebrand factor as an additional criteria for prolonging antiplatelet therapy after acute coronary syndrome

Abstract

The purpose of the study was to assess the prospects for using the von Willebrand factor as an additional criterion for prolonging dual antiplatelet therapy in patients at risk of developing cardiovascular complications after acute coronary syndrome. The study involved 80 patients who underwent acute coronary syndrome and/or surgical treatment of coronary heart disease. In addition to the standard clinical study, the level of von Willebrand factor was determined in all patients. In a prospective follow-up after two years, the incidence of recurrent cardiovascular complications was assessed and the need for prolongation of dual antiplatelet therapy was retrospectively calculated using a risk assessment scale. Among patients with normal level of von Willebrand factor, no cardiovascular complications were recorded after two years of follow-up. A number of the most important factors were identified, including the von Willebrand factor, were used in the predictive model for the development of recurrent cardiovascular complications. The classification ability of the model showed 92.5 % agreement between the forecast results and the observation results. According to the risk score, longerterm dual antiplatelet therapy was required in 24 patients, only 6 of whom developed cardiovascular complications. Of the 13 patients with such complications, six patients needed to prolong therapy according to the risk assessment scale, and 4 patients required the standard duration of therapy. When using the prognostic model developed by us, the percentage of coincidence of the predicted unfavorable course of the disease with the actual development of a cardiovascular complication was higher: in 8 out of 13 cases. The developed prognostic model, including the determination of the von Willebrand factor level, makes it possible to predict with high reliability and certainty the likelihood of developing cardiovascular complications in patients with early coronary atherosclerosis and can be used to clarify the indications for prolonged dual antiplatelet therapy in addition to the risk assessment scale, in patients not undergoing percutaneous coronary intervention inclusive.