Effect of citicoline on some parameters of platelet aggregation in acute myocardial infarction

We studied the effect of the intravenous administration (slowly over 3 minutes) of citicoline (500 mg every 12 hours for 30 days) on some indices of platelet aggregation activity (platelet factor 4 (PF4), beta-thromboglobulin (B-TG), thromboxane B2 (TxB2), spontaneous and ADP-induced aggregation) in patients with acute myocardial infarction, admitted to hospital within 12 hours from onset of chest pain. The study design was double-blind: 15 patients were treated with placebo (Group A) and 15 patients with citicoline (Group B). The two groups of patients were homogeneous with respect to the incidence of risk factors for ischemic heart disease, size of infarcted area (estimated with both enzyme assays and electrocardiography recordings) and incidence of complications (arrhythmias, congestive heart failure, cardiogenic shock). No patient died during the study period. In Group A, the highest PF4 value was observed 24 hours after admission (X̄ ± S.E. = 36.9 ± 4.6 ng/ml). Thereafter we observed a decrease until day 10 (X̄ ± S.E. = 31.5 ± 4.5 ng/ml), a subsequent increase (X̄ ± S.E. = 34.1 ± 6.2 ng/ml on day 19) and finally another decrease (X̄ ± S.E. = 26.8 ± 5.4 ng/ml on day 30). In Group B, instead, a constant decrease in plasma values of PF4 was observed (from 36.6 ± 5.6 ng/ml on admission to 17 ± 3.5 ng/ml on day 30). Statistical comparison between the two groups revealed significantly lower values of PF4 in Group B especially with regards to the PF4 peaks seen on days 1 and 19 (1st, 2nd, 3rd, 4th, 5th, 13th, 14th, 15th, 17th, 18th, 19th, 20th, 21st, 22nd, 23rd, 24th, 25th, 26th day). With regards to B-TG, statistical comparison between the two groups of patients revealed significant lower values in Group B only occasionally in the study period (5th, 10th, 12th, 13th, 14th, 28th day). In Group B, patients' plasma TxB2 values were significantly lower in the first few days of the study (1st, 2nd, 5th, 6th, 11th day). No statistically significant differences were observed between the two groups in the spontaneous and ADP-induced platelet aggregation activity. From the results obtained in this study it may be concluded that citicoline is able to decrease platelet activation in patients with acute myocardial infarction probably through a mechanism of platelet membranes stabilization, especially those of the alpha granules. The drug does not appear to have an effect on cyclo-oxygenase activity since it does not significantly affect plasma TxB2 concentrations.