Agnieszka Kapłon-Cieślicka

The effect of doubling the dose of acetylsalicylic acid (ASA) on platelet function parameters in patients with type 2 diabetes and platelet hyperreactivity during treatment with 75 mg of ASA: a subanalysis of the AVOCADO study

BACKGROUND Individuals with diabetes are at 2- to 4-fold higher risk of cardiovascular disease than those without diabetes. High platelet reactivity (HPR) plays a pivotal role in atherothrombotic complications of diabetes. Polish and American diabetes associations recommend treating high-risk diabetic patients with low doses of acetylsalicylic acid (ASA) in primary and secondary prevention of cardiovascular events. Unfortunately, some patients show HPR despite treatment with ASA. AIM To determine the effect of doubling the dose of ASA on platelet reactivity in patients with type 2 diabetes and HPR despite treatment of with 75 mg of ASA. METHODS 304 type 2 diabetes patients treated with 75 mg of ASA were enrolled into the prospective, randomised, open-label Aspirin Versus/Or Clopidogrel in Aspirin-resistant Diabetics inflammation Outcomes (AVOCADO) study. Platelet reactivity was assessed by Platelet Function Analyser (PFA)-100®, VerifyNow® Aspirin Assay, and serum thromboxane B2 (sTXB2) and urinary 11-dehydrothromboxane B2 (u11dhTXB2) level measurements. Patients with HPR determined by collagen/epinephrine-induced closure time (CEPI-CT) measured by PFA-100® were randomised in a 2:3 ratio to receive 150 mg of ASA (Group 1) or 75 mg of clopidogrel (Group 2), respectively. Platelet reactivity was assessed at baseline and after 8 weeks of treatment. RESULTS Complete clinical data and blood samples were ultimately available for 260 of 304 patients initially enrolled to the study. Subsequently, six patients were excluded from the analysis based on suspected ASA non-compliance (sTXB2 level > 7200 pg/mL). Among 254 patients finally included into analysis, HPR was found in 90 (35.4%) patients of whom 38 patients were randomised to Group 1 and 52 patients to Group 2. Doubling the dose of ASA resulted in a significant CEPI-CT prolongation (Delta 111 s, p < 0.001) and reduction of sTXB2 level (Delta -101.3 pg/mL, p = 0.001) but did not significantly affect results of other platelet function tests. CONCLUSIONS Doubling the dose of ASA improved platelet reactivity in patients with type 2 diabetes and HPR.

Predictors of high platelet reactivity during aspirin treatment in patients with type 2 diabetes

BACKGROUND Diabetes mellitus type 2 (DM2) is associated with high platelet reactivity both in patients who do not receive antiplatelet drugs and in those treated with acetylsalicylic acid (ASA). The pathomechanism of this phenomenon has not been fully understood. AIM 1. To evaluate variability of platelet reactivity in patients with DM2 treated with oral antidiabetic drugs and receiving chronic ASA therapy. 2. To identify independent predictors of high platelet reactivity during ASA therapy in patients with DM2. METHODS We studied 171 patients with DM2 treated with oral antidiabetic drugs and receiving long-term treatment with 75 mg of ASA daily, selected among the participants of the prospective AVOCADO study. Platelet function was simultaneously evaluated using 4 methods: 1. measurement of serum thromboxane B2 (TXB2) concentration; 2. measurement of urinary 11-dehydrothromboxane B2 (11-dhTXB2) concentration; 3. VerifyNow® automated analyser; 4. PFA-100® automated analyser.High platelet reactivity was defined as at least 3 of the following criteria: 1. serum TXB2 concentration in the upper quartile;2. urinary 11-dhTXB2 concentration in the upper quartile; 3. value ≥ 550 aspirin reaction units (ARU) by VerifyNow®;4. collagen-epinephrine closure time (CEPI-CT) below median of readings other than 300 s by PFA-100®. In all patients, DM2 control was evaluated, insulin resistance was measured using HOMA-IR, and routine laboratory tests were performed, including full blood count, renal function parameters, and inflammation markers. RESULTS Mean patient age was 67.8 years, and median duration of DM2 was 5 years. We found poor agreement between different tests of platelet function. ARU ≥ 550 (VerifyNow®) was found in 14.0% of patients, and CEPI-CT below median of readings other than 300 s (PFA-100®) was found in 32.8% of patients. Our criteria of high platelet reactivity were met by 9.9% of patients. In multivariate logistic regression analysis, independent predictors of high platelet reactivity despite ASA therapy included chronic heart failure, current smoking, and higher leukocyte count. CONCLUSIONS 1. Patients with DM2 are characterised by large variability of platelet reactivity, with little agreement between various methods. 2. Smoking, chronic heart failure, and subclinical inflammation may be associated with high platelet reactivity in patients with DM2 treated with ASA.

Ex vivo Effects of an Oenothera paradoxa Extract on the Reactive Oxygen Species Generation and Neutral Endopeptidase Activity in Neutrophils from Patients after Acute Myocardial Infarction

Oxidative stress induced by reactive oxygen species (ROS) is considered to play an important part in the aetiology of coronary heart disease. Apart from ROS, neutrophils are a source of neutral endopeptidase (NEP) that inactivates protective natriuretic peptides. The aim of the present study was to evaluate the in vitro ROS generation and inhibition of NEP activity in neutrophils obtained from healthy volunteers and from patients after acute myocardial infarction (AMI) by an aqueous extract of Oenothera paradoxa. Neutrophils isolated from AMI patients showed two‐fold higher ROS generation compared with cells from healthy donors, especially in the lucigenin‐enhanced luminescence model, which suggests intensive O‐2 generation. The addition of O. paradoxa extract at concentrations of 0.2, 2 and 20 µg/mL resulted in a significant reduction in ROS generation. The extracellular NEP activity was higher in patients after AMI compared with healthy individuals (15.0 ± 0.9 versus 10.3 ± 0.5 nmol AMC/106 cells/60 min; p = 0.001). The addition of O. paradoxa extract at concentrations of 20, 50 and 100 µg/mL resulted in a significant reduction in NEP activity in both groups. O. paradoxa extract appears to be an interesting candidate for supplementation in the prevention of cardiovascular diseases. Copyright

Coronary artery dissection, traumatic liver and spleen injury after cardiopulmonary resuscitation - a case report and review of the literature.

Early cardiopulmonary resuscitation (CPR) plays a pivotal role in survival from cardiac arrest. Complications associated with external cardiac compression include trauma to the chest wall, heart and lungs, as well as intra-abdominal injuries. A 51-year-old woman, a former smoker, was admitted to the University Hospital Emergency Department following an out-of-hospital sudden cardiac arrest preceded by stenocardial pain. Successful CPR of approximately 10 min was immediately applied by a non-professional witness, followed by advanced medical care provided by an ambulance service team. The first recorded rhythm was sinus rhythm with ST-segment elevation in the lateral, inferior and posterior wall leads. Loading doses of aspirin (300 mg) and clopidogrel (600 mg) were administered. While in the ambulance, the patient required defibrillation for ventricular fibrillation. Upon hospital admission the patient was conscious and hemodynamically stable. Coronary angiography revealed a long critical stenosis of the first marginal branch which was identified as the infarct-related artery. Additionally, up to 40% stenosis of the left anterior descending artery (LAD) was found but considered insignificant. Successful primary coronary angioplasty of the culprit lesion with implantation of two bare-metal stents was performed. Periprocedurally, the patient received 5000 U of unfractionated heparin and a continuous intravenous infusion of abciximab. The patient was transferred to the Intensive Cardiac Care Unit, where initially she remained hemodynamically stable, with no recurrence of chest pain. ST-segment elevation resolution was observed. On the second day of her hospital stay, the patient complained of abdominal pain. The abdomen was tender and rigid on palpation, and peritoneal signs were present. Alanine aminotransferase and aspartate aminotransferase activity rose to 229 U/l (normal range: 7–56 U/l) and 235 U/L (normal range: 5–40 U/l), respectively. Hemoglobin concentration decreased from 9.8 g/dl on admission to 7.4 g/dl. Abciximab infusion was discontinued and the patient received a transfusion of 2 U of packed red cells, achieving hemoglobin concentration of 10.3 g/dl. Abdominal ultrasound examination revealed free intraperitoneal fluid without any other significant abnormalities. A few minutes after the ultrasound examination the patient suffered cardiac arrest due to ventricular fibrillation, which was successfully defibrillated. A new ST-segment elevation in V2-V5 leads was recorded. The patient was immediately transported to the Catheterization Laboratory. Coronary angiography showed a total occlusion of the LAD due to a long dissection, which was reopened with three bare-metal stents (Figure 1). The beneficial effect of the marginal branch angioplasty was maintained. Abdominal computed tomography (CT) scan performed directly after the coronary procedure revealed grade IV liver injury (graded according to the American Association for the Surgery of Trauma Liver Injury Scale [1]), with lesions localized predominantly in the left hepatic lobe, spleen lacerations and a hematoma in the peritoneum (Figure 2). There was no evidence of rib or sternal fractures. During the immediate surgical intervention a total splenectomy was performed and bleeding from the liver was stemmed. Histopathological examination of the excised hepatic and splenic tissues was unremarkable. After the surgery, the patient remained conscious and hemodynamically stable. Abdominal ultrasound examination showed only a small amount of intraperitoneal fluid and no new lesions in the liver. Treatment with daily doses of 75 mg of aspirin, 75 mg of clopidogrel and 40 mg of enoxaparin was restarted. The day after the surgical procedure, the patient suffered cardiac arrest due to asystole. She was intubated, mechanically ventilated and received CPR. Adrenaline and atropine were administered in typical doses. A blood sample was collected during resuscitation, revealing a decrease in hemoglobin level from 10.6 g/dl to 7.8 g/dl, and the patient received intravenous fluids. After 20 min of sustained asystole despite resuscitation the patient was considered dead. No autopsy was performed. Figure 1 Left descending artery (LAD). A – Initial angiography: LAD with no significant stenosis. B – Second angiography: LAD occlusion due to dissection. C – Final result of angioplasty: LAD after implantation of three bare-metal stents ... Figure 2 An abdominal CT scan demonstrating hemoperitoneum, liver lacerations (A) and subcapsular lesion in the spleen (B) Rib and sternum fractures are the most common complications associated with CPR. Other thoracic complications include hemothorax, pneumothorax and hemopericardium [2]. Coronary artery dissection has not been described as a CPR complication so far. However, given the angiographic presentation and the timely relation between external chest compressions and the subsequent acute coronary syndrome, we hypothesize that LAD occlusion in our patient might have been a result of trauma-related dissection of the initially diseased vessel wall. Although infrequent, coronary artery dissection after blunt chest trauma has been described previously [3–6]. Intra-abdominal injuries are rare complications of CPR and include hepatic, splenic and intestinal trauma, as well as intraperitoneal bleeding and retroperitoneal hematoma. A review of relevant available publications implies that liver injury is the most common of the CPR-related intra-abdominal complications, with an incidence of approximately 0.6% [7–13]. Ruptured spleen is the second most common gastrointestinal visceral injury attributable to CPR [12]. Liver lacerations occur most frequently in the left lobe [11, 12]. This could be explained by the close anatomical relationship between the left hepatic lobe and the xiphoid process of the sternum. Two important factors that may aggravate the risk of liver rupture in patients suffering from cardiopulmonary arrest are hepatic ischemia and liver distention due to venous congestion. Another precipitating factor in patients with myocardial infarction is treatment with antiplatelet, antithrombotic and thrombolytic agents [8, 9, 14]. As intra-abdominal injuries are infrequent complications of CPR, their diagnosis may be difficult and requires careful clinical evaluation as well as regular monitoring of standard hemodynamic and laboratory parameters. Routine implementation of abdominal imaging techniques in every patient after successful CPR seems redundant. In our opinion, a decision to perform an abdominal ultrasound or CT scan should be based on clinical assumptions and premises. So far, due to insufficient evidence, no unequivocal recommendations for the management of CPR-related liver injuries have been made. However, according to the guidelines of the Eastern Association for the Surgery of Trauma [15], nonoperative management of blunt hepatic injuries in hemodynamically stable patients is reasonable. In patients with CPR-related liver trauma mortality remains high, irrespective of the treatment received [12], although single reports of successful conservative therapy are available [14]. The scarcity of data makes it difficult to anticipate which patients with CPR-related liver trauma will benefit from surgical intervention.

Clinical characteristics and predictors of one-year outcome of heart failure patients with atrial fibrillation compared to heart failure patients in sinus rhythm

BACKGROUND Atrial fibrillation (AF) frequently coexists with heart failure (HF). AIM To assess clinical characteristics and to identify predictors of one-year outcome of patients hospitalised for HF, depending on whether they were in sinus rhythm (SR) or had AF. METHODS The study included Polish patients hospitalised for HF, participating in the Heart Failure Pilot Survey of the European Society of Cardiology, who were followed for 12 months after discharge. Patients with paced heart rhythm were excluded from the study. The primary endpoint was all-cause death at 12 months. RESULTS The final analysis included 587 patients. AF occurred in 215 (36.6%) patients. Compared to patients in SR, patients with AF were older, more often had a history of previous HF hospitalisation, were characterised by a higher New York Heart Association (NYHA) class, higher heart rate, and lower diastolic blood pressure at hospital admission, and had higher serum creatinine and lower haemoglobin concentration at admission. In-hospital mortality was higher in AF patients compared to SR patients (5.1% vs. 2.4%, respectively), but the difference did not reach statistical significance (p = 0.1). The primary endpoint occurred in 41 of 215 AF patients (19.1%) and in 40 of 372 SR patients (10.8%; p = 0.006). In a multivariate analysis, predictors of the primary endpoint in AF patients were: higher NYHA class at hospital admission (p = 0.02), higher admission heart rate (p = 0.04), lower admission serum sodium concentration (p = 0.0001), and higher heart rate at discharge (p = 0.01). In patients with SR, independent predictors of the primary endpoint included: older age (p = 0.007), lower serum sodium concentration at admission (p = 0.0006), and higher heart rate at discharge (p = 0.008). CONCLUSIONS Patients with HF and concomitant AF differ significantly from HF patients in SR. In the studied group of real-world HF patients, serum sodium concentration at hospital admission and heart rate at hospital discharge were independent prognostic factors in patients with AF and in patients in SR. In contrast to SR patients, heart rate at hospital admission in AF patients was also predictive of long-term mortality.

Common carotid artery access for transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) is an alternative method of treatment for severe symptomatic aortic stenosis in patients who are at high risk of surgical aortic valve replacement (AVR). In randomised clinical trials TAVI was shown to be superior to standard medical therapy in a cohort of inoperable patients and non-inferior to AVR in high-risk operable patients. Additionally, in a recent trial with self-expandable prosthesis use, TAVI was associated with lower mortality compared with surgery. Usually, femoral arteries are the most common vascular access to deliver the bioprosthesis; however, in some cases (up to 20%) this route may not be applied because of significant peripheral artery disease or tortuosity. In this article, we present the first two TAVI procedures in Poland performed via the left common carotid artery.

Letter to the Editor Coronary artery dissection, traumatic liver and spleen injury after cardiopulmonary resuscitation – a and review of the literature

Early cardiopulmonary resuscitation (CPR) plays a pivotal role in survival from cardiac arrest. Complications associated with external cardiac compression include trauma to the chest wall, heart and lungs, as well as intra-abdominal injuries. A 51-year-old woman, a former smoker, was admitted to the University Hospital Emergency Department following an out-of-hospital sudden cardiac arrest preceded by stenocardial pain. Successful CPR of approximately 10 min was immediately applied by a non-professional witness, followed by advanced medical care provided by an ambulance service team. The first recorded rhythm was sinus rhythm with ST-segment elevation in the lateral, inferior and posterior wall leads. Loading doses of aspirin (300 mg) and clopidogrel (600 mg) were administered. While in the ambulance, the patient required defibrillation for ventricular fibrillation. Upon hospital admission the patient was conscious and hemodynamically stable. Coronary angiography revealed a long critical stenosis of the first marginal branch which was identified as the infarct-related artery. Additionally, up to 40% stenosis of the left anterior descending artery (LAD) was found but considered insignificant. Successful primary coronary angioplasty of the culprit lesion with implantation of two bare-metal stents was performed. Periprocedurally, the patient received 5000 U of unfractionated heparin and a continuous intravenous infusion of abciximab. The patient was transferred to the Intensive Cardiac Care Unit, where initially she remained hemodynamically stable, with no recurrence of chest pain. ST-segment elevation resolution was observed. On the second day of her hospital stay, the patient complained of abdominal pain. The abdomen was tender and rigid on palpation, and peritoneal signs were present. Alanine aminotransferase and aspartate aminotransferase activity rose to 229 U/l (normal range: 7–56 U/l) and 235 U/L (normal range: 5–40 U/l), respectively. Hemoglobin concentration decreased from 9.8 g/dl on admission to 7.4 g/dl. Abciximab infusion was discontinued and the patient received a transfusion of 2 U of packed red cells, achieving hemoglobin concentration of 10.3 g/dl. Abdominal ultrasound examination revealed free intraperitoneal fluid without any other significant abnormalities. A few minutes after the ultrasound examination the patient suffered cardiac arrest due to ventricular fibrillation, which was successfully defibrillated. A new ST-segment elevation in V2-V5 leads was recorded. The patient was immediately transported to the Catheterization Laboratory. Coronary angiography showed a total occlusion of the LAD due to a long dissection, which was reopened with three bare-metal stents (Figure 1). The beneficial effect of the marginal branch angioplasty was maintained. Abdominal computed tomography (CT) scan performed directly after the coronary procedure revealed grade IV liver injury (graded according to the American Association for the Surgery of Trauma Liver Injury Scale [1]), with lesions localized predominantly in the left hepatic lobe, spleen lacerations and a hematoma in the peritoneum (Figure 2). There was no evidence of rib or sternal fractures. During the immediate surgical intervention a total splenectomy was performed and bleeding from the liver was stemmed. Histopathological examination of the excised hepatic and splenic tissues was unremarkable. After the surgery, the patient remained conscious and hemodynamically stable. Abdominal ultrasound examination showed only a small amount of intraperitoneal fluid and no new lesions in the liver. Treatment with daily doses of 75 mg of aspirin, 75 mg of clopidogrel and 40 mg of enoxaparin was restarted. The day after the surgical procedure, the patient suffered cardiac arrest due to asystole. She was intubated, mechanically ventilated and received CPR. Adrenaline and atropine were administered in typical doses. A blood sample was collected during resuscitation, revealing a decrease in hemoglobin level from 10.6 g/dl to 7.8 g/dl, and the patient received intravenous fluids. After 20 min of sustained asystole despite resuscitation the patient was considered dead. No autopsy was performed. Figure 1 Left descending artery (LAD). A – Initial angiography: LAD with no significant stenosis. B – Second angiography: LAD occlusion due to dissection. C – Final result of angioplasty: LAD after implantation of three bare-metal stents ... Figure 2 An abdominal CT scan demonstrating hemoperitoneum, liver lacerations (A) and subcapsular lesion in the spleen (B) Rib and sternum fractures are the most common complications associated with CPR. Other thoracic complications include hemothorax, pneumothorax and hemopericardium [2]. Coronary artery dissection has not been described as a CPR complication so far. However, given the angiographic presentation and the timely relation between external chest compressions and the subsequent acute coronary syndrome, we hypothesize that LAD occlusion in our patient might have been a result of trauma-related dissection of the initially diseased vessel wall. Although infrequent, coronary artery dissection after blunt chest trauma has been described previously [3–6]. Intra-abdominal injuries are rare complications of CPR and include hepatic, splenic and intestinal trauma, as well as intraperitoneal bleeding and retroperitoneal hematoma. A review of relevant available publications implies that liver injury is the most common of the CPR-related intra-abdominal complications, with an incidence of approximately 0.6% [7–13]. Ruptured spleen is the second most common gastrointestinal visceral injury attributable to CPR [12]. Liver lacerations occur most frequently in the left lobe [11, 12]. This could be explained by the close anatomical relationship between the left hepatic lobe and the xiphoid process of the sternum. Two important factors that may aggravate the risk of liver rupture in patients suffering from cardiopulmonary arrest are hepatic ischemia and liver distention due to venous congestion. Another precipitating factor in patients with myocardial infarction is treatment with antiplatelet, antithrombotic and thrombolytic agents [8, 9, 14]. As intra-abdominal injuries are infrequent complications of CPR, their diagnosis may be difficult and requires careful clinical evaluation as well as regular monitoring of standard hemodynamic and laboratory parameters. Routine implementation of abdominal imaging techniques in every patient after successful CPR seems redundant. In our opinion, a decision to perform an abdominal ultrasound or CT scan should be based on clinical assumptions and premises. So far, due to insufficient evidence, no unequivocal recommendations for the management of CPR-related liver injuries have been made. However, according to the guidelines of the Eastern Association for the Surgery of Trauma [15], nonoperative management of blunt hepatic injuries in hemodynamically stable patients is reasonable. In patients with CPR-related liver trauma mortality remains high, irrespective of the treatment received [12], although single reports of successful conservative therapy are available [14]. The scarcity of data makes it difficult to anticipate which patients with CPR-related liver trauma will benefit from surgical intervention.

Predictors of one-year outcome in patients hospitalised for heart failure: results from the Polish part of the Heart Failure Pilot Survey of the European Society of Cardiology.

BACKGROUND Over the last few decades, the incidence and prevalence of chronic heart failure (HF) have been constantly increasing. AIM To identify predictors of one-year mortality and hospital readmissions in patients discharged after hospitalisation for HF. METHODS The study included Polish patients who agreed to participate in the Heart Failure Pilot Survey of the European Society of Cardiology and were followed for 12 months. The primary endpoint was all-cause death at 12 months. The secondary endpoint was a composite of all-cause death and readmission for cardiac causes at 12 months. RESULTS The final analysis included 629 patients. The primary end point occurred in 68 of 629 patients (10.8%). In multivariate analysis, independent predictors of one-year mortality were: higher New York Heart Association (NYHA) class at admission (odds ratio [OR] 1.90; 95% confidence interval [CI] 1.01-3.59; p = 0.0478), inotropic support during hospitalisation (OR 3.95; 95% CI 1.49-10.47; p = 0.0056), and lower glomerular filtration rate at discharge (OR 0.978; 95% CI 0.961-0.995; p = 0.0117). The secondary endpoint occurred in 278 of 503 patients (55.3%). In multivariate analysis, predictors of secondary endpoint were a history of previous coronary revascularisation (OR 2.403; 95% CI 1.221-4.701; p = 0.002) and inotropic support during hospitalisation (OR 2.521; 95% CI 1.062-5.651; p = 0.009). CONCLUSIONS Patients discharged after hospitalisation for HF remained at high risk of death and hospital readmission. A previous history of coronary revascularisation, decreased renal function, and worse clinical status at admission with the need for inotropic support were predictors of one-year outcome in Polish patients hospitalised for HF.

Influence of echocardiographic and radiographic characteristics on atrial sensing amplitude in patients with Linox Smart S DX defibrillation leads.

BACKGROUND Single-lead for implantable cardioverter-defibrillator (ICD) with floating atrial sensing dipole is a new diagnostic tool with the potential advantage in terms of arrhythmia discrimination. We sought to determine whether right heart size and dipole position influence atrial sensing. METHODS Atrial sensing (AS) amplitude was measured during implantation (PP, periprocedural), predischarge (IHFU, in-hospital follow-up) and 3-6 months after the procedure (AFU, ambulatory follow-up). Results were related to atrial dipole position in the right atrium (RA) on the basis of chest X-ray examination as well as right heart dimensions at echocardiography. RESULTS Twenty-four patients were included into final analysis. In 14 (58.3%) patients, sensing dipole was located in regions 1 and 2 of the RA. AS amplitude was greater in regions 1 and 2 when com¬pared to other locations (3.15 vs. 1.2 mV, p = 0.045, 7.53 vs. 3.8 mV, p < 0.001 and 5.63 vs. 2.44 mV, p = 0.017 for PP measurements, IHFU and AFU, respectively). There was a significant negative correlation between AS-PP and short RA dimension (RADs) (r = -0.56, p = 0.02), AS-IHFU and RA area (RAA) (r = -0.45, p < 0.05), AS-AFU and long RA dimension (RADl) (r = -0.46; p = 0.02), AS-AFU and RADs (r = -0,48, p = 0.02), and AS-AFU and RAA (and r = -0.52, p < 0.01). There was no relationship between AS and other right heart dimensions. CONCLUSIONS Larger RA size and low sensing dipole location were associated with lower AS amplitude in single-lead dual chamber ICD.

Serum Brain-Derived Neurotrophic Factor is Related to Platelet Reactivity but not to Genetic Polymorphisms within BDNF Encoding Gene in Patients with Type 2 Diabetes.

Background The aim of this study was to investigate the association between serum concentrations of the brain-derived neurotrophic factor (BDNF), platelet reactivity and inflammatory markers, as well as its association with BDNF encoding gene variants in type 2 diabetic patients (T2DM) during acetylsalicylic acid (ASA) therapy. Material/Methods This retrospective, open-label study enrolled 91 patients. Serum BDNF, genotype variants, hematological, biochemical, and inflammatory markers were measured. Blood samples were taken in the morning 2–3 h after the last ASA dose. The BDNF genotypes for selected variants were analyzed by use of the iPLEX Sequenom assay. Results In multivariate linear regression analysis, CADP-CT >74 sec (p<0.001) and sP-selectin concentration (p=0.03) were predictive of high serum BDNF. In multivariate logistic regression analysis, CADP-CT >74 sec (p=0.02) and IL-6 concentration (p=0.03) were risk factors for serum BDNF above the median. Non-significant differences were observed between intronic SNP rs925946, missense SNP rs6265, and intronic SNP rs4923463 allelic groups and BDNF concentrations in the investigated cohort. Conclusions Chronic inflammatory condition and enhanced immune system are associated with the production of BDNF, which may be why the serum BDNF level in T2DM patients with high platelet reactivity was higher compared to subjects with normal platelet reactivity in this study.