Increased risk in patients with high platelet amregation receiving chronic clopidogrel therapy undergoing percutaneous coronary intervention - Is the current antiplatelet therapy adequate?
Increased risk in patients with high platelet amregation receiving chronic clopidogrel therapy undergoing percutaneous coronary intervention - Is the current antiplatelet therapy adequate?
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DOI：
10.1016/j.jacc.2006.10.050
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发表时间：
2007-02-13
影响因子：
24
通讯作者：
Gurbel, Paul A.
中科院分区：
文献类型：
--
作者：
Bliden, Kevin P.;DiChiara, Joseph;Gurbel, Paul A.
目的我们试图确定接受慢性氯吡格雷治疗的患者在接受非紧急支架植入术时，如果通过标准透光率聚集测定法和血栓弹力图（TEG）测量显示治疗前血小板聚集率较高，是否会增加支架植入术后缺血事件的风险。方法对100例接受阿司匹林（325 mg qd）和氯吡格雷（75 mg qd）组成的慢性抗血小板治疗的患者在接受非急诊支架术前进行研究。患者在冠状动脉支架植入术后随访1年，观察死亡、心肌梗死、支架内血栓形成、卒中或缺血是否需要住院治疗。通过聚集测定法和TEG，1年内发生缺血性事件的患者（23/100，23%）的治疗期间ADP诱导的血小板聚集率高于未发生缺血性事件的患者（两种测量值均为p < 0.001）。在发生缺血性事件的患者中，分别有70%和87%的患者在基线时通过聚集测定法和TEG显示出较高的治疗血小板反应性。通过聚集测定法和TEG测量的高治疗血小板反应性是与缺血事件显著相关的唯一变量（两种测定法的p < 0.001）。eptifibatide的管理减少围手术期升高血小板反应性，出血events.Conclusions接受慢性氯吡格雷治疗的患者接受非紧急经皮冠状动脉介入治疗谁表现出高治疗ADP诱导的血小板聚集的风险增加术后缺血性事件没有显着差异。这些发现可能对氯吡格雷维持剂量的改变和糖蛋白IIb/IIIa抑制剂在选定患者中的使用有意义。
Objectives We sought to determine whether patients receiving chronic clopidogrel therapy undergoing nonemergent stenting who display high on-treatment preprocedural platelet aggregation measured by standard light transmittance aggregometry and thrombelastography (TEG) will be at increased risk for poststenting ischemic events.Background Patients exhibiting heightened platelet reactivity to adenosine diphosphate (ADP) might be at increased risk for recurrent ischemic events after coronary stenting.Methods A total of 100 consecutive patients receiving chronic antiplatelet therapy consisting of aspirin (325 mg qd) and clopidogrel (75 mg qd) were studied before undergoing nonemergent stenting. Patients were followed for 1 year after coronary stenting for the occurrence of death, myocardial infarction, stent thrombosis, stroke, or ischemia requiring a hospital stay.Results All patients were aspirin responsive. Patients with ischemic events (23 of 100, 23%) within 1 year had greater on-treatment prestent ADP-induced platelet aggregation than patients without ischemic events by aggregometry and TEG (p < 0.001 for both measurements). Of patients with an ischemic event, 70% and 87% displayed high on-treatment platelet reactivity at baseline by aggregometry and TEG, respectively. High on-treatment platelet reactivity as measured by aggregometry and TEG were the only variables significantly related to ischemic events (p < 0.001 for both assays). The administration of eptifibatide reduced periprocedural elevation in platelet reactivity, with no significant differences in bleeding events.Conclusions Patients receiving chronic clopidogrel therapy undergoing nonemergent percutaneous coronary intervention who exhibit high on-treatment ADP-induced platelet aggregation are at increased risk for postprocedural ischemic events. These findings might have implications for the alteration in clopidogrel maintenance dose and use of glycoprotein IIb/IIIa inhibitors in selected patients.