Head to Head Comparison of Two Point-of-care Platelet Function Tests Used for Assessment of On-clopidogrel Platelet Reactivity in Chinese Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention.
Head to Head Comparison of Two Point-of-care Platelet Function Tests Used for Assessment of On-clopidogrel Platelet Reactivity in Chinese Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention.
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两种用于评估接受经皮冠状动脉介入治疗的中国急性心肌梗死患者氯吡格雷血小板反应性的即时血小板功能测试的头对头比较
DOI：
10.4103/0366-6999.190664
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发表时间：
2016-10-05
影响因子：
6.1
通讯作者：
Yuan JQ
中科院分区：
文献类型：
--
作者：
Yao Y;Zhang JH;Tang XF;He C;Ma YL;Xu JJ;Song Y;Liu R;Meng XM;Song L;Wang M;Gao RL;Yuan JQ
血小板功能检测在临床实践中被广泛用于指导个体化抗血小板治疗。在中国，血栓弹力图（TEG）检测已在临床中得到较好应用，而VerifyNow主要用于科研，尚未应用于常规临床实践。本研究旨在比较这两种即时检测血小板功能的方法，并分析这两种方法在评估接受经皮冠状动脉介入治疗（PCI）的中国急性心肌梗死患者氯吡格雷抗血小板反应性方面的一致性。
本研究共纳入2014年8月至2015年5月期间阜外医院收治的184例患者。PCI术后3天，采用TEG和VerifyNow以二磷酸腺苷为激动剂评估氯吡格雷抗血小板反应性。根据既往报道，TEG检测血小板聚集抑制率（IPA）<30%或VerifyNow检测P2Y12反应单位（PRU）>230定义为高氯吡格雷抗血小板反应性（HPR）。IPA>70%或PRU<178定义为低氯吡格雷抗血小板反应性（LPR）。分别采用Spearman相关系数（r）和kappa值（κ）分析两种方法之间的相关性和一致性。
研究结果显示，VerifyNow和TEG在评估血小板反应性方面具有中等程度但显著的相关性（r = -0.511）。TEG和VerifyNow在识别HPR方面一致性虽差但具有统计学意义（κ = 0.225），在识别LPR方面具有显著的中度一致性（κ = 0.412）。以TEG为参照进行比较，本研究中中国患者VerifyNow检测HPR的临界值为PRU>205，检测LPR的临界值为PRU<169。
与已在临床广泛应用的TEG相比，VerifyNow可能是监测中国患者氯吡格雷抗血小板反应性的一种有吸引力的替代TEG的方法。
Background: Platelet function tests are widely used in clinical practice to guide personalized antiplatelet therapy. In China, the thromboelastography (TEG) test has been well accepted in clinics, whereas VerifyNow, mainly used for scientific research, has not been used in routine clinical practice. The aim of the current study was to compare these two point-of-care platelet function tests and to analyze the consistency between the two tests for evaluating on-clopidogrel platelet reactivity in Chinese acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI). Methods: A total of 184 patients admitted to Fuwai Hospital between August 2014 and May 2015 were enrolled in the study. On-clopidogrel platelet reactivity was assessed 3 days after PCI by TEG and VerifyNow using adenosine diphosphate as an agonist. Based on the previous reports, an inhibition of platelet aggregation (IPA) <30% for TEG or a P2Y12 reaction unit (PRU) >230 for VerifyNow was defined as high on-clopidogrel platelet reactivity (HPR). An IPA >70% or a PRU <178 was defined as low on-clopidogrel platelet reactivity (LPR). Correlation and agreement between the two methods were analyzed using the Spearman correlation coefficient (r) and kappa value (&kgr;), respectively. Results: Our results showed that VerifyNow and TEG had a moderate but significant correlation in evaluating platelet reactivity (r = −0.511). A significant although poor agreement (&kgr; = 0.225) in identifying HPR and a significantly moderate agreement in identifying LPR (&kgr; = 0.412) were observed between TEG and VerifyNow. By using TEG as the reference for comparison, the cutoff values of VerifyNow for the Chinese patients in this study were identified as PRU >205 for HPR and PRU <169 for LPR. Conclusions: By comparing VerifyNow to TEG which has been widely used in clinics, VerifyNow could be an attractive alternative to TEG for monitoring on-clopidogrel platelet reactivity in Chinese patients.
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影响因子：
6.1
作者：
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通讯作者：
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作者：
Kwak, Young-Lan;Kim, Jong-Chan;Shim, Jae-Kwang
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