P2Y12 inhibitor use predicts hematoma expansion in patients with intracerebral hemorrhage.
P2Y12 inhibitor use predicts hematoma expansion in patients with intracerebral hemorrhage.
复制标题
P2Y12 抑制剂的使用可预测脑出血患者的血肿扩大。
DOI：
10.1002/acn3.52070
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发表时间：
2024
影响因子：
5.3
通讯作者：
Naidech,AndrewM
中科院分区：
文献类型：
--
作者：
Houskamp,EthanJ;Liu,Yuzhe;SilvaPinheirodoNascimento,Juliana;Jahromi,BabakS;Lindholm,PaulF;Kwaan,HauC;Naidech,AndrewM
血肿扩大（HE）可预测急性脑出血（ICH）后的残疾和死亡。阿司匹林和抗凝剂与HE相关。我们检验了P2 Y12抑制剂预测患者随后发生HE的假设。我们探讨了P2 Y12抑制和阿司匹林（DAPT）双重抗血小板治疗的实验室指标。使用VerifyNow‐ P2 Y12检测试剂盒测量血小板活性。使用经确认的半自动技术计算初始和随访CT的血肿体积。HE定义为初始和随访CT扫描时血肿体积之间的差异。非参数统计进行Kruskal-WallisH，校正与Dunn's test.ResultsIn 194例患者进行多重比较，15（7.7%）已知采取P2 Y12抑制剂（氯吡格雷，但在所有）。与未服用P2 Y12抑制剂的患者相比，服用P2 Y12抑制剂的患者发生更多HE（3.5 [1.2-11.9] vs. 0.1 [-0.8-1.4] mL，p= 0.004）。接受DAPT的患者发生HE的次数最多（7.2 [2.6-13.8] vs. 0.0 [−1.0-1.1] mL，p= 0.04）。P2 Y12抑制剂的使用与P2 Y12活性降低相关（178 [149-203] vs. 288 [246-319] P2 Y12反应单位，p= 0.005）。该效应在接受DAPT的患者中最为明显，表明P2 Y12抑制剂和阿司匹林对HE具有协同效应。P2 Y12抑制剂在急性ICH中的急性逆转需要进一步研究。
ObjectiveHematoma expansion (HE) predicts disability and death after acute intracerebral hemorrhage (ICH). Aspirin and anticoagulants have been associated with HE. We tested the hypothesis that P2Y12 inhibitors predict subsequent HE in patients. We explored laboratory measures of P2Y12 inhibition and dual antiplatelet therapy with aspirin (DAPT).MethodsWe prospectively identified patients with ICH. Platelet activity was measured with the VerifyNow‐P2Y12 assay. Hematoma volumes for initial and follow‐up CTs were calculated using a validated semi‐automated technique. HE was defined as the difference between hematoma volumes on the initial and follow‐up CT scans. Nonparametric statistics were performed with Kruskal–WallisH, and correction for multiple comparisons performed with Dunn's test.ResultsIn 194 patients, 15 (7.7%) were known to take a P2Y12 inhibitor (clopidogrel in all but one). Patients taking a P2Y12 inhibitor had more HE compared to patients not taking a P2Y12 inhibitor (3.5 [1.2–11.9] vs. 0.1 [−0.8–1.4] mL,p= 0.004). Patients taking DAPT experienced the most HE (7.2 [2.6–13.8] vs. 0.0 [−1.0–1.1] mL,p= 0.04). The use of P2Y12 inhibitors was associated with less P2Y12 activity (178 [149–203] vs. 288 [246–319] P2Y12 reaction units,p= 0.005).InterpretationPatients taking a P2Y12 inhibitor had more HE and less P2Y12 activity. The effect was most pronounced in patients on DAPT, suggesting a synergistic effect of P2Y12 inhibitors and aspirin with respect to HE. Acute reversal of P2Y12 inhibitors in acute ICH requires further study.