Platelet reactivity in patients and recurrent events post-stenting - Results of the PREPARE POST-STENTlNG study
Platelet reactivity in patients and recurrent events post-stenting - Results of the PREPARE POST-STENTlNG study
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DOI：
10.1016/j.jacc.2005.07.041
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发表时间：
2005-11-15
影响因子：
24
通讯作者：
Tantry, US
中科院分区：
文献类型：
--
作者：
Gurbel, PA;Bliden, KP;Tantry, US
我们研究了体外高血小板反应性、快速纤维蛋白生成和高凝血酶诱导的凝块强度与接受经皮冠状动脉介入治疗（PCI）患者出院后缺血事件的关系。然而，有限的数据是可用的链接这些离体标记物的发生events.METHODS我们测量血小板反应性腺苷二磷酸（ADP）的透光率聚集测定法（LTA）在接受PCI的患者（n = 192）。通过血栓弹力图测量凝块强度（凝血酶诱导的纤维蛋白和血小板相互作用的量度）和至初始纤维蛋白生成的时间（凝血酶活性的标志物）。这些测量缺血性事件发生的关系进行了前瞻性检查超过6个months.Results一个总数的100%和84%的患者分别对阿司匹林和氯吡格雷治疗，在最初的事件。处理后ADP诱导的聚集（LTA法）（63 +/- 12% vs. 56 +/-15%，p = 0.02）和凝块强度（NIA）更高（74 +/- 5 min vs. 65 +/- 4 mm，p < 0.001），至初始纤维蛋白生成的时间较短（4.3 +/- 1.3 min vs. 5.9 +/- 1.5 min，p < 0.001）。LTA和NIA的最高四分位数的事件发生率分别为32%和58%，force.CONCLUSIONS高血小板反应性和凝块强度，快速纤维蛋白形成是PCI术后缺血性事件的新危险因素。凝块强度比ADP诱导的血小板聚集更具预测性，并且可以解释尽管使用环氧合酶-1和P2 Y抑制剂治疗，但仍发生事件的原因（12）。
OBJECTIVES We investigated the relation of high ex vivo platelet reactivity, rapid fibrin generation, and high thrombin-induced clot strength to postdischarge ischemic events in patients undergoing percutaneous coronary intervention (PCI).BACKGROUND High platelet reactivity and rapid fibrin generation may affect the incidence of ischemic events after PCI. However, limited data is available to link these ex vivo markers to the occurrence of events.METHODS We measured platelet reactivity to adenosine diphosphate (ADP) by light transmittance aggregometry (LTA) in patients undergoing PCI (n = 192). Clot strength, a measure of thrombin-induced fibrin and platelet interactions, and the time to initial fibrin generation, a marker of thrombin activity, were measured by thrombelastography. The relation of these measurements to ischemic event occurrence was prospectively examined over six months.RESULTS A total of 100% and 84% of patients were on aspirin and clopidogrel therapy, respectively, at the time of the initial event. Posttreatment ADP-induced aggregation by LTA (63 +/- 12% vs. 56 +/- 15%, p = 0.02) and clot strength (NIA) were higher (74 +/- 5 min vs. 65 +/- 4 mm, p < 0.001) and time to initial fibrin generation was shorter (4.3 +/- 1.3 min vs. 5.9 +/- 1.5 min, p < 0.001) in patients with events (n = 38). The event rates in the highest quartiles of LTA and NIA were 32% and 58%, respectively.CONCLUSIONS High platelet reactivity and clot strength, and rapid fibrin formation are novel risk factors for ischemic events after PCI. Clot strength is more predictive than ADP-induced platelet aggregation and may explain the occurrence of events despite treatment with cyclooxygenase-1 and P2Y(12), inhibitors.