Validation of Three Platelet Function Tests for Bleeding Risk Stratification During Dual Antiplatelet Therapy Following Coronary Interventions
Validation of Three Platelet Function Tests for Bleeding Risk Stratification During Dual Antiplatelet Therapy Following Coronary Interventions
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DOI：
10.1002/clc.22540
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发表时间：
2016-07-01
影响因子：
2.7
通讯作者：
Serebruany, Victor
中科院分区：
文献类型：
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作者：
Kim, Moo Hyun;Choi, Sun Young;Serebruany, Victor
背景虽然低血小板反应性 (LPR) 在出血过程中经常被检测到，但缺乏可靠的 DAPT 出血风险分层的经过验证的阈值。我们测试了 3 种传统血小板活性测定的诊断效用，以确定 LPR 对出血的预测价值（如果有）。假设我们假设这些测试之一是否比其他任何测试更好地预测出血事件。方法药物洗脱支架植入后的患者 (n=800) 接受 DAPT。出血由出血学术研究联盟 (BARC) 分类进行评估，并收集支架植入后 1 年内的事件。通过透光率聚集测定法 (LTA)、VerifyNow 和多电极聚集测定法 (MEA) 测量血小板反应性。出血事件分层的 LPR 值定义为：LTA 为 15%，VerifyNow 为 139 PRU，MEA 为 25 U。 结果 18 名患者 (2.3%) 发生了出血事件。通过单变量分析，所有测试均将 LPR 区分为出血的独立预测因子（LTA 的[HR]：5.00，95% [CI]：1.8-14.0，P = 0.002；HR：21.3，95% CI：6.2-73.0，VerifyNow 的 P < 0.0001；HR：7.4，95% CI： 2.2-25.5，MEA 的 P = 0.002）。多变量分析显示，只有VerifyNow（HR：11.5，95% CI：2.9-45.7，P < 0.0004）仍然是出血的独立预测因子。然而，所有 3 项测试的特异性（分别为 81.5%、60.2% 和 81.7%）和敏感性（分别为 61.1%、83.3% 和 83.2%）都相当低。 结论 在 3 种传统血小板活性测定中，VerifyNow 在分类未来出血风险方面优于 LTA 或 MEA。然而，所有 3 项测试均未能可靠地预测未来出血。
BackgroundAlthough low platelet reactivity (LPR) is commonly detected during bleeding, a validated threshold for reliable DAPT bleeding risk stratification is lacking. We tested the diagnostic utility of 3 conventional platelet-activity assays to define the predictive value (if any) of LPR for bleeding.HypothesisWe hypothesized whether one of these tests be better than any others for predicting bleeding events.MethodsPatients (n=800) following drug-eluting stent implantation received DAPT. Bleeding was assessed by Bleeding Academic Research Consortium (BARC) classification and events were collected for 1 year after stenting. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow, and multiple electrode aggregometry (MEA). The LPR values for bleeding event stratification were defined as 15% for LTA, 139 PRU for VerifyNow, and 25 U for MEA.ResultsBleeding events occurred in 18 patients (2.3%). All tests distinguished LPR as an independent predictor for bleeding by univariate analysis ([HR]: 5.00, 95% [CI]: 1.8-14.0, P = 0.002 for LTA; HR: 21.3, 95% CI: 6.2-73.0, P < 0.0001 for VerifyNow; and HR: 7.4, 95% CI: 2.2-25.5, P = 0.002 for MEA). Multivariate analysis revealed that only VerifyNow (HR: 11.5, 95% CI: 2.9-45.7, P < 0.0004) remained an independent predictor for bleeding. However, the specificity (81.5%, 60.2%, and 81.7%, respectively) and sensitivity (61.1%, 83.3%, and 83.2%, respectively) of all 3 tests were quite low.ConclusionsAmong 3 conventional platelet-activity assays, VerifyNow was better than LTA or MEA for triaging future bleeding risks. However, all 3 tests failed to reliably predict future bleeding.