Residual platelet reactivity is preferred over platelet inhibition rate in monitoring antiplatelet efficacy: insights using thrombelastography
Residual platelet reactivity is preferred over platelet inhibition rate in monitoring antiplatelet efficacy: insights using thrombelastography
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DOI：
10.1038/s41401-019-0278-9
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发表时间：
2020-02-01
影响因子：
8.2
通讯作者：
Ge, Jun-bo
中科院分区：
文献类型：
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作者：
Wu, Hong-yi;Zhang, Chi;Ge, Jun-bo
尽管血栓弹力图（TEG）已广泛应用于血管内介入的临床环境中，但由于各种 TEG 参数与临床结果之间关系的数据有限，因此对于定义高缺血风险患者的最佳参数缺乏共识。在本文中，我们报告了一项前瞻性单中心队列研究的事后分析，该研究包括 447 名急性冠脉综合征 (ACS) 患者。花生四烯酸（AA）或二磷酸腺苷（ADP）诱导的血小板纤维蛋白凝块强度（MA（AA）或MA（ADP））分别指示阿司匹林或氯吡格雷治疗后的净残留血小板反应性。 AA%或ADP%是AA或ADP途径血小板相对抑制率的指标。我们发现，即使在调整混杂因素后，每个参数单独也能预测 6 个月缺血事件的风险。然而，当进一步调整 MA(AA) 后，AA% 与临床结果之间的关联消失。同样，MA(ADP) 的纳入改变了 ADP% 与临床结果之间的显着关系。通过接受者操作特征分析，MA(ADP) > 47.0 mm 和 MA(AA) > 15.1 mm 被确定为最佳截止值。当高 MA(AA)（HR = 3.963；95% CI：1.152-13.632；P = 0.029）和高 MA（ADP）（HR = 5.185；95% CI：2.228-12.062；P < 0.001）均纳入多变量 Cox 回归风险模型时，两者是独立的预测因子。有趣的是，同时存在高 MA(AA) 和高 MA(ADP) 的风险更高（HR = 7.870；95% CI：3.462-17.899；P < 0.001）。我们的结论是，当进行 TEG 来预测临床疗效时，残余血小板反应性优于血小板抑制率，作为 ACS 后接受阿司匹林和氯吡格雷治疗的患者血栓形成风险的衡量标准。
Although thrombelastography (TEG) has been widely implemented in the clinical setting of endovascular intervention, consensus on the optimal parameter for defining high ischemic risk patients is lacking due to the limited data about the relationship between various TEG parameters and clinical outcomes. In this article, we report a post hoc analysis of a prospective, single-center cohort study, including 447 patients with acute coronary syndrome (ACS). Arachidonic acid (AA)- or adenosine diphosphate (ADP)-induced platelet-fibrin clot strength (MA(AA) or MA(ADP)) was indicative of the net residual platelet reactivity after the treatment with aspirin or clopidogrel, respectively. AA% or ADP% was indices of the relative platelet inhibition rate on AA or ADP pathway. We found that each parameter alone was predictive of the risk of 6-month ischemic event, even after adjusting for confounding factors. However, the association between AA% and clinical outcome disappeared when further adjusted for MA(AA). Likewise, inclusion of MA(ADP) changed the significant relation between ADP% and clinical outcome. MA(ADP) > 47.0 mm and MA(AA) > 15.1 mm were identified as the optimal cutoffs by receiver operating characteristic analysis. High MA(AA) (HR = 3.963; 95% CI: 1.152-13.632; P = 0.029) and high MA(ADP) (HR = 5.185; 95% CI: 2.228-12.062; P < 0.001) were independent predictors when both were included in multivariable Cox regression hazards model. Interestingly, an even higher risk was found for the coexisting high MA(AA) and high MA(ADP) (HR = 7.870; 95% CI: 3.462-17.899; P < 0.001). We conclude that when performing TEG to predict clinical efficacy, residual platelet reactivity has superiority over platelet inhibition rate as a measure of thrombotic risk in patients treated with aspirin and clopidogrel after ACS.