Reversal of the anti-platelet effects of aspirin and clopidogrel
Reversal of the anti-platelet effects of aspirin and clopidogrel
复制标题
逆转阿司匹林和氯吡格雷的抗血小板作用
DOI：
10.1111/j.1538-7836.2012.04641.x
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发表时间：
2012-04-01
影响因子：
10.4
通讯作者：
Eikelboom, J. W.
中科院分区：
文献类型：
--
作者：
Li, C.;Hirsh, J.;Eikelboom, J. W.
。背景：指南建议在手术前7 - 10天停用阿司匹林和氯吡格雷，以便有时间将永久抑制的血小板替换为新释放的未抑制的血小板。目的：本研究的目的是确定阿司匹林和氯吡格雷停止治疗后抗血小板作用的抵消率，以及未治疗的供体血小板逆转其抗血小板作用所需的比例。方法：队列1包括15名健康受试者，服用阿司匹林81 mg day-1或氯吡格雷75 mg day-1，连续7天，并进行连续采血，直到血小板功能检测结果正常化。队列2由36名健康受试者组成，他们分别接受阿司匹林325 mg day-1、氯吡格雷75 mg day-1、阿司匹林81 mg day-1加氯吡格雷75 mg day-1或不接受治疗7天，并进行一次血液采样。结果：在队列1中，所有受试者在停用阿司匹林4天内，花生四烯酸（AA）诱导的光透射聚集（LTA）恢复到基线水平，与血浆血栓素B2浓度部分恢复一致。adp诱导的LTA直到停用氯吡格雷10天后才恢复到基线水平。在队列2中，接受阿司匹林治疗的患者在与30%未经治疗的供体血小板混合后aa诱导的LTA达到控制水平，而接受氯吡格雷治疗的患者只有在加入90%或更多的供体血小板后adp诱导的LTA才达到控制水平。结论：停药后4天内血小板聚集恢复，但氯吡格雷必须停药10天才能达到正常的聚集反应。
. Background: Guidelines recommend stopping aspirin and clopidogrel 7 to 10 days before surgery to allow time for replacement of permanently inhibited platelets by newly released uninhibited platelets.Objectives: The purpose of the present study was to determine the rate of offset of the anti-platelet effects of aspirin and clopidogrel after stopping treatment and the proportion of untreated donor platelets that are required to reverse their anti-platelet effects.Methods: Cohort 1 consisted of 15 healthy subjects who received aspirin 81 mg day-1 or clopidogrel 75 mg day-1 for 7 days and underwent serial blood sampling until platelet function testing results normalized. Cohort 2 consisted of 36 healthy subjects who received aspirin 325 mg day-1, clopidogrel 75 mg day-1, aspirin 81 mg day-1 plus clopidogrel 75 mg day-1 or no treatment for 7 days and underwent a single blood sampling.Results: In cohort 1, arachidonic acid (AA)-induced light transmission aggregation (LTA) returned to baseline levels in all subjects within 4 days of stopping aspirin, coinciding with the partial recovery of plasma thromboxane B2 concentrations. ADP-induced LTA did not return to baseline levels until 10 days after stopping clopidogrel. In cohort 2, AA-induced LTA in patient treated with aspirin reached control levels after mixing with 30% untreated donor platelets whereas ADP-induced LTA in patients treated with clopidogrel reached control levels only after the addition of 90% or more donor platelets.Conclusions: Platelet aggregation recovers within 4 days of stopping aspirin but clopidogrel must be stopped for 10 days to achieve a normal aggregatory response.