High On-Treatment Platelet Reactivity as Predictor of Long-term Clinical Outcomes in Stroke Patients with Antiplatelet Agents
High On-Treatment Platelet Reactivity as Predictor of Long-term Clinical Outcomes in Stroke Patients with Antiplatelet Agents
复制标题
治疗中血小板高反应性是使用抗血小板药物的中风患者长期临床结果的预测因子
DOI：
10.1007/s12975-021-00949-7
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发表时间：
2021-10-01
影响因子：
6.9
通讯作者：
Han, Yan
中科院分区：
文献类型：
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作者：
Lv, Huihui;Yang, Zidong;Han, Yan
目的是探讨高治疗期血小板反应性（HTPR）在预测脑卒中患者长期临床结局中的价值。在脑卒中患者每日使用75 mg氯吡格雷或100 mg阿司匹林后，用VerifyNow系统检测血小板反应性。氯吡格雷的HTPR定义为PRU≥208，阿司匹林的HTPR定义为ARU≥550。使用Sequenom MassARRAY iPLEX平台进行CYP2C19基因分型。主要终点为复发性缺血性卒中、短暂性缺血性发作、心肌梗死或缺血性血管性死亡。安全终点是出血。在氯吡格雷组，在招募的345例患者中，174例被归类为HTPR。对270例患者进行了为期54个月的随访。HTPR与主要终点有显著相关性（HRadj2.13 [95% CI, 1.43-3.15],p< 0.001）。在314名CYP2C19基因分型的参与者中，187名（59.6%）被归类为CYP2C19功能缺失等位基因携带者。至少有1个功能缺失等位基因的患者更容易出现HTPR (ORadj2.61 [95%CI, 1.43-4.77],p= 0.008)，并且主要终点的风险更高（HRadj2.05 [95%CI, 1.30, 3.25],p= 0.002）。在阿司匹林组，在招募的140例患者中，28例被归类为HTPR。121例患者随访30个月。同样，HTPR与主要终点之间也存在显著相关性（HRadj3.28 [95% CI, 1.52-7.71],p= 0.002）。HTPR是脑卒中患者长期随访中发生缺血性事件的独立危险因素。血小板功能检测有助于评价脑卒中患者抗血小板治疗的效果。
The purpose was to explore the value of high on-treatment platelet reactivity (HTPR) in predicting long-term clinical outcomes for stroke patients. The platelet reactivity was assayed after being treated with either 75 mg clopidogrel or 100 mg aspirin daily with VerifyNow System in stroke patients. HTPR for clopidogrel was defined as PRU ≥ 208, and that for aspirin was defined as ARU ≥ 550. CYP2C19 genotyping was performed using the Sequenom MassARRAY iPLEX platform. The primary endpoint was a composite of recurrent ischemic stroke, transient ischemic attack, myocardial infarction, or ischemic vascular death. The safety endpoint was bleeding. In the clopidogrel group, among 345 patients recruited, 174 of them were categorized as HTPR. A total of 270 patients were followed up for 54 months. There was a significant association between HTPR and the primary endpoint (HRadj2.13 [95% CI, 1.43–3.15],p< 0.001). Among the 314 participants genotyped for CYP2C19, 187 (59.6%) were classified as CYP2C19 loss-of-function allele carriers. Patients with at least 1 loss-of-function allele were more likely to present with HTPR (ORadj2.61 [95%CI, 1.43–4.77],p= 0.008), and had a higher risk of the primary endpoint (HRadj2.05 [95% CI, 1.30, 3.25],p= 0.002). In the aspirin group, among 140 patients recruited, 28 of them were categorized as HTPR. A total of 121 patients were followed up for 30 months. Similarly, there was a significant association between HTPR and the primary endpoint (HRadj3.28 [95% CI, 1.52–7.71],p= 0.002). HTPR is an independent risk factor for ischemic events during long-term follow-up in stroke patients. Platelet function testing is helpful to evaluate the effect of antiplatelet therapy for stroke patients.