Madan Mina, Berkowitz Scott D, Christie Douglas J, Smit Astrid C, Sigmon Kristina N, Tcheng James E
Duke Clinical Research Institute, Durham, NC, USA.
Am Heart J. 2002 Jul;144(1):151-8. doi: 10.1067/mhj.2002.123581.
A simple device to rapidly evaluate platelet function may aid in optimizing glycoprotein IIb/IIIa inhibition during percutaneous coronary intervention (PCI). We prospectively studied platelet function in 250 patients receiving abciximab or eptifibatide during PCI.
The platelet function analyzer PFA-100 (Dade-Behring, Deerfield, Ill) measures platelet function by determining the time to occlusion of an aperture in a biochemically active membrane as whole blood flows under high shear conditions. Platelet aggregation causes aperture occlusion, and results are reported as a closure time (CT). All patients received either abciximab or eptifibatide, along with aspirin and heparin; patients undergoing stent implantation received aspirin and a thienopyridine postprocedure. The CT was measured at baseline and 10 minutes, 4 hours, 12 hours (abciximab-only), and 24 hours after the bolus. Profound inhibition was exhibited in most patients shortly after the platelet inhibitor bolus and during the course of therapy. We observed recovery of platelet function 12 hours after discontinuation of abciximab, with a high degree of interpatient variability, and ongoing profound platelet inhibition 4 to 6 hours after the discontinuation of eptifibatide. Among patients treated with abciximab, patients who were obese recovered from platelet inhibition sooner than patients who were not obese, whereas patients who were elderly had delayed recovery compared with patients who were not elderly. Failure to achieve maximal platelet inhibition (nonclosure) at 10 minutes indicated a possible association with adverse clinical events at the 6-month follow-up examination (60% vs 20%).
PFA-100 is a rapid simple assay used as a means of assessing inhibition of platelet aggregation during PCI performed with glycoprotein IIb/IIIa inhibition. Failure to achieve nonclosure early after the initiation of abciximab therapy warrants further investigation because there may be an association with adverse cardiac events at 6-month follow-up.
一种能快速评估血小板功能的简单装置可能有助于在经皮冠状动脉介入治疗（PCI）期间优化糖蛋白IIb/IIIa抑制作用。我们前瞻性地研究了250例在PCI期间接受阿昔单抗或依替巴肽治疗的患者的血小板功能。
血小板功能分析仪PFA - 100（达德 - 拜林公司，伊利诺伊州迪尔菲尔德）通过在高剪切条件下全血流动时测定生化活性膜上小孔闭塞时间来测量血小板功能。血小板聚集导致小孔闭塞，结果以封闭时间（CT）报告。所有患者均接受阿昔单抗或依替巴肽治疗，同时服用阿司匹林和肝素；接受支架植入的患者术后服用阿司匹林和噻吩吡啶。在推注后基线、10分钟、4小时、12小时（仅阿昔单抗组）和24小时测量CT。在血小板抑制剂推注后不久及治疗过程中，大多数患者表现出深度抑制。我们观察到停用阿昔单抗12小时后血小板功能恢复，患者间差异很大，而停用依替巴肽4至6小时后仍有持续的深度血小板抑制。在接受阿昔单抗治疗的患者中，肥胖患者比非肥胖患者血小板抑制恢复得更快，而老年患者与非老年患者相比恢复延迟。10分钟时未达到最大血小板抑制（未封闭）表明在6个月随访检查时可能与不良临床事件相关（60%对20%）。
PFA - 100是一种快速简单的检测方法，用于评估在使用糖蛋白IIb/IIIa抑制的PCI期间血小板聚集的抑制情况。阿昔单抗治疗开始后早期未达到未封闭状态值得进一步研究，因为这可能与6个月随访时的不良心脏事件相关。
