亚急性支架血栓形成患者中剪切诱导的血小板聚集增强：一项病例对照研究。

Enhanced shear-induced platelet aggregation in patients who experience subacute stent thrombosis: a case-control study.

作者信息

Ajzenberg Nadine, Aubry Pierre, Huisse Marie-Genevieve, Cachier Agnés, El Amara Walid, Feldman Laurent J, Himbert Dominique, Baruch Dominique, Guillin Marie-Claude, Steg Ph Gabriel

机构信息

Hématologie et Immunologie, Hôpital Bichat, Paris, France.

出版信息

J Am Coll Cardiol. 2005 Jun 7;45(11):1753-6. doi: 10.1016/j.jacc.2004.10.079.

DOI:10.1016/j.jacc.2004.10.079

PMID:15936600

Abstract

OBJECTIVES

The goal of this study was to identify differences in shear-induced platelet aggregation (SIPA) between patients who did or did not experience subacute stent thrombosis (SAT).

BACKGROUND

Despite dual antiplatelet therapy, SAT after coronary stenting occurs in approximately 1% of patients. There is no accepted platelet function test to identify patients at risk.

METHODS

We analyzed platelet aggregation in 10 patients who had experienced SAT (cases), 22 stented patients without SAT (controls), and 17 healthy volunteers (normals). All patients except normals were treated with both aspirin and clopidogrel.

RESULTS

Shear-induced platelet aggregation was higher in cases than in controls at both shear rates of 200 s(-1) (40.9 +/- 12.2% vs. 18.2 +/- 18%, p = 0.013) and 4,000 s(-1) (57.4 +/- 16.4% vs. 23.4 +/- 21.2%, p = 0.009). Moreover, SIPA in cases was significantly higher than in normals both at 200 s(-1) (p = 0.013) and 4,000(-1) (p = 0.009).

CONCLUSIONS

Shear-induced platelet aggregation is increased in patients experiencing SAT compared with controls receiving dual antiplatelet therapy and to normals receiving no antiplatelet therapy, which suggests increased intrinsic patient-related platelet reactivity in patients with SAT. The predictive value of SIPA for SAT requires prospective investigation.

摘要

目的

本研究的目的是确定发生或未发生亚急性支架内血栓形成（SAT）的患者之间在剪切诱导的血小板聚集（SIPA）方面的差异。

背景

尽管采用了双联抗血小板治疗，但冠状动脉支架置入术后仍有大约1%的患者发生SAT。目前尚无公认的血小板功能检测方法来识别有风险的患者。

方法

我们分析了10例发生SAT的患者（病例组）、22例未发生SAT的支架置入患者（对照组）和17名健康志愿者（正常组）的血小板聚集情况。除正常组外，所有患者均接受阿司匹林和氯吡格雷治疗。

结果

在剪切速率为200 s(-1)时（40.9±12.2%对18.2±18%，p = 0.013）和4000 s(-1)时（57.4±16.4%对23.4±21.2%，p = 0.009），病例组的剪切诱导血小板聚集均高于对照组。此外，在200 s(-1)时（p = 0.013）和4000 s(-1)时（p = 0.009），病例组的SIPA均显著高于正常组。