Michelson Alan D, Frelinger Andrew L, Furman Mark I
Center for Platelet Function Studies, Division of Cardiovascular Medicine, Department of Pediatrics and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Am J Cardiol. 2006 Nov 20;98(10A):4N-10N. doi: 10.1016/j.amjcard.2006.09.008. Epub 2006 Sep 29.
The variable response to antiplatelet therapy has led to the use of platelet function tests to monitor the effects of antiplatelet drugs in cardiovascular diseases. The goal is to guide antiplatelet therapy to the optimal dose for the prevention or treatment of thrombosis while minimizing hemorrhagic side effects. The bleeding time is no longer recommended for use because of its nonspecificity and lack of clinical correlations. The current de facto "gold standard" test of platelet function is turbidometric platelet aggregometry. Although this method has been successful in measuring the aggregation of platelets in a glycoprotein (GP) IIb/IIIa (integrin alpha(IIb)beta(3))-dependent manner, it has several limitations, including poor reproducibility, high sample volume, requirement for sample preparation, length of assay time, requirement for a skilled technician, and cost. Therefore, new options for platelet function testing have been developed to address these disadvantages and to meet the need for point-of-care testing that can be performed at or near a patient's bedside without requiring a high degree of technical expertise. The new tests include VerifyNow (Accumetrics, San Diego, CA); Plateletworks (Helena Laboratories, Beaumont, TX); Thrombelastograph PlateletMapping System (Haemoscope Corporation, Niles, IL); Impact cone and plate(let) analyzer (DiaMed, Cressier, Switzerland); and Platelet Function Analyzer 100 (PFA-100; Dade Behring, Newark, DE). In patients treated with antiplatelet drugs, the degree of platelet inhibition, as determined by several of these new platelet function assays, has been shown to predict major adverse cardiac events.
抗血小板治疗反应的变异性促使人们使用血小板功能检测来监测抗血小板药物在心血管疾病中的疗效。目的是将抗血小板治疗引导至预防或治疗血栓形成的最佳剂量，同时将出血副作用降至最低。由于出血时间缺乏特异性且与临床无相关性，已不再推荐使用。目前血小板功能的实际“金标准”检测方法是比浊法血小板聚集试验。尽管该方法已成功地以糖蛋白（GP）IIb/IIIa（整合素α（IIb）β（3））依赖性方式测量血小板聚集，但它有几个局限性，包括重复性差、样本量要求高、需要样本制备、检测时间长、需要技术熟练的技术人员以及成本高。因此，已开发出血小板功能检测的新方法来解决这些缺点，并满足即时检测的需求，即时检测可在患者床边或附近进行，无需高度的技术专长。这些新检测方法包括VerifyNow（Accumetrics公司，加利福尼亚州圣地亚哥）；Plateletworks（Helena Laboratories公司，得克萨斯州博蒙特）；血栓弹力图血小板功能分析系统（Haemoscope Corporation公司，伊利诺伊州奈尔斯）；冲击圆锥平板（血小板）分析仪（DiaMed公司，瑞士克雷西耶）；以及血小板功能分析仪100（PFA - 100；Dade Behring公司，特拉华州纽瓦克）。在接受抗血小板药物治疗的患者中，通过几种这些新的血小板功能检测方法确定的血小板抑制程度已被证明可预测主要不良心脏事件。
