比较不同方法评估阿司匹林对接受双联抗血小板治疗的高危缺血性心脏病患者血小板功能的影响。

Comparison of different methods to evaluate the effect of aspirin on platelet function in high-risk patients with ischemic heart disease receiving dual antiplatelet treatment.

作者信息

Paniccia Rita, Antonucci Emilia, Gori Anna Maria, Marcucci Rossella, Poli Serena, Romano Eloisa, Valente Serafina, Giglioli Cristina, Fedi Sandra, Gensini Gian Franco, Abbate Rosanna, Prisco Domenico

机构信息

Department of Medical and Surgical Critical Care, Thrombosis Center, Center for Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases to Develop Novel Therapies, University of Florence, Italy.

出版信息

Am J Clin Pathol. 2007 Jul;128(1):143-9. doi: 10.1309/0G1PEJ00J8KP8357.

DOI:10.1309/0G1PEJ00J8KP8357

PMID:17580282

Abstract

Patients with coronary artery disease (CAD) receiving aspirin therapy with a residual platelet reactivity (RPR) may be at increased risk of ischemic vascular events. Point-of-care (POC) methods PFA-100 (Dade-Behring, Marburg, Germany) and VerifyNow (Accumetrics, San Diego, CA) assays have been suggested as rapid tools to evaluate RPR. We compared PFA-100 closure times by collagen/epinephrine and VerifyNow Aspirin assays with light transmission aggregation (LTA) induced by 1 mmol/L of arachidonic acid in 484 patients with CAD undergoing percutaneous coronary intervention and receiving dual antiplatelet therapy. RPR was detected in 30.0% of patients by LTA, in 32.4% by PFA-100, and in 14.3% by VerifyNow. Significant correlations were found among 3 methods (all P < .0001). In relation to the presence or absence of RPR by LTA and PFA-100, by LTA and VerifyNow, and by PFA-100 and VerifyNow, samples were significantly concordant (all P < .0001). Assuming LTA as the reference method, PFA-100 and VerifyNow showed sensitivity of 62.1% and 39.3% and specificity of 80.2% and 96.4%, respectively. The cutoff values for POC methods need to be defined for clinical use.

摘要

接受阿司匹林治疗但仍有残余血小板反应性（RPR）的冠心病（CAD）患者发生缺血性血管事件的风险可能会增加。即时检测（POC）方法，即PFA-100（德国马尔堡达德-拜林公司）和VerifyNow（加利福尼亚州圣地亚哥Accumetrics公司）检测，已被提议作为评估RPR的快速工具。我们比较了484例接受经皮冠状动脉介入治疗并接受双联抗血小板治疗的CAD患者，通过胶原/肾上腺素检测的PFA-100封闭时间以及VerifyNow阿司匹林检测结果与1 mmol/L花生四烯酸诱导的透光率聚集（LTA）结果。通过LTA检测，30.0%的患者存在RPR；通过PFA-100检测，32.4%的患者存在RPR；通过VerifyNow检测，14.3%的患者存在RPR。三种方法之间存在显著相关性（所有P < .0001）。就LTA和PFA-100、LTA和VerifyNow以及PFA-100和VerifyNow检测RPR的情况而言，样本具有显著的一致性（所有P < .0001）。以LTA作为参考方法，PFA-100和VerifyNow的敏感性分别为62.1%和39.3%，特异性分别为80.2%和96.4%。POC方法的临界值需要为临床应用进行定义。