Kotzailias Nicole, Elwischger Kirsten, Sycha Thomas, Rinner Walter, Quehenberger Peter, Auff Eduard, Müller Christian
Department of Neurology, Medical University Vienna, Austria.
J Stroke Cerebrovasc Dis. 2007 Sep-Oct;16(5):199-202. doi: 10.1016/j.jstrokecerebrovasdis.2007.05.001.
The administration of an adenosine diphosphate (ADP) receptor antagonist, such as clopidogrel, is recommended for recurrent stroke patients under aspirin treatment. However, up to 25% of vascular patients have an inadequate response to clopidogrel treatment, which could be associated with increased reinfarction rates. This study investigated whether the platelet function analyzer (PFA-100) system represents an appropriate tool for monitoring clopidogrel's antiplatelet effects in stroke patients. Sixteen stroke patients on clopidogrel therapy (75 mg/day) were included in a prospective analyst-blinded, cross-sectional study. Platelet function was assayed by collagen/epinephrine (CEPI)- and collagen/ADP (CADP)-induced closure times (CTs) using the PFA-100 system. von Willebrand factor antigen (vWF-Ag) levels were measured by enzyme immunoassay. CEPI-CT and CADP-CT values averaged 160 +/- 15 seconds and 102 +/- 10 seconds, respectively, and were in the normal range. vWF-Ag concentrations averaged 153 +/- 17% and correlated inversely with CTs (r = .71; P < .002 for CEPI-CT, r = .54; P < .04 for CADP-CT). Our data indicate that the current PFA-100 cartridges are not sufficiently sensitive to detect clopidogrel-induced platelet inhibition in stroke patients.
对于正在接受阿司匹林治疗的复发性中风患者，建议给予二磷酸腺苷（ADP）受体拮抗剂，如氯吡格雷。然而，高达25%的血管疾病患者对氯吡格雷治疗反应不佳，这可能与再梗死率增加有关。本研究调查了血小板功能分析仪（PFA-100）系统是否是监测氯吡格雷在中风患者中抗血小板作用的合适工具。16名接受氯吡格雷治疗（75毫克/天）的中风患者被纳入一项前瞻性、分析者盲法的横断面研究。使用PFA-100系统通过胶原/肾上腺素（CEPI）和胶原/ADP（CADP）诱导的封闭时间（CT）来测定血小板功能。采用酶免疫测定法测量血管性血友病因子抗原（vWF-Ag）水平。CEPI-CT和CADP-CT值分别平均为160±15秒和102±10秒，均在正常范围内。vWF-Ag浓度平均为153±17%，与CT呈负相关（CEPI-CT的r = 0.71；P < 0.002，CADP-CT的r = 0.54；P < 0.04）。我们的数据表明，目前的PFA-100检测杯对检测氯吡格雷诱导的中风患者血小板抑制作用不够敏感。
