Shenkman Boris, Matetzky Shlomi, Fefer Paul, Hod Hanoch, Einav Yulia, Lubetsky Aharon, Varon David, Savion Naphtali
Amalia Biron Research Institute of Thrombosis and Hemostasis, Israel.
Thromb Res. 2008;122(3):336-45. doi: 10.1016/j.thromres.2007.10.018. Epub 2007 Dec 26.
Unresponsiveness to clopidogrel or aspirin has been reported in patients with acute coronary syndrome (ACS). Platelet aggregometry (PA) and the Impact-R [Cone and Plate(let) Analyzer (CPA) technology, measuring whole blood platelet adhesion under flow conditions] were compared in detecting laboratory unresponsiveness to clopidogrel and aspirin among ACS patients. Platelet-rich plasma (PRP) samples were evaluated in 404 patients by PA using adenosine diphosphate (ADP) and arachidonic acid (AA) and whole blood samples by the Impact-R ADP- and AA-response tests. The first cohort (n=114) was assayed by PA on days 1 and 4 of the onset of ACS. A patient with relative decrease of </=10% in ADP-induced maximal platelet aggregation after clopidogrel treatment was defined as laboratory non-responding (NR) patient to clopidogrel. This relative value correlated well with an absolute value of ADP-induced aggregation >/=70%. A patient with an absolute value of AA-induced maximal aggregation >/=60% was defined as laboratory NR patient to aspirin. The second cohort (n=290) was tested on day 4 by both systems and results analyzed by receiver operating characteristic curve. The following cut-off values of the Impact-R surface coverage were obtained: </=2.8% and </=3.4% for clopidogrel and aspirin NR patients, respectively. The incidence of NR patients to clopidogrel and aspirin, according to the two methods was 27% and 22%, respectively. Impact-R compared to PA in detecting clopidogrel and aspirin NR patients revealed: 79% and 82% agreement, 71% and 73% sensitivity, 83% and 86% specificity, respectively. In conclusion, the Impact-R and PA results demonstrated high degree of similarity.
据报道，急性冠状动脉综合征（ACS）患者对氯吡格雷或阿司匹林无反应。在检测ACS患者中实验室对氯吡格雷和阿司匹林无反应的情况时，比较了血小板聚集测定法（PA）和Impact-R[锥板（血小板）分析仪（CPA）技术，用于测量流动条件下的全血血小板黏附]。404例患者的富血小板血浆（PRP）样本通过PA使用二磷酸腺苷（ADP）和花生四烯酸（AA）进行评估，全血样本通过Impact-R的ADP和AA反应试验进行评估。第一组（n=114）在ACS发病第1天和第4天通过PA进行检测。氯吡格雷治疗后ADP诱导的最大血小板聚集相对降低≤10%的患者被定义为实验室对氯吡格雷无反应（NR）患者。该相对值与ADP诱导聚集的绝对值≥70%密切相关。AA诱导的最大聚集绝对值≥60%的患者被定义为实验室对阿司匹林无反应患者。第二组（n=290）在第4天通过两种系统进行检测，并通过受试者操作特征曲线分析结果。获得了Impact-R表面覆盖率的以下临界值：氯吡格雷和阿司匹林无反应患者分别为≤2.8%和≤3.4%。根据这两种方法，氯吡格雷和阿司匹林无反应患者的发生率分别为27%和22%。在检测氯吡格雷和阿司匹林无反应患者方面，与PA相比，Impact-R显示：一致性分别为79%和82%，敏感性分别为71%和73%，特异性分别为83%和86%。总之，Impact-R和PA的结果显示出高度相似性。
