McCloskey Donna Jo, Postolache Teodor T, Vittone Bernard J, Nghiem Khanh L, Monsale Jude L, Wesley Robert A, Rick Margaret E
National Institutes of Health, Warren Grant Magnuson Clinical Center, Department of Laboratory Medicine, Bethesda, MD 20892, USA.
Transl Res. 2008 Mar;151(3):168-72. doi: 10.1016/j.trsl.2007.10.004. Epub 2007 Nov 20.
Selective serotonin reuptake inhibitors (SSRIs) reduce platelet serotonin and are associated with increased gastrointestinal bleeding, an effect that is enhanced when taken with NSAIDs or aspirin. The best method to evaluate hemorrhagic events in patients taking SSRIs has not been determined. Platelet aggregation, which is not widely available, shows SSRI inhibition of platelet function; we tested whether a platelet function analyzer could detect SSRI inhibition of platelet function. Two groups of outpatients with mood disorders were recruited; each patient was taking a stable dose of either an SSRI or bupropion for at least 6 weeks. They were tested using the platelet function analyzer-100 (PFA-100; Dade International Inc, Miami, Fla) concomitantly with platelet aggregation. Fifty-eight patients were analyzed. We detected significant differences between the groups using aggregation methods with arachidonic acid (aggregation, P = 0.00001; release, P = 0.009) and collagen (aggregation, P = 0.016; release, P = 0.006). The PFA-100 did not detect differences between the groups or results outside the reference range. The PFA-100 does not detect the inhibitory effects of SSRIs on platelet function, but it can be used to direct evaluation of bleeding in a patient taking an SSRI. Abnormal PFA-100 results suggest additional evaluation for von Willebrand disease, other platelet inhibitory medications, or underlying intrinsic platelet dysfunction.
选择性5-羟色胺再摄取抑制剂（SSRI）可降低血小板5-羟色胺水平，并与胃肠道出血增加有关，当与非甾体抗炎药或阿司匹林合用时，这种作用会增强。评估服用SSRI患者出血事件的最佳方法尚未确定。血小板聚集试验虽未广泛应用，但显示SSRI可抑制血小板功能；我们测试了血小板功能分析仪能否检测出SSRI对血小板功能的抑制作用。招募了两组患有情绪障碍的门诊患者；每位患者服用稳定剂量的SSRI或安非他酮至少6周。他们同时使用血小板功能分析仪-100（PFA-100；达德国际公司，迈阿密，佛罗里达州）和血小板聚集试验进行检测。对58名患者进行了分析。我们使用花生四烯酸聚集法（聚集，P = 0.00001；释放，P = 0.009）和胶原聚集法（聚集，P = 0.016；释放，P = 0.006）检测出两组之间存在显著差异。PFA-100未检测出两组之间的差异或超出参考范围的结果。PFA-100无法检测出SSRI对血小板功能的抑制作用，但可用于指导对服用SSRI患者的出血情况进行评估。PFA-100结果异常提示需进一步评估是否患有血管性血友病、其他血小板抑制药物或潜在的先天性血小板功能障碍。
