van Werkum J W, Harmsze A M, Elsenberg E H A M, Bouman H J, ten Berg J M, Hackeng C M
Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands.
Platelets. 2008 Nov;19(7):479-88. doi: 10.1080/09537100802317918.
Multiple studies have demonstrated the effectiveness of dual or triple antiplatelet therapy with aspirin, clopidogrel and glycoprotein (GP) IIb/IIIa therapy in patients with acute coronary syndromes as well as in patients undergoing coronary stent implantation. In the last few years, it is becoming clear that not all patients receive the full benefits with the current standard dosages of antiplatelet therapy. Specifically, numerous studies have revealed a wide interindividual variability in the response to these antiplatelet agents and, more importantly, both nonresponsiveness as well as a heightened residual platelet reactivity have been linked to the occurrence of adverse cardiovascular events. Therefore, assays that identify those patients with an impaired responsiveness or a heightened platelet reactivity despite dual antiplatelet therapy may contribute to better risk stratification and will probably improve clinical outcome when appropriate action is initiated. Likewise, a considerable number of patients do not achieve the minimal inhibition of aggregation threshold with the current recommended weight-adjusted dosages of GP IIb/IIIa therapy. Identifying and optimizing the absolute degree of platelet inhibition in this subgroup of patients will probably improve clinical outcome. The VerifyNow platform is one of the most user friendly point-of-care platelet function test systems because it produces rapid results at the patient bedside. The purpose of the present paper is to give insight into the principal mechanisms of the VerifyNow system, to discuss its clinical utility for the monitoring of antiplatelet therapy and to discuss the proposed cut-off levels to segregate responders from non-responders for the different types of antiplatelet therapy.
多项研究已证明，对于急性冠脉综合征患者以及接受冠状动脉支架植入术的患者，采用阿司匹林、氯吡格雷和糖蛋白（GP）IIb/IIIa治疗的双联或三联抗血小板疗法是有效的。在过去几年中，越来越明显的是，并非所有患者都能从当前标准剂量的抗血小板治疗中获得全部益处。具体而言，大量研究表明，个体对这些抗血小板药物的反应存在很大差异，更重要的是，无反应以及残余血小板反应性增强均与不良心血管事件的发生有关。因此，能够识别那些尽管接受双联抗血小板治疗但反应性受损或血小板反应性增强的患者的检测方法，可能有助于更好地进行风险分层，并且在采取适当措施时可能会改善临床结局。同样，相当数量的患者在目前推荐的体重调整剂量的GP IIb/IIIa治疗下，并未达到聚集抑制阈值的最小抑制。识别并优化该亚组患者血小板抑制的绝对程度可能会改善临床结局。VerifyNow平台是最便于用户操作的即时血小板功能检测系统之一，因为它能在患者床边快速得出结果。本文的目的是深入了解VerifyNow系统的主要机制，讨论其在监测抗血小板治疗方面的临床应用，并讨论针对不同类型抗血小板治疗区分反应者与无反应者的建议临界值。
