Velik-Salchner Corinna, Maier Stephan, Innerhofer Petra, Streif Werner, Klingler Anton, Kolbitsch Christian, Fries Dietmar
Department of Anesthesiology and Intensive Care Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
Anesth Analg. 2008 Dec;107(6):1798-806. doi: 10.1213/ane.0b013e31818524c1.
We determined whether whole blood impedance aggregometry using the Multiplate detects the effects of antiplatelet drugs as reliably as does classical light transmission aggregometry (LTA) or the platelet function analyzer PFA-100(R).
Multiplate (M) assays, measuring changes in electrical resistance as aggregation units over time (AU*min), and LTA assays induced by collagen (COL), adenosine diphosphate (ADP) or arachidonic acid (AA) and PFA-100 testing, using epinephrine (PFA100-EPI) or ADP (PFA100-ADP) cartridges, were performed simultaneously using arterial blood samples obtained before induction of anesthesia in 70 consecutive patients scheduled for elective coronary artery bypass grafting. Patients in group A (n = 48) served as controls, patients in group B (n = 11) received aspirin 100 mg/d and those in group C (n = 11) aspirin 100 mg/d and clopidogrel 75 mg/d until the day before surgery.
In controls the median (1st, 3rd quartiles) change in impedance AU*min for M-COL (374 [231-469]) was significantly greater than in patients receiving aspirin (164 [86-211], P = 0.0009) or receiving aspirin and clopidogrel (118 [101-244], P = 0.004). M-ADP values in controls were 258 (158-389), in patients receiving aspirin 261 (159-393), and in patients receiving aspirin and clopidogrel 88 (48-231, P = 0.054). M-AA values were significantly lower in patients receiving aspirin alone (45 [28-60], P = 0.0004) or aspirin and clopidogrel (44 [26-221], P = 0.008) than in controls (200 [86-345]). The areas under the receiver operating characteristic curves indicating the ability to discriminate patients taking aspirin from those not taking aspirin were comparable for COL and AA assays using whole blood impedance aggregometry or classical LTA (M-COL 0.84 [P = 0.001], LTA-COL 0.85 [P = < .001], M-AA 0.84 [P = < .001] and LTA-AA 0.87 [P = < .001]), but only 0.74 for PFA-100-EPI (P = 0.03). Similarly, for discrimination of patients not taking antiplatelet drugs from patients taking clopidogrel and aspirin the areas under the receiver operating characteristic curve were also comparable for both aggregometry methods M-COL 0.77 (P = 0.006), LTA-COL 0.78 (P = 0.004), M-ADP 0.74 (P = 0.015), LTA-ADP 0.73 (P = 0.018).
Results achieved with the bedside Multiplate assays were not different than those obtained with classical aggregometry for detecting the effects of aspirin and clopidogrel in preoperative patients scheduled for elective cardiac surgery.
我们确定了使用多电极血小板功能分析仪（Multiplate）进行全血阻抗凝集试验检测抗血小板药物的效果是否与传统的光透射凝集试验（LTA）或血小板功能分析仪PFA - 100(R)一样可靠。
对70例择期冠状动脉搭桥手术患者在麻醉诱导前采集动脉血样本，同时进行多电极血小板功能分析仪（M）检测，测量电阻抗随时间变化的聚集单位（AU*min）；进行由胶原（COL）、二磷酸腺苷（ADP）或花生四烯酸（AA）诱导的LTA检测；以及使用肾上腺素（PFA100 - EPI）或ADP（PFA100 - ADP）检测卡的PFA - 100检测。A组（n = 48）患者作为对照，B组（n = 11）患者接受阿司匹林100 mg/d，C组（n = 11）患者接受阿司匹林100 mg/d和氯吡格雷75 mg/d直至手术前一天。
在对照组中，M - COL的阻抗AU*min变化中位数（第1、3四分位数）为374（231 - 469），显著高于接受阿司匹林的患者（164 [86 - 211]，P = 0.0009）或接受阿司匹林和氯吡格雷的患者（118 [101 - 244]，P = 0.004）。对照组的M - ADP值为258（158 - 389），接受阿司匹林的患者为261（159 - 393），接受阿司匹林和氯吡格雷的患者为88（48 - 231，P = 0.054）。单独接受阿司匹林（45 [28 - 60]，P = 0.0004）或阿司匹林和氯吡格雷（44 [26 - 221]，P = 0.008）的患者的M - AA值显著低于对照组（200 [86 - 345]）。用于区分服用阿司匹林患者和未服用阿司匹林患者的受试者工作特征曲线下面积，使用全血阻抗凝集试验或传统LTA的COL和AA检测结果相当（M - COL为0.84 [P = 0.001]，LTA - COL为0.85 [P = <.001]，M - AA为0.84 [P = <.001]，LTA - AA为0.87 [P = <.001]），但PFA - 100 - EPI仅为0.74（P = 0.03）。同样，对于区分未服用抗血小板药物的患者与服用氯吡格雷和阿司匹林的患者，两种凝集试验方法的受试者工作特征曲线下面积也相当，M - COL为0.77（P = 0.006），LTA - COL为0.78（P = 0.004），M - ADP为0.74（P = 0.015），LTA - ADP为0.73（P = 0.018）。
对于择期心脏手术术前患者，床边多电极血小板功能分析仪检测结果与传统凝集试验检测阿司匹林和氯吡格雷效果的结果无差异。
