von Beckerath Nicolas, Sibbing Dirk, Jawansky Stefan, Braun Siegmund, Morath Tanja, Vogt Wolfgang, Schömig Albert, Kastrati Adnan
Deutsches Herzzentrum, 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany.
Blood Coagul Fibrinolysis. 2010 Jan;21(1):46-52. doi: 10.1097/MBC.0b013e328332dbd4.
Multiple electrode platelet aggregometry (MEA) adenosine diphosphate (ADP) test is able to detect the platelet response to clopidogrel. The values obtained with MEA ADPtest correlate with those obtained with light transmission aggregometry and peri-interventional MEA ADPtest measurements are highly associated with the risk of early stent thrombosis after percutaneous coronary intervention. The main purpose of the present study was to correlate MEA ADPtest with the VerifyNow P2Y12 analyzer, Platelet VASP flow cytometry and the MEA ADPtest HS in order to test if these assays can substitute for each other. Blood samples from 60 consecutive patients scheduled for coronary angiography before and after administration of 600 mg of clopidogrel were analyzed. The correlation of MEA ADPtest with the other whole blood tests was moderate. The following order for the degree of correlation with MEA ADPtest for postclopidogrel values was found: MEA ADPtest HS (R = 0.83) > VerifyNow P2Y12 (R = 0.47) > Platelet VASP (R = 0.35). Of the 12 patients in the upper quintile of postclopidogrel values according to MEA ADPtest, seven were in the upper quintile according to VerifyNow P2Y12 (P < 0.001), six were in the upper quintile according to MEA ADPtest HS (P = 0.004) and three were in the upper quintile according to VASP (P = 0.63). Therefore, the studied whole blood assays cannot substitute for each other. Each assay with prognostic significance will have to undergo the ultimate test for individualized antiplatelet therapy in form of an adequately powered randomized clinical trial that shows that adjustment of antiplatelet therapy is beneficial for the patient.
多电极血小板聚集测定法（MEA）二磷酸腺苷（ADP）试验能够检测血小板对氯吡格雷的反应。MEA ADP试验获得的值与光透射聚集测定法获得的值相关，并且介入治疗期间的MEA ADP试验测量值与经皮冠状动脉介入治疗后早期支架血栓形成的风险高度相关。本研究的主要目的是将MEA ADP试验与VerifyNow P2Y12分析仪、血小板VASP流式细胞术和MEA ADP试验HS进行关联，以测试这些检测方法是否可以相互替代。对60例连续接受冠状动脉造影的患者在服用600mg氯吡格雷前后采集的血样进行分析。MEA ADP试验与其他全血检测的相关性为中等。发现氯吡格雷后值与MEA ADP试验的相关程度顺序如下：MEA ADP试验HS（R = 0.83）> VerifyNow P2Y12（R = 0.47）>血小板VASP（R = 0.35）。在根据MEA ADP试验处于氯吡格雷后值上五分位数的12例患者中，7例根据VerifyNow P2Y12处于上五分位数（P < 0.001），6例根据MEA ADP试验HS处于上五分位数（P = 0.004），3例根据VASP处于上五分位数（P = 0.63）。因此，所研究的全血检测方法不能相互替代。每种具有预后意义的检测方法都必须通过充分有力的随机临床试验形式进行个体化抗血小板治疗的最终测试，该试验表明调整抗血小板治疗对患者有益。
