Department of Anesthesiology, Critical Care and Pain Medicine, Lady Davis Carmel Medical Center, affiliated to Technion-Israel Institute of Technology, Haifa, Israel.
Eur J Anaesthesiol. 2010 Jul;27(7):617-23. doi: 10.1097/EJA.0b013e328335b354.
Recent evidence indicates that platelet function may recover more rapidly after cessation of aspirin therapy than previously thought. The present study evaluated the effect of aspirin on platelet function using platelet aggregometry in healthy individuals and in aspirin-treated patients scheduled for surgery.
Platelet aggregation in response to arachidonic acid, epinephrine, and adenosine diphosphate was determined in 14 male volunteers during and after 10 days' aspirin administration (100 mg) and in 58 aspirin-treated patients during intake, on days 3, 4 or 6 after drug cessation, and on day 10 after drug cessation, prior to elective surgery. Urine thromboxane (11-dehydro-thromboxane B2) concentrations were also measured.
Platelet aggregation in response to arachidonic acid and epinephrine was significantly decreased in both volunteers and patients during aspirin administration. The aggregation normalized within 3 days of aspirin cessation in the volunteers and within 4-6 days in the patients. Urine concentration of 11-dehydro-thromboxane B2 was about three times lower with aspirin treatment than without, although in two patients concentrations were higher with aspirin.
Platelet aggregometry with arachidonic acid is a sensitive test for the evaluation of the effects of aspirin on platelet function. In most aspirin-treated patients, platelet function recovers 4 days after drug cessation, although the process is sometimes prolonged. Therefore, the time of aspirin cessation before scheduled surgery should be determined individually.
最近的证据表明,血小板功能在停止阿司匹林治疗后可能比之前认为的恢复得更快。本研究评估了阿司匹林对健康个体和接受阿司匹林治疗计划手术的患者血小板功能的影响,使用血小板聚集仪进行评估。
在 14 名男性志愿者中,在服用阿司匹林(100mg)的 10 天期间和之后,以及在 58 名接受阿司匹林治疗的患者在服药期间、停药后第 3、4 或 6 天以及停药后第 10 天,在接受择期手术前,测定了对花生四烯酸、肾上腺素和二磷酸腺苷的血小板聚集反应。还测量了尿液血栓素(11-去氢血栓素 B2)浓度。
在志愿者和患者中,阿司匹林给药期间,对花生四烯酸和肾上腺素的血小板聚集均显著降低。在志愿者中,阿司匹林停药后 3 天内恢复正常,在患者中 4-6 天内恢复正常。与未服用阿司匹林相比,服用阿司匹林后尿液中 11-去氢血栓素 B2 的浓度降低了约三倍,但在两名患者中,服用阿司匹林后浓度升高。
用花生四烯酸进行血小板聚集试验是评估阿司匹林对血小板功能影响的敏感试验。在大多数接受阿司匹林治疗的患者中,停药后 4 天血小板功能恢复,但有时过程会延长。因此,应根据个体情况确定计划手术前阿司匹林停药的时间。