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氯吡格雷反应:不同血小板检测方法的头对头比较,以确定冠状动脉支架置入术后氯吡格雷无应答患者。

Clopidogrel response: head-to-head comparison of different platelet assays to identify clopidogrel non responder patients after coronary stenting.

机构信息

Department of Cardiology, CHU Timone, Marseille, France.

出版信息

Arch Cardiovasc Dis. 2010 Jan;103(1):39-45. doi: 10.1016/j.acvd.2009.11.004. Epub 2010 Jan 25.


DOI:10.1016/j.acvd.2009.11.004
PMID:20142119
Abstract

OBJECTIVES: We investigated the agreement between different platelet tests to identify clopidogrel non response. BACKGROUND: Biological definition of clopidogrel non response remains controversial. Different platelet tests have been linked with recurrent ischemic events and proposed for daily practice. METHODS: We prospectively investigated the agreement of platelet tests to isolate clopidogrel non response in patients receiving high 150 mg clopidogrel maintenance dose after coronary stenting. Clopidogrel response was assessed with ADP-induced aggregation (ADP-Ag) (non response if >70%), Platelet reactivity index VASP (PRI VASP) (non response if >50%) and Verify Now Point-of-care assay (VN) (non response if PRU > 240 AU). RESULTS: Seventy consecutive patients were included. The rates of non-responders were respectively: 13% (n = 9) with the ADP-Ag, 39% (n = 27) with the PRI VASP and 33% (n = 23) with the VN. We observed significant correlation between different platelet tests assessing clopidogrel response: r = 0.55 (p < 0.0001) for ADP-Ag and PRI VASP, r = 0.64 (p < 0.0001) for ADP-Ag and VN and r = 0.59 (p < 0.0001) for PRI VASP and VN. However, using the most common thresholds, the agreement between the difference tests was poor: 0.35 for ADP-Ag and PRI VASP, 0.36 for ADP-Ag and VN and 0.46 for PRI VASP and VN. CONCLUSION: This study showed that assessment of platelet function inhibition by clopidogrel is highly test-specific. Indeed, our results demonstrated a poor agreement between different platelet assays and suggested that identification of clopidogrel non responders is test-dependent.

摘要

目的:我们研究了不同血小板检测方法在识别氯吡格雷无反应中的一致性。

背景:氯吡格雷无反应的生物学定义仍存在争议。不同的血小板检测方法与复发性缺血事件相关,并被提议用于日常实践。

方法:我们前瞻性地研究了在接受冠状动脉支架置入术后高剂量 150 毫克氯吡格雷维持治疗的患者中,血小板检测方法在分离氯吡格雷无反应中的一致性。通过 ADP 诱导的聚集(ADP-Ag)(如果>70%则为无反应)、血小板反应指数 VASP(PRI VASP)(如果>50%则为无反应)和即时检验点护理测定法(VN)(如果 PRU>240 AU 则为无反应)评估氯吡格雷反应。

结果:共纳入 70 例连续患者。无反应者的发生率分别为:ADP-Ag 为 13%(n=9),PRI VASP 为 39%(n=27),VN 为 33%(n=23)。我们观察到不同血小板检测方法评估氯吡格雷反应之间存在显著相关性:ADP-Ag 和 PRI VASP 之间 r=0.55(p<0.0001),ADP-Ag 和 VN 之间 r=0.64(p<0.0001),PRI VASP 和 VN 之间 r=0.59(p<0.0001)。然而,使用最常见的阈值,差异检测之间的一致性较差:ADP-Ag 和 PRI VASP 之间为 0.35,ADP-Ag 和 VN 之间为 0.36,PRI VASP 和 VN 之间为 0.46。

结论:本研究表明,氯吡格雷抑制血小板功能的评估具有高度的检测特异性。实际上,我们的结果表明,不同血小板检测方法之间的一致性较差,表明氯吡格雷无反应者的识别取决于检测方法。

相似文献

[1]
Clopidogrel response: head-to-head comparison of different platelet assays to identify clopidogrel non responder patients after coronary stenting.

Arch Cardiovasc Dis. 2010-1-25

[2]
The influencing factors for clopidogrel-mediated platelet inhibition are assay-dependent.

Thromb Res. 2011-5-28

[3]
Predictive values of post-treatment adenosine diphosphate-induced aggregation and vasodilator-stimulated phosphoprotein index for stent thrombosis after acute coronary syndrome in clopidogrel-treated patients.

Am J Cardiol. 2009-10-15

[4]
Impact of P2Y12 inhibition by clopidogrel on cardiovascular mortality in unselected patients treated by percutaneous coronary angioplasty: a prospective registry.

JACC Cardiovasc Interv. 2010-6

[5]
Platelet function analysis: at the edge of meaning.

Thromb Haemost. 2009-2

[6]
Comparison of methods to evaluate clopidogrel-mediated platelet inhibition after percutaneous intervention with stent implantation.

Thromb Haemost. 2009-2

[7]
Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events.

Thromb Haemost. 2011-5-26

[8]
Comparison of conventional aggregometry with VASP for monitoring P2Y12-specific platelet inhibition.

Platelets. 2010

[9]
Differential sensitivity and kinetics of response of different ex vivo tests monitoring functional variability of platelet response to clopidogrel.

Thromb Haemost. 2010-7-20

[10]
Adrenergic receptor polymorphisms and platelet reactivity after treatment with dual antiplatelet therapy with aspirin and clopidogrel in acute coronary syndrome.

Thromb Haemost. 2010-2-2

引用本文的文献

[1]
Clopidogrel Resistance in Ischemic Stroke Patients.

Ann Indian Acad Neurol. 2024-9-1

[2]
A Sticky Situation: Variable Agreement Between Platelet Function Tests Used to Assess Anti-platelet Therapy Response.

Front Cardiovasc Med. 2022-7-1

[3]
Contemporary antiplatelet therapy for secondary stroke prevention: a narrative review of current literature and guidelines.

Stroke Vasc Neurol. 2022-10

[4]
Response to clopidogrel is associated with early neurological deterioration after acute ischemic stroke.

Oncotarget. 2018-4-13

[5]
Impact of Boosted Antiretroviral Therapy on the Pharmacokinetics and Efficacy of Clopidogrel and Prasugrel Active Metabolites.

Clin Pharmacokinet. 2018-10

[6]
Interactions among -2, and variants are associated with aspirin responsiveness and adverse events in patients with ischemic stroke.

Ther Adv Neurol Disord. 2017-3

[7]
Safety and Efficacy of Intensified Antiplatelet Therapy in Patients Undergoing Neuroendovascular Procedures.

J Vasc Interv Neurol. 2017-1

[8]
Aspirin and clopidogrel resistance using the cone and plate(let) analyser in Indian patients with coronary artery disease.

Heart Asia. 2014-11-7

[9]
Antiplatelet drug resistance is associated with early neurological deterioration in acute minor ischemic stroke in the Chinese population.

J Neurol. 2016-8

[10]
Association of Cytochrome P450 Genetic Variants with Clopidogrel Resistance and Outcomes in Acute Ischemic Stroke.

J Atheroscler Thromb. 2016-10-1

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