Department of Cardiology, CHU Timone, Marseille, France.
Arch Cardiovasc Dis. 2010 Jan;103(1):39-45. doi: 10.1016/j.acvd.2009.11.004. Epub 2010 Jan 25.
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.
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。
Thromb Haemost. 2009-2
Ann Indian Acad Neurol. 2024-9-1
Front Cardiovasc Med. 2022-7-1
J Vasc Interv Neurol. 2017-1
J Atheroscler Thromb. 2016-10-1