Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
J Cardiovasc Pharmacol. 2010 Jul;56(1):29-37. doi: 10.1097/FJC.0b013e3181dd0ec2.
We compared platelet function results obtained with the VerifyNow P2Y12 (VN-P2Y12) point-of-care device and the light transmission aggregometry (5 and 20 microM adenosine diphosphate) method using an integrated database of eight clinical trials with a total of 591 subjects. The study was performed in healthy subjects, patients with coronary artery disease, patients with end-stage renal disease, and patients with acute coronary syndrome after treatment with prasugrel or clopidogrel. Analyses focused on loading doses of 60 mg prasugrel or 600 mg clopidogrel and daily maintenance doses of 10 mg prasugrel or 75 or 150 mg clopidogrel. Similar patterns of platelet inhibition were observed for light transmission aggregometry versus VN-P2Y12 and assay results were well correlated (r approximately 0.7), although a sigmoidal model may more accurately represent the relationship between light transmission aggregometry and VN-P2Y12, because VN-P2Y12 was relatively less sensitive to low and high levels of inhibition. The percentage of poor responders was less with prasugrel compared with clopidogrel by both assays, but the percentages tended to differ between the assays. The VN-P2Y12 "BASE" channel appeared to be susceptible to high levels of P2Y12 blockade, which would underestimate the VN-P2Y12-reported percent inhibition in individuals who respond well to loading doses of thienopyridines. This integrated analysis supports the findings of earlier individual studies comparing these methodologies that assess platelet function.
我们比较了通过即时血小板功能检测设备(VerifyNow P2Y12,VN-P2Y12)和光传输聚集法(5 和 20 μM 二磷酸腺苷)两种方法得到的血小板功能结果,这两种方法是使用包括 591 名受试者在内的 8 项临床试验的综合数据库进行的。该研究在健康受试者、冠心病患者、终末期肾病患者以及接受普拉格雷或氯吡格雷治疗的急性冠脉综合征患者中进行。分析主要集中在普拉格雷 60mg 负荷剂量或氯吡格雷 600mg 负荷剂量和 10mg 普拉格雷日维持剂量或 75mg 或 150mg 氯吡格雷日维持剂量。光传输聚集法与 VN-P2Y12 观察到相似的血小板抑制模式,且检测结果相关性良好(r 约为 0.7),尽管可能更准确地代表光传输聚集法与 VN-P2Y12 之间关系的是一种 S 形模型,因为 VN-P2Y12 对低水平和高水平抑制的敏感性相对较低。两种检测方法均显示,普拉格雷的低反应者比例低于氯吡格雷,但不同检测方法之间的百分比存在差异。VN-P2Y12 的“BASE”通道似乎容易受到高水平的 P2Y12 阻断,这将低估对噻吩吡啶类药物负荷剂量反应良好的个体中 VN-P2Y12 报告的抑制百分比。这项综合分析支持了早期比较这些评估血小板功能的方法学的个别研究的结果。