Taomoto Katsushi, Ohnishi Hideyuki, Kuga Yoshihiro, Nakashima Kazuya, Ichioka Tsugumichi, Kodama Yuuji, Kubota Hisashi, Tominaga Takashi, Hirose Tomofumi, Hayashi Masato, Kinugasa Chifumi, Yamashita Tsutomu, Yamamoto Junichiro
Department of Neurosurgery, Ohnishi Neurological Center, Akashi, Japan. ktaomoto @ onc.akashi.hyogo.jp
Pathophysiol Haemost Thromb. 2010;37(1):43-8. doi: 10.1159/000315494. Epub 2010 May 28.
Measurements of platelet reactivity and assessment of the efficacy of antiplatelet drugs are widely recognized as pre-requisite for the diagnosis and treatment of stroke patients. A recently established shear-induced platelet reactivity test using non-anticoagulated blood (the Global Thrombosis Test) has facilitated measurements of physiologically relevant platelet function and thrombolytic activity. 195 healthy volunteers, not taking antiplatelet drugs or anticoagulants, and 185 patients with acute cerebrovascular diseases were enrolled. The effect of antiplatelet drugs on platelet function and thrombolytic activity was assessed using the Global Thrombosis Test after 14 days of medication. The occlusion time (OT), an index of platelet reactivity, in healthy controls was 284.9 ± 92.2 s. The lysis time (LT), an index of thrombolytic activity, in healthy controls was 2,231 ± 1,223 s. Both times had no significant difference between males and females. The OT of all stroke patients was 210.3 ± 140.8 s and was shorter than that of the healthy controls (284.9 ± 92.2, p < 0.0001). The LT of all stroke patients was 3,159 ± 1,549 s and was longer than that of the controls (2,231 ± 1,223, p < 0.0001). Medication significantly prolonged the OT from 184.5 ± 150.6 s (before) to 295.3 ± 208.1 s (after) in all patients, indicating a reversal of the hyper-platelet reactivity. In addition, medication shortened the LT from 3,924 ± 1,718 s (before) to 3,107 ± 1,794 s (after) in all patients. A prothrombotic state exists in stroke patients due to enhanced platelet function and suppressed thrombolytic activity. Medication improved these physiological parameters of haemostasis.
血小板反应性的测量以及抗血小板药物疗效的评估被广泛认为是中风患者诊断和治疗的先决条件。最近建立的使用非抗凝血液的剪切诱导血小板反应性测试（全球血栓形成测试）有助于测量生理相关的血小板功能和溶栓活性。招募了195名未服用抗血小板药物或抗凝剂的健康志愿者以及185名急性脑血管疾病患者。用药14天后，使用全球血栓形成测试评估抗血小板药物对血小板功能和溶栓活性的影响。健康对照组中，作为血小板反应性指标的闭塞时间（OT）为284.9±92.2秒。健康对照组中，作为溶栓活性指标的溶解时间（LT）为2231±1223秒。这两个时间在男性和女性之间均无显著差异。所有中风患者的OT为210.3±140.8秒，短于健康对照组（284.9±92.2，p<0.0001）。所有中风患者的LT为3159±1549秒，长于对照组（2231±1223，p<0.0001）。用药使所有患者的OT从184.5±150.6秒（用药前）显著延长至295.3±208.1秒（用药后），表明高血小板反应性得到逆转。此外，用药使所有患者的LT从3924±1718秒（用药前）缩短至3107±1794秒（用药后）。由于血小板功能增强和溶栓活性受抑制，中风患者存在血栓前状态。用药改善了这些止血生理参数。
