ADP 诱导的血小板-纤维蛋白凝块强度：一种新的血栓弹力图指标，可预测支架置入后长期缺血事件。
Adenosine diphosphate-induced platelet-fibrin clot strength: a new thrombelastographic indicator of long-term poststenting ischemic events.
机构信息
Sinai Center for Thrombosis Research, Baltimore, MD 21215, USA.
出版信息
Am Heart J. 2010 Aug;160(2):346-54. doi: 10.1016/j.ahj.2010.05.034.
BACKGROUND
Poststenting ischemic events occur despite dual-antiplatelet therapy, suggesting that a "one size fits all" antithrombotic strategy has significant limitations. Ex vivo platelet function measurements may facilitate risk stratification and personalized antiplatelet therapy.
METHODS
We investigated the prognostic utility of the strength of adenosine diphosphate (ADP)-induced (MA(ADP)) and thrombin-induced (MA(THROMBIN)) platelet-fibrin clots measured by thrombelastography and ADP-induced light transmittance aggregation (LTA(ADP)) in 225 serial patients after elective stenting treated with aspirin and clopidogrel. Ischemic and bleeding events were assessed over 3 years.
RESULTS
Overall, 59 (26%) first ischemic events occurred. Patients with ischemic events had higher MA(ADP), MA(THROMBIN), and LTA(ADP) (P < .0001 for all comparisons). By receiver operating characteristic curve analysis, MA(ADP) >47 mm had the best predictive value of long-term ischemic events compared with other measurements (P < .0001), with an area under the curve = 0.84 (95% CI 0.78-0.89, P < .0001). The univariate Cox proportional hazards model identified MA(ADP) >47 mm, MA(THROMBIN) >69 mm, and LTA(ADP) >34% as significant independent predictors of first ischemic events at the 3-year time point, with hazard ratios of 10.3 (P < .0001), 3.8 (P < .0001), and 4.8 (P < .0001), respectively. Fifteen bleeding events occurred. Receiver operating characteristic curve and quartile analysis suggests MA(ADP) <or=31 as a predictive value for bleeding.
CONCLUSION
This study is the first demonstration of the prognostic utility of MA(ADP) in predicting long-term event occurrence after stenting. The quantitative assessment of ADP-stimulated platelet-fibrin clot strength measured by thrombelastography can serve as a future tool in investigations of personalized antiplatelet treatment designed to reduce ischemic events and bleeding.
背景
尽管进行了双联抗血小板治疗，但是仍会发生支架置入后缺血事件，这表明“一刀切”的抗血栓策略存在显著局限性。体外血小板功能检测可能有助于危险分层和个体化抗血小板治疗。
方法
我们研究了经皮冠状动脉介入治疗后 225 例连续患者的血小板 - 纤维蛋白血栓强度（由血栓弹力图测量的二磷酸腺苷（ADP）诱导的（MA（ADP））和凝血酶诱导的（MA（THROMBIN）））和 ADP 诱导的光透射聚集（LTA（ADP））的预后价值。这些患者接受阿司匹林和氯吡格雷治疗。在 3 年内评估缺血和出血事件。
结果
共有 59 例（26%）发生首次缺血事件。发生缺血事件的患者 MA（ADP）、MA（THROMBIN）和 LTA（ADP）较高（所有比较 P <.0001）。通过接收者操作特征曲线分析，MA（ADP）> 47mm 对长期缺血事件的预测值优于其他测量值（P <.0001），曲线下面积= 0.84（95%CI 0.78-0.89，P <.0001）。单变量 Cox 比例风险模型确定 MA（ADP）> 47mm、MA（THROMBIN）> 69mm 和 LTA（ADP）> 34% 是 3 年时间点首次缺血事件的独立预测因素，风险比分别为 10.3（P <.0001）、3.8（P <.0001）和 4.8（P <.0001）。发生 15 例出血事件。接收者操作特征曲线和四分位数分析表明 MA（ADP）<or=31 是出血的预测值。
结论
这项研究首次证明了 MA（ADP）在预测支架置入后长期事件发生中的预后价值。血栓弹力图测量的 ADP 刺激血小板 - 纤维蛋白血栓强度的定量评估可以作为减少缺血事件和出血的个体化抗血小板治疗研究中的一种未来工具。
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