Thrombosis Center, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy.
J Thromb Haemost. 2011 Feb;9(2):373-82. doi: 10.1111/j.1538-7836.2010.04144.x.
Patients treated with percutaneous coronary intervention receive aspirin and P2Y12 ADP receptor inhibitors to reduce thrombotic complications. The choice of methodology for monitoring the effects of treatment and assessing its efficacy is still a topic of debate. We evaluated how decreased P2Y12 function influences platelet aggregate (thrombus) size measured ex vivo.
We used confocal videomicroscopy to measure in real time the volume of platelet thrombi forming upon blood perfusion over fibrillar collagen type I at a wall shear rate of 1500 s(-1). The average volume was significantly smaller in 31 patients receiving aspirin and clopidogrel (19) or ticlopidine (12) than in 21 controls, but individual values were above the lower limit of the normal distribution, albeit mostly within the lower quartile, in 61.3% of cases. Disaggregation of platelet thrombi at later perfusion times occurred frequently in the patients. Vasodilator-stimulated phosphoprotein phosphorylation, reflecting P2Y12 inhibition, was also decreased in the patient group, and only 22.6% of individual values were above the lower normal limit. We found no correlation between volume of thrombus formed on collagen fibrils and level of P2Y12 inhibition, suggesting that additional and individually variable factors can influence the inhibitory effect of treatment on platelet function.
Measurements of platelet thrombus formation in flowing blood reflects the consequences of antiplatelet therapy in a manner that is not proportional to P2Y12 inhibition. Combining the results of the two assays may improve the assessment of thrombotic risk.
接受经皮冠状动脉介入治疗的患者接受阿司匹林和 P2Y12 ADP 受体抑制剂治疗，以减少血栓并发症。监测治疗效果和评估其疗效的方法选择仍然是一个争论的话题。我们评估了 P2Y12 功能降低如何影响体外测量的血小板聚集（血栓）大小。
我们使用共焦视频显微镜实时测量在 1500 s(-1)壁剪切率下血液灌注在纤维状 I 型胶原蛋白上形成的血小板血栓的体积。在接受阿司匹林和氯吡格雷（19 例）或噻氯匹定（12 例）治疗的 31 例患者中，平均体积明显小于 21 例对照者，但个体值虽然大多在四分位数范围内，但在 61.3%的情况下仍高于正常分布的下限。在患者中，血小板血栓的解聚在后期灌注时间经常发生。反映 P2Y12 抑制的血管扩张刺激磷酸蛋白磷酸化在患者组中也降低，并且只有 22.6%的个体值高于正常下限。我们发现胶原纤维上形成的血栓体积与 P2Y12 抑制程度之间没有相关性，这表明其他单独的可变因素可以影响治疗对血小板功能的抑制作用。
在流动血液中测量血小板血栓形成以与 P2Y12 抑制不成比例的方式反映抗血小板治疗的后果。将两种检测结果结合起来可能会改善血栓形成风险的评估。
