Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Am J Cardiol. 2011 Apr 1;107(7):995-1000. doi: 10.1016/j.amjcard.2010.11.025. Epub 2011 Jan 20.
Platelet reactivity predicts ischemic outcomes in patients who undergo percutaneous coronary intervention (PCI), but the correlation of heightened platelet response with bleeding has not been characterized. The aim of this study was to evaluate whether low platelet reactivity by point-of-care measurement after clopidogrel administration correlates with bleeding complications of PCI. A total of 310 patients receiving clopidogrel before PCI were prospectively enrolled. Platelet reactivity was measured with the VerifyNow P2Y12 assay. The primary end point was the 30-day incidence of major bleeding or entry-site complications according to quartile distribution of P2Y12 reaction units (PRU). The primary end point occurred more frequently in patients with preprocedural PRU levels in the lowest quartile compared to those in the highest quartile (10.1% vs 1.3%, p = 0.043), due mainly to entry-site hemorrhages. Absolute PRU levels were lower in patients with major bleeding (171 ± 49 vs 227 ± 68 in patients without, p = 0.002). On multivariate analysis, pre-PCI PRU levels in the first quartile were associated with a 4.5-fold increased risk for major bleeding (odds ratio 4.5, 95% confidence interval 1.9 to 25.9, p = 0.01). By receiver-operating characteristic curve analysis, the optimal cutoff for the primary end point was a pre-PCI PRU value ≤ 189 (area under the curve 0.76, 95% confidence interval 0.66 to 0.87, p = 0.001). In conclusion, this study suggests that an enhanced response to clopidogrel may be associated with higher risk for early major bleeding or entry-site complications in patients who undergo PCI. Point-of-care monitoring of platelet reactivity after clopidogrel administration may help identify patients in whom individualized strategies are indicated to limit bleeding complications after coronary intervention.
血小板反应性可预测行经皮冠状动脉介入治疗（PCI）患者的缺血性结局，但血小板反应增强与出血之间的相关性尚未明确。本研究旨在评估氯吡格雷治疗后即时检测的低血小板反应性是否与 PCI 后的出血并发症相关。共前瞻性纳入 310 例接受 PCI 前氯吡格雷治疗的患者。采用 VerifyNow P2Y12 测定法检测血小板反应性。主要终点是根据 P2Y12 反应单位（PRU）四分位分布的 30 天内主要出血或入路并发症的发生率。与最高四分位数组相比，术前 PRU 水平处于最低四分位数组的患者更易发生主要终点事件（10.1% vs 1.3%，p = 0.043），主要归因于入路部位出血。主要出血患者的绝对 PRU 水平较低（171 ± 49 比无出血患者，227 ± 68，p = 0.002）。多变量分析显示，第一四分位数的术前 PRU 水平与主要出血风险增加 4.5 倍相关（优势比 4.5，95%置信区间 1.9 至 25.9，p = 0.01）。通过接受者操作特征曲线分析，主要终点的最佳截断值为术前 PRU 值≤189（曲线下面积 0.76，95%置信区间 0.66 至 0.87，p = 0.001）。总之，本研究表明，在接受 PCI 的患者中，氯吡格雷增强反应可能与早期主要出血或入路并发症的风险增加相关。氯吡格雷治疗后即时检测血小板反应性可能有助于识别需要个体化策略以限制冠状动脉介入治疗后出血并发症的患者。
