Clinical Chemistry Unit, Maggiore della Carità Hospital, Novara, Italy.
Int J Lab Hematol. 2012 Oct;34(5):484-94. doi: 10.1111/j.1751-553X.2012.01428.x. Epub 2012 May 21.
The increasing demand for therapeutic monitoring in patients receiving antiplatelet therapy has been paralleled by the development of instruments and tests whose clinical usefulness is still under debate. We devised a laboratory approach to detect patients with antiplatelet resistance at risk to develop thrombotic events.
One hundred and eighty patients, under aspirin and clopidogrel after angioplasty and stent implantation, were studied by PFA100(®) with collagen/epinephrine (CoEPI, cutoff 165s) cartridge and by Multiplate(®) using arachidonic acid (ASPItest, pos < 862AUC), ADP (ADPtest, pos < 417AUC), and collagen (COLtest, pos < 607AUC).
Only 67 of 173 patients with ASPI < 862 displayed a prolonged CoEPI and up to 65 patients had normal CoEPI despite ASPI < 300. Patients with ASPI < 300 had significantly lower COL than patients with ASPI > 300. One hundred and thirty-eight patients displaying ADP < 417 had significantly lower COL than those with ADP > 417. Association between COL and ADP remained after ASPI stratification: in patients with suboptimal (ASPI 300-892) or maximal (ASPI < 300) response to aspirin, having ADP < 417 (clopidogrel responsive) increased COL positivity, respectively, from 9.5 to 58.8% and from 47.6 to 82.7%.
A combination of specific tests may be useful in identifying higher-risk patients with poor compliance or drug resistance who potentially may benefit from therapy change.
随着抗血小板治疗患者对治疗监测需求的增加，各种仪器和检测方法也不断发展，但这些方法的临床实用性仍存在争议。我们设计了一种实验室方法来检测有发生血栓事件风险的抗血小板治疗抵抗患者。
180 名接受经皮腔内血管成形术和支架植入术后阿司匹林和氯吡格雷治疗的患者，采用 PFA100（®）检测胶原/肾上腺素（CoEPI，截止值 165s）和 Multiplate（®）检测花生四烯酸（ASPItest，pos < 862AUC）、ADP（ADPtest，pos < 417AUC）和胶原（COLtest，pos < 607AUC）。
在 173 名 ASPI < 862 的患者中，只有 67 名患者的 CoEPI 延长，尽管 ASPI < 300，但多达 65 名患者的 CoEPI 正常。ASPI < 300 的患者的 COL 明显低于 ASPI > 300 的患者。138 名 ADP < 417 的患者的 COL 明显低于 ADP > 417 的患者。在 ASPI 分层后，COL 与 ADP 之间仍存在相关性：在阿司匹林反应不佳（ASPI 300-892）或最大（ASPI < 300）的患者中，ADP < 417（氯吡格雷反应）分别使 COL 阳性率从 9.5%增加到 58.8%和从 47.6%增加到 82.7%。
特定检测方法的组合可能有助于识别出依从性差或耐药的高危患者，这些患者可能受益于治疗方法的改变。
