VA Boston Healthcare System, 1400 VFW Parkway, Boston, MA 02132, USA.
Stroke. 2012 Sep;43(9):2376-81. doi: 10.1161/STROKEAHA.112.655084. Epub 2012 Jun 19.
Antiplatelet therapy nonresponse is associated with worse clinical outcomes. We studied the clinical outcomes associated with platelet function-guided modifications in antiplatelet therapy in patients with ischemic stroke or transient ischemic attack.
From January 2005 to August 2007, 324 patients with ischemic stroke underwent platelet function testing using platelet aggregometry. Aspirin nonresponse was defined as a mean platelet aggregation ≥20% with 0.5 mg/mL arachidonic acid and/or ≥70% with 5 μmol/L adenosine diphosphate. Clopidogrel nonresponse was defined as a mean platelet aggregation ≥40% with 5 μmol/L adenosine diphosphate. A modification was any increase in antiplatelet therapy occurring after testing. Clinical outcomes were compared between patients with and without platelet function-guided antiplatelet therapy modifications using univariate and propensity score-adjusted analyses.
In patients with ischemic stroke or transient ischemic attack, 43% (n=128) and 35% (n=54) were nonresponders to aspirin and clopidogrel, respectively. After platelet function testing, antiplatelet therapy was increased in 23% of patients (n=73). After propensity score matching (n=61 in each group), antiplatelet therapy modification was associated with significantly increased rates of death, ischemic events, or bleeding (hazard ratio, 2.24; 95% CI, 1.12-4.47; P=0.02) compared with no modification in antiplatelet therapy and a trend toward increased bleeding (hazard ratio, 3.56; 95% CI, 0.98-12.95; P=0.05). No differences in ischemic events were observed.
Platelet function-guided modification in antiplatelet therapy after an ischemic stroke or transient ischemic attack was associated with significantly higher rates of adverse clinical outcomes.
抗血小板治疗无反应与更差的临床结局相关。我们研究了与缺血性卒中和短暂性脑缺血发作患者的抗血小板治疗中血小板功能指导的治疗改变相关的临床结局。
从 2005 年 1 月至 2007 年 8 月，324 例缺血性卒患者接受了血小板功能检测，采用血小板聚集测定法。阿司匹林无反应定义为：用 0.5mg/mL 花生四烯酸时平均血小板聚集≥20%和/或用 5μmol/L 二磷酸腺苷时平均血小板聚集≥70%。氯吡格雷无反应定义为：用 5μmol/L 二磷酸腺苷时平均血小板聚集≥40%。治疗改变是指在检测后发生的任何增加抗血小板治疗。使用单变量和倾向评分调整分析比较了血小板功能指导的抗血小板治疗改变的患者和未进行血小板功能指导的抗血小板治疗改变的患者之间的临床结局。
在缺血性卒中和短暂性脑缺血发作患者中，阿司匹林和氯吡格雷的无反应率分别为 43%（n=128）和 35%（n=54）。在血小板功能检测后，有 23%的患者（n=73）增加了抗血小板治疗。在倾向评分匹配（每组 61 例）后，与未改变抗血小板治疗相比，抗血小板治疗改变与死亡、缺血事件或出血的发生率显著增加相关（风险比，2.24；95%置信区间，1.12-4.47；P=0.02），且有趋势表明出血增加（风险比，3.56；95%置信区间，0.98-12.95；P=0.05）。未观察到缺血事件的差异。
缺血性卒中和短暂性脑缺血发作后，抗血小板治疗的血小板功能指导改变与更差的临床结局显著相关。
