Département de Cardiologie, Hôpital universitaire nord, Aix-Marseille Univ., France.
J Thromb Haemost. 2012 Oct;10(10):1999-2005. doi: 10.1111/j.1538-7836.2012.04875.x.
Post-treatment platelet reactivity (PR) is associated with ischemic and bleeding events in patients receiving P2Y12 receptor antagonists.
We aimed to study the relationship between post-treatment PR after a 60-mg loading dose (LD) of prasugrel and 1-year thrombotic and bleeding events.
Patients were prospectively included in this multicenter study if they had a successful percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and received prasugrel. The platelet reactivity index (PRI) was measured using the Vasodilator-Stimulated Phosphoprotein index (VASP) after a prasugrel LD. Endpoints included the rate of thrombotic events and bleeding events at 1 year.
Among the 301 patients enrolled, 9 (3%) were lost to follow-up at 1 year. The rates of thrombotic and bleeding events at 1 year were of 7.5% and 6.8%, respectively. Receiver-operating curve (ROC) analysis demonstrated an optimal cut-off value of 53.5% of PRI to predict thrombotic events at 1 year. Using this cut-off value we observed that patients exhibiting high on-treatment platelet reactivity (HTPR) had a higher rate of thrombotic events (22.4% vs. 2.9%; P < 0.001). In parallel the optimal cut-off value of PRI to predict bleeding was 16%. Patients with a PRI ≤ 16% had a higher rate of bleeding events compared with those with a PRI > 16% (15.6% vs. 3.3%; P < 0.001). In multivariate analysis, the PRI predicted both thrombotic and bleeding events (OR: 1.44, 95% confidence interval [CI]: 1.2-1.72; P < 0.001 and OR: 0.75, 95% CI: 0.59-0.96; P = 0.024 [respectively, per 10% increase]).
Platelet reactivity measurement after a prasugrel LD predicts both ischemic and bleeding events at 1 year follow-up for ACS patients undergoing PCI.
接受 P2Y12 受体拮抗剂治疗的患者，治疗后血小板反应性（PR）与缺血和出血事件相关。
我们旨在研究普拉格雷 60mg 负荷剂量（LD）后治疗后 PR 与 1 年血栓形成和出血事件之间的关系。
如果患者经皮冠状动脉介入治疗（PCI）治疗急性冠脉综合征（ACS）且接受普拉格雷治疗后成功，则前瞻性纳入本多中心研究。使用血小板反应指数（PRI）测量 VASP 后，使用血小板反应指数（PRI）测量血小板反应性指数（PRI）。终点包括 1 年时的血栓形成和出血事件发生率。
在纳入的 301 例患者中，9 例（3%）在 1 年时失访。1 年时的血栓形成和出血事件发生率分别为 7.5%和 6.8%。受试者工作特征曲线（ROC）分析显示，PRI 预测 1 年血栓形成事件的最佳截断值为 53.5%。使用该截断值，我们观察到表现出高治疗时血小板反应性（HTPR）的患者血栓形成事件发生率更高（22.4%比 2.9%；P<0.001）。同时，PRI 预测出血的最佳截断值为 16%。PRI≤16%的患者出血事件发生率高于 PRI>16%的患者（15.6%比 3.3%；P<0.001）。在多变量分析中，PRI 预测血栓形成和出血事件（OR：1.44，95%置信区间[CI]：1.2-1.72；P<0.001和 OR：0.75，95%CI：0.59-0.96；P=0.024[分别为每增加 10%]）。
普拉格雷 LD 后血小板反应性测量可预测 ACS 患者 PCI 后 1 年随访时的缺血和出血事件。
