Gaglia Michael A, Torguson Rebecca, Pokharel Shreejana, Pakala Rajbabu, Xue Zhenyi, Suddath William O, Kent Kenneth M, Satler Lowell F, Pichard Augusto D, Waksman Ron
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC 20010, USA.
Cardiovasc Revasc Med. 2013 Mar-Apr;14(2):76-80. doi: 10.1016/j.carrev.2012.12.005. Epub 2013 Jan 31.
We hypothesized that patients with a history of either alarming or nuisance bleeding events, compared to those with no history of bleeding, would have lower levels of on-treatment platelet reactivity (aspirin and a thienopyridine).
In total, 42 patients with no bleeding, 34 with nuisance bleeding, and 14 with alarming bleeding underwent platelet reactivity testing 1 month to 1 year after PCI with light transmission aggregometry (LTA 5 and 20 μM adenosine disphosphate [ADP]), vasodilator stimulated phosphoprotein phosphorylation (VASP) and VerifyNow P2Y12. Clinical and demographic characteristics of the 3 groups were generally similar, except that patients with alarming bleeding were less likely to be Caucasian; only 6 patients (6.7%) were taking prasugrel. There was considerable overlap between no bleeding, nuisance bleeding and alarming bleeding groups with respect to on-treatment platelet reactivity. Furthermore, there was no difference in the median platelet reactivity values for all assays. Prevalence of high on-treatment platelet reactivity did not differ among the 3 groups; 32.6% of patients had high on-treatment platelet reactivity as measured by LTA with 5 μM ADP (P=.91); 40.0% as measured by VASP (P=.35); and 35.6% as measured by VerifyNow P2Y12 (P=.61).
The use of platelet reactivity assays to identify patients on thienopyridine therapy at higher risk of bleeding is an unfounded strategy.
我们假设，与无出血史的患者相比，有警示性或烦扰性出血事件史的患者在接受治疗时的血小板反应性（阿司匹林和噻吩并吡啶类药物）水平会更低。
总共42例无出血患者、34例有烦扰性出血患者和14例有警示性出血患者在PCI术后1个月至1年接受了血小板反应性检测，检测方法包括光透射聚集法（LTA，5和20 μM二磷酸腺苷[ADP]）、血管扩张剂刺激的磷蛋白磷酸化（VASP）以及VerifyNow P2Y12检测。三组患者的临床和人口统计学特征总体相似，只是有警示性出血的患者为白种人的可能性较小；只有6例患者（6.7%）服用普拉格雷。在接受治疗时的血小板反应性方面，无出血、烦扰性出血和警示性出血组之间有相当大的重叠。此外，所有检测方法的血小板反应性中位数均无差异。三组中接受治疗时血小板高反应性的患病率无差异；LTA检测5 μM ADP时，32.6%的患者有接受治疗时血小板高反应性（P = 0.91）；VASP检测时为40.0%（P = 0.35）；VerifyNow P2Y12检测时为35.6%（P = 0.61）。
使用血小板反应性检测来识别接受噻吩并吡啶类药物治疗且出血风险较高的患者是一种没有依据的策略。
