Phankingthongkum Rewat, Panchavinnin Pradit, Chinthammitr Yingyong, Tresukosol Damras, Chotinaiwattarakul Chunhakasem, Tungsubutra Wiwun, Wongpraparut Nattawut, Kitrattana Bussakorn, Leewanun Piyachat
Division of Cardiology, Department of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2013 May;96(5):538-43.
To determine the prevalence, clinical profile, and risk factors of high on-clopidogrel treatment platelet reactivity in Thai patients with chronic stable angina scheduled for percutaneous coronary intervention.
The patients were prospectively recruited from the consecutive patients undergoing coronary angiography and planned for elective percutaneous coronary intervention (PCI). Ten ml of blood samples were cautiously drawn from the antecubital vein of the patients to determine the hemoglobin and platelet count. Platelet aggregation test was performed by light transmittance aggregometry using platelet-rich plasma. Platelets were stimulated with 5 microM adenosine diphosphate (ADP). Platelet aggregation was expressed as the maximal percent change in light transmittance from baseline. High on-clopidogrel treatment platelet reactivity was defined as post treatment maximal platelet aggregation > 46% with 5 micromol/l ADP used as agonist.
The present study consecutively enrolled two hundred four patients diagnosed with chronic stable angina planned for PCI. Seventy-nine patients demonstrated the high on-clopidogrel treatment platelet reactivity (38.7%). Among these patients, 48% were men with a mean age of 66 years. Diabetes mellitus and chronic kidney disease were detected in 34.2%. Original clopidogrel (Plavix) was prescribed in 72% of the patients and 28% received generic clopidogrel (Apolets). The prevalence of high on-clopidogrel treatment platelet reactivity increased in the older patients, patients with CKD and patients receiving angiotensin receptor blockers (ARB). However from multivariate analysis, none of the risk factors, including age, BMl, diabetes mellitus, smoking, CKD, ARB use, and type of clopidogrel (Plavix versus Apolets) had a statistically significant association with the high on-clopidogrel treatment platelet reactivity.
The prevalence of high on-clopidogrel treatment platelet reactivity in the present study was 38.7%. No significant association was demonstrated between age, BMI, diabetes mellitus, smoking, CKD, ARB use, type of clopidogrel, and high on-clopidogrel treatment platelet reactivity.
确定计划接受经皮冠状动脉介入治疗的泰国慢性稳定型心绞痛患者中氯吡格雷治疗期间高血小板反应性的患病率、临床特征及危险因素。
前瞻性招募连续接受冠状动脉造影并计划进行择期经皮冠状动脉介入治疗（PCI）的患者。从患者肘前静脉谨慎抽取10毫升血样以测定血红蛋白和血小板计数。采用富含血小板血浆通过透光比浊法进行血小板聚集试验。用5微摩尔/升二磷酸腺苷（ADP）刺激血小板。血小板聚集以相对于基线的最大透光率变化百分比表示。氯吡格雷治疗期间高血小板反应性定义为以5微摩尔/升ADP作为激动剂时治疗后最大血小板聚集>46%。
本研究连续纳入204例诊断为慢性稳定型心绞痛并计划进行PCI的患者。79例患者表现出氯吡格雷治疗期间高血小板反应性（38.7%）。在这些患者中，48%为男性，平均年龄66岁。34.2%的患者检测出患有糖尿病和慢性肾脏病。72%的患者使用原研氯吡格雷（波立维），28%的患者接受氯吡格雷仿制药（阿波立特）。年龄较大的患者、慢性肾脏病患者及接受血管紧张素受体阻滞剂（ARB）治疗的患者中氯吡格雷治疗期间高血小板反应性的患病率增加。然而，多因素分析显示，包括年龄、体重指数、糖尿病、吸烟、慢性肾脏病、ARB使用及氯吡格雷类型（波立维与阿波立特）在内的所有危险因素与氯吡格雷治疗期间高血小板反应性均无统计学显著关联。
本研究中氯吡格雷治疗期间高血小板反应性的患病率为38.7%。年龄、体重指数、糖尿病、吸烟、慢性肾脏病、ARB使用、氯吡格雷类型与氯吡格雷治疗期间高血小板反应性之间未显示出显著关联。
