抗血小板药物治疗患者停用抗血小板药物后择期非心脏手术可行时机的评估。

Evaluation of feasible timing of elective noncardiac procedure after antiplatelet discontinuation in patients treated with antiplatelet agents.

作者信息

Joo Min Sun, Ahn Byung Moo, Kim Hee Jun, Mun Hee-Sun, Kang Min Kyung, Choi Seong Hoon, Park Min Jeong, Song Won Keun, Lee Nam Ho, Cho Jung Rae

机构信息

From the *Kangnam Sacred Heart Hospital, Hallym University College of Medicine; and †Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea.

出版信息

J Investig Med. 2014 Jun;62(5):808-12. doi: 10.2310/JIM.0000000000000070.

DOI:10.2310/JIM.0000000000000070

PMID:24569484

Abstract

BACKGROUND

The current standard of care is to delay noncardiac procedure (NCP) 5 to 7 days after discontinuation of antiplatelet agents (APAs) in patients with coronary stents. However, it is often difficult to follow because of concerns over stent thrombosis. The point-of-care aspirin/P2Y(12) assay (VerifyNow; Accumetrics Inc, San Diego, CA) is useful to evaluate platelet reactivity in conjunction with APAs. In this study, we evaluated the feasible timing after discontinuation of APAs.

METHODS AND RESULTS

Sixty-two patients taking APAs, who were scheduled to undergo elective NCP, were enrolled. All patients took either aspirin 100 mg or aspirin 100 mg plus clopidogrel 75 mg daily. The aspirin-reactivity unit (ARU) and P2Y(12)-reactivity unit (PRU) were measured from 0 days (day 0, no discontinuation) to as long as 5 days (day 5, 5 days after discontinuation) depending on each procedure schedule. For 15 patients, baseline ARU and PRU (592 and 288) before aspirin/clopidogrel loading at index percutaneous coronary intervention were collected as control. For ARU after discontinuation of APA, days 0 to 5 values progressively increased over time (489.4 T 85.3, 512.6 T 77.0, 589.9 T 58.8, 613.6 T 47.3, 632.6 T 49.2, 662.0 T 4.2). Likewise, for PRUs, days 0 to 5 values also increased over time (245.0 T 96.9, 253.9 T 80.9, 270.9 T 45.8, 289.0 T 68.6, 306.5 T 29.2, 351.0 T 8.5). The ARU and PRU well correlated with days after APA discontinuation by linear regression analysis ( y = 490.897 + 39.238 * x, R(2) = 0.43, P G 0.001; y = 241.739 + 16.701 * x, R(2) = 0.092, P = 0.018, respectively). Assuming baseline ARU and PRU as 592 and 288, the mean days after complete reversal of platelet reactivity by APAs are 2.6 and 2.8, respectively.

CONCLUSIONS

The feasible timing of NCP after discontinuation of APAs showed less than 5 days. VerifyNow is useful in the evaluation of antiplatelet reversal after discontinuation of APAs. .

摘要

背景

目前的护理标准是，对于置入冠状动脉支架的患者，在停用抗血小板药物（APA）后5至7天延迟进行非心脏手术（NCP）。然而，由于担心支架血栓形成，这一标准往往难以遵循。即时检验阿司匹林/P2Y（12）检测（VerifyNow；Accumetrics公司，加利福尼亚州圣地亚哥）有助于结合APA评估血小板反应性。在本研究中，我们评估了停用APA后的可行时间。

方法与结果

纳入62例服用APA且计划接受择期NCP的患者。所有患者每日服用阿司匹林100mg或阿司匹林100mg加氯吡格雷75mg。根据每个手术计划，从0天（第0天，未停药）至长达5天（第5天，停药后5天）测量阿司匹林反应单位（ARU）和P2Y（12）反应单位（PRU）。对于15例患者，收集其在首次经皮冠状动脉介入治疗时阿司匹林/氯吡格雷负荷前的基线ARU和PRU（分别为592和288）作为对照。对于停用APA后的ARU，第0至5天的值随时间逐渐升高（分别为489.4±85.3、512.6±77.0、589.9±58.8、613.6±47.3、632.6±49.2、662.0±4.2）。同样，对于PRU，第0至5天的值也随时间升高（分别为245.0±96.9、253.9±80.9、270.9±45.8、289.0±68.6、306.5±29.2、351.0±8.5）。通过线性回归分析，ARU和PRU与停用APA后的天数具有良好的相关性（y = 490.897 + 39.238 * x，R² = 0.43，P＜0.001；y = 241.739 + 16.701 * x，R² = 0.092，P = 0.018）。假设基线ARU和PRU分别为592和288，则血小板反应性被APA完全逆转后的平均天数分别为2.6天和2.8天。