Baxter Healthcare Corporation, Deerfield, IL, USA.
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Austrian Cluster for Tissue Regeneration, Vienna, Austria.
Thromb J. 2014 May 7;12:10. doi: 10.1186/1477-9560-12-10. eCollection 2014.
Platelet inhibitors are commonly used to reduce the risk of atherothrombotic events. The aim of this study was to determine the impact of platelet inhibitors, specifically clopidogrel and aspirin, on clot kinetics, strength, and/or structure during the use of thrombin based gelatin matrices and fibrin sealants.
Blood was collected and heparinized from donors on clopidogrel (and aspirin) and age matched control donors. Blood component analysis, whole blood platelet aggregometry, and activated clotting time (ACT) were used to monitor compliance to therapy and identify any differences between donor groups. Clot kinetics and strength were analyzed using thrombelastography (TEG). Field Emission Scanning Electron Microscopy (FESEM) was used to analyze clot structure.
Blood component profiles were similar for both donor groups. Aggregometry indicated that aggregation response to adenosine diphosphate (ADP) for clopidogrel donors was 12% of that for the controls (p = 0.0021), an expected result of clopidogrel induced platelet inhibition. However, blood from both donor groups had an elevated thrombin induced aggregation response. Heparinization of donor blood resulted in similarly elevated ACTs for both donor groups. TEG results indicated similar clot kinetics and strength between clopidogrel and control donor groups for blood alone and when clotting was induced using thrombin based gelatin matrices and fibrin sealants. FESEM images supported TEG findings in that similar morphologies were observed in ex vivo formed clots from both donor groups when thrombin based gelatin matrices and fibrin sealants were used.
These results suggest that platelet inhibitors do not negatively impact clot kinetics, strength, and structure when clotting is initiated with thrombin based gelatin matrices and fibrin sealants.
血小板抑制剂常用于降低动脉血栓栓塞事件的风险。本研究旨在确定血小板抑制剂（氯吡格雷和阿司匹林）对基于凝血酶的明胶基质和纤维蛋白密封剂使用过程中血栓动力学、强度和/或结构的影响。
从接受氯吡格雷（和阿司匹林）治疗的患者和年龄匹配的对照患者中采集并肝素化血液。血液成分分析、全血血小板聚集测定和活化凝血时间（ACT）用于监测治疗依从性并识别供体组之间的差异。血栓弹性描记术（TEG）用于分析血栓动力学和强度。场发射扫描电子显微镜（FESEM）用于分析血栓结构。
两组供体的血液成分谱相似。聚集度测定表明，氯吡格雷供体对二磷酸腺苷（ADP）的聚集反应为对照组的 12%（p=0.0021），这是氯吡格雷诱导血小板抑制的预期结果。然而，两组供体的血液均有升高的凝血酶诱导聚集反应。供体血液的肝素化导致两组供体的 ACT 均升高。TEG 结果表明，仅使用血液或使用基于凝血酶的明胶基质和纤维蛋白密封剂诱导凝血时，氯吡格雷和对照供体组的血栓动力学和强度相似。FESEM 图像支持 TEG 发现，当使用基于凝血酶的明胶基质和纤维蛋白密封剂时，来自两组供体的体外形成的血栓具有相似的形态。
这些结果表明，当使用基于凝血酶的明胶基质和纤维蛋白密封剂启动凝血时，血小板抑制剂不会对血栓动力学、强度和结构产生负面影响。
