Polzin Amin, Afzal Shazia, Balzer Jan, Rassaf Tienush, Kelm Malte, Zeus Tobias
Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany.
Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany.
Vascul Pharmacol. 2016 Feb;77:54-9. doi: 10.1016/j.vph.2015.07.015. Epub 2015 Aug 1.
Common complications during MitraClip procedure are bleeding and ischemic events. The right strategy of platelet inhibition is unknown and challenging, as there are substantial interindividual response-variabilities to antiplatelet drugs and additionally, many MitraClip patients are on permanent oral anticoagulation because of atrial fibrillation. We aimed to investigate the incidence of (i) high- and low on-treatment platelet reactivity (HTPR, LTPR) to antiplatelet medication and (ii) clinical complications in MitraClip patients.
In an observational single-center cohort study we investigated 73 patients who underwent MitraClip implantation. Clopidogrel effects were measured using the vasodilator-stimulated protein phosphorylation (VASP) assay, aspirin effects by light-transmission aggregometry (LTA). Clinical complications were investigated during six-month follow-up.
HTPR to clopidogrel was observed in 44 patients, LTPR to clopidogrel in 6 patients. 16 patients had HTPR to aspirin. Major complications occurred in 12 patients, overall bleeding complications in 27 patients, overall ischemic events in two patients. The incidence of HTPR/LTPR did not differ between patients with- vs. without clinical complications. Bleeding complications were not more frequent in patients with additional oral anticoagulation.
In this study, the incidence of HTPR to clopidogrel was very high (60% of patients). Despite these insufficient clopidogrel antiplatelet effects, ischemic events were rare and bleeding complications more frequent. Additionally, many patients undergoing MitraClip procedure were on permanent oral anticoagulation because of atrial fibrillation. The optimal antithrombotic regiment should be investigated in large scale clinical trials under consideration of the high incidence of HTPR to clopidogrel medication in MitraClip patients.
MitraClip手术常见并发症为出血和缺血事件。由于个体对抗血小板药物的反应存在显著差异，且许多MitraClip患者因房颤接受长期口服抗凝治疗，因此血小板抑制的正确策略尚不清楚且具有挑战性。我们旨在调查（i）MitraClip患者抗血小板药物治疗时高、低血小板反应性（HTPR、LTPR）的发生率，以及（ii）临床并发症情况。
在一项观察性单中心队列研究中，我们调查了73例接受MitraClip植入术的患者。使用血管扩张剂刺激的蛋白磷酸化（VASP）试验测定氯吡格雷的效果，通过透光聚集法（LTA）测定阿司匹林的效果。在六个月的随访期间调查临床并发症。
44例患者出现氯吡格雷HTPR，6例患者出现氯吡格雷LTPR。16例患者出现阿司匹林HTPR。12例患者发生主要并发症，27例患者出现总体出血并发症，2例患者出现总体缺血事件。有临床并发症与无临床并发症的患者之间HTPR/LTPR发生率无差异。额外接受口服抗凝治疗的患者出血并发症并不更常见。
在本研究中，氯吡格雷HTPR的发生率非常高（60%的患者）。尽管氯吡格雷的抗血小板作用不足，但缺血事件罕见，出血并发症更常见。此外，许多接受MitraClip手术的患者因房颤接受长期口服抗凝治疗。应在大规模临床试验中考虑MitraClip患者氯吡格雷药物HTPR的高发生率，研究最佳抗栓方案。
