Kurak J, Zając P, Czyżewski D, Kucharski R, Grzanka R, Kasperska-Zajac A, Koczy B
a Department of Trauma and Orthopaedics , District Trauma and Orthopaedic Hospital , Piekary Sląskie , Poland.
b Department of Thoracic Surgery, SMDZ in Zabrze , Medical University of Silesia , Katowice , Poland.
Platelets. 2016 Nov;27(7):680-686. doi: 10.3109/09537104.2016.1158401. Epub 2016 Apr 20.
The phenomenon of high on-acetylsalicylic acid (ASA) treatment platelet (PLT) reactivity - HATPR - and its clinical implications have not been fully understood. Little data is available on assessing PLT activity based on the severity of intra- and postoperative bleeding in a population of orthopedic patients with normal closure time (CT) measured by a PLT function analyzer PFA-100®, despite being given long-term ASA therapy. The aim is to assess PLT function using PFA-100® in patients with ASA therapy and qualified for trauma and orthopedic surgery procedures. The retrospective analysis covered 384 patients whose PLT reactivity was assessed using PFA-100®. Out of those, 198 had been taking ASA with a 75 mg dose until hospital admission. In addition, a group of 70 patients with a proximal femoral fracture surgically treated using the dynamic hip screw (DHS) was selected, in whom severity of bleeding was assessed by HIP ASA (+). The reference group comprised 52 patients (without ASA therapy) who were operated on due to the same indications. Normal CT was found in 37% of ASA-receiving patients. Patients with normal CT, despite ASA therapy, exhibited significantly more intense bleeding after DHS surgery. A similar number of patients required red blood cells (RBCs) transfusion in HIP ASA (+) and HIP ASA (-). Increased risk of complications in HIP ASA (+) group was not found.
Normal PLT function assessed using PFA-100® is a common phenomenon in patients with long-term ASA treatment and who are qualified for trauma and orthopedic surgery procedures. In many cases, it seems that inadequate response to ASA is only a laboratory phenomenon.
高阿司匹林（ASA）治疗血小板（PLT）反应性现象——高阿司匹林治疗血小板反应性（HATPR）——及其临床意义尚未完全明确。尽管接受长期ASA治疗，但在通过血小板功能分析仪PFA-100®测量闭合时间（CT）正常的骨科患者群体中，基于术中和术后出血严重程度评估血小板活性的数据很少。目的是使用PFA-100®评估接受ASA治疗且有资格接受创伤和骨科手术的患者的血小板功能。回顾性分析涵盖了384例使用PFA-100®评估血小板反应性的患者。其中，198例在入院前一直服用75毫克剂量的ASA。此外，选择了一组70例使用动力髋螺钉（DHS）手术治疗股骨近端骨折的患者，通过髋部ASA（+）评估出血严重程度。参照组包括52例因相同适应证接受手术的患者（未接受ASA治疗）。37%接受ASA治疗的患者CT正常。尽管接受ASA治疗，但CT正常的患者在DHS手术后出血明显更严重。髋部ASA（+）组和髋部ASA（-）组需要输注红细胞（RBC）的患者数量相似。未发现髋部ASA（+）组并发症风险增加。
使用PFA-100®评估的正常血小板功能在长期接受ASA治疗且有资格接受创伤和骨科手术的患者中是一种常见现象。在许多情况下，对ASA反应不足似乎只是一种实验室现象。
