Li Dan-Dan, Wang Xu-Yun, Xi Shao-Zhi, Liu Jia, Qin Liu-An, Jing Jing, Yin Tong, Chen Yun-Dai
Department of Cardiology, Chinese PLA General Hospital, Beijing China.
J Geriatr Cardiol. 2016 May;13(4):282-9. doi: 10.11909/j.issn.1671-5411.2016.04.012.
Ticagrelor provides enhanced antiplatelet efficacy but increased risk of bleeding and dyspnea. This study aimed to display the relationship between ADP-induced platelet-fibrin clot strength (MAADP) and clinical outcomes in acute coronary syndrome (ACS) patients treated by ticagrelor.
Consecutive Chinese-Han patients with ACS who received maintenance dose of ticagrelor on top of aspirin were recruited. After 5-day ticagrelor maintenance treatment, MAADP measured by thrombelastography (TEG) were recorded for the evaluation of ticagrelor anti-platelet reactivity. Pre-specified cutoffs of MAADP > 47 mm for high on-treatment platelet reactivity (HTPR) and MAADP < 31 mm for low on-treatment platelet reactivity (LTPR) were applied for evaluation. The occurrences of primary ischemic cardiovascular events (including a composite of cardiac death, non-fatal myocardial infarction and stroke), the Thrombolysis in Myocardial Infarction (TIMI) defined bleeding events, and ticagrelor related dyspnea were recorded after a follow-up of three months.
Overall, 176 ACS patients (Male: 79.55%, Age: 59.91 ± 10.54 years) under ticagrelor maintenance treatment were recruited. The value of MAADP ranged from 4.80% to 72.90% (21.27% ± 12.07% on average), with the distribution higher skewed towards the lower values. Using the pre-specific cutoffs for HTPR and LTPR, seven patients (3.98%) were identified as HTPR and 144 patients (81.82%) as LTPR. After a follow-up of three months in 172 patients, major cardiovascular events occurred in no patient, but TIMI bleeding events in 81 (47.09%) with major bleedings in three patients. All patients with major bleedings were classified as LTPR. Ticagrelor related dyspnea occurred in 31 (18.02%) patients, with 30 (21.28%) classified as LTPR and no one as HTPR (P = 0.02).
In ticagrelor treated ACS patients, MAADP measured by TEG might be valuable for the prediction of major bleeding and ticagrelor related dyspnea. Due to the small number of patients with HTPR after ticagrelor maintenance treatment, larger scale study should be warranted to verify the relationship between MAADP defined HTPR and ticagrelor related ischemic events.
替格瑞洛具有更强的抗血小板疗效，但出血和呼吸困难风险增加。本研究旨在揭示在接受替格瑞洛治疗的急性冠脉综合征（ACS）患者中，ADP诱导的血小板-纤维蛋白凝块强度（MAADP）与临床结局之间的关系。
招募连续的中国汉族ACS患者，这些患者在阿司匹林基础上接受替格瑞洛维持剂量治疗。在替格瑞洛维持治疗5天后，记录通过血栓弹力图（TEG）测量的MAADP，以评估替格瑞洛的抗血小板反应性。应用预先设定的MAADP>47mm为高治疗期血小板反应性（HTPR）、MAADP<31mm为低治疗期血小板反应性（LTPR）的临界值进行评估。在随访3个月后，记录主要缺血性心血管事件（包括心源性死亡、非致死性心肌梗死和中风的复合事件）、心肌梗死溶栓（TIMI）定义的出血事件以及与替格瑞洛相关的呼吸困难的发生情况。
总体而言，共招募了176例接受替格瑞洛维持治疗的ACS患者（男性：79.55%，年龄：59.91±10.54岁）。MAADP值范围为4.80%至72.90%（平均为21.27%±12.07%），分布更偏向较低值。使用针对HTPR和LTPR的预先设定临界值，7例患者（3.98%）被确定为HTPR，144例患者（81.82%）为LTPR。在172例患者随访3个月后，无患者发生主要心血管事件，但81例患者（47.09%）发生TIMI出血事件，其中3例患者发生大出血。所有大出血患者均被归类为LTPR。31例患者（18.02%）发生与替格瑞洛相关的呼吸困难，其中30例（21.28%）被归类为LTPR，无HTPR患者（P=0.02）。
在接受替格瑞洛治疗的ACS患者中，通过TEG测量的MAADP可能对预测大出血和与替格瑞洛相关的呼吸困难有价值。由于替格瑞洛维持治疗后HTPR患者数量较少，需要更大规模的研究来验证MAADP定义的HTPR与替格瑞洛相关缺血事件之间的关系。
