Kukula Krzysztof, Klopotowski Mariusz, Kunicki Pawel, Jamiolkowski Jacek, Debski Artur, Bekta Pawel, Chmielak Zbigniew, Witkowski Adam
aDepartment of Interventional Cardiology and Angiology bClinical Pharmacology Unit, Department of Clinical Biochemistry, Institute of Cardiology, Warsaw cDepartment of Public Health, Medical University of Bialystok, Bialystok, Poland.
Blood Coagul Fibrinolysis. 2017 Jul;28(5):383-388. doi: 10.1097/MBC.0000000000000614.
: Platelet aggregation monitoring in patients after stent implantation is a promising way of preventing stent thrombosis and bleeding. The aim of the study was to verify whether clopidogrel (ADPtest) and aspirin (ASPItest) response measured by Multiplate (Dynabyte, Munich, Germany) analyzer in elective percutaneous coronary implantation patients predict the risk of stent thrombosis or other ischemic adverse events and bleeding. In this prospective, observational study 697 elective percutaneous coronary implantation patients were analyzed. The median ASPItest was 86 AU min. In 69 patients (9.9%), an ASPI result of more than 203 AU min was observed. The median ADP-dependent platelet aggregation was 212 AU min. In 36 (5.2%) patients, the result was at least 468 AU min. Cox regression analysis showed the prognostic factors of definite or probable stent thrombosis and cardiac death at 1 year were higher ASPItest result [odds ratio (OR) 1.006, 95% confidence interval (CI) 1.004-1.008, P < 0.001], ASPItest more than 203 AU min (OR 7.61, 95% CI 2.83-20.43, P < 0.001), higher ADPtest result (OR 1.005, 95% CI 1.003-1.007, P < 0.001) and ADPtest at least 468 AU min (OR 12.54, 95% CI 4.56-35.53, P < 0.001). In turn, ADPtest 188 AU min or less predicted GUSTO scale major and moderate bleeding (OR 4.15, 95% CI 1.12-15.32, P = 0.033). There was also a strong trend toward higher rate of major and moderate bleeding for the ASPItest less than 35 AU min (lowest quintile) - (OR 3.04, 95% CI 0.96-9.58, P = 0.058). Lower creatinine clearance and lower hemoglobin level were associated with both ischemic and bleeding complications. The results of this study show that impaired platelet response to clopidogrel and aspirin measured by the Multiplate analyzer results in increased risk of stent thrombosis and cardiac death. Furthermore, the study showed that increased response to clopidogrel is related to major and moderate bleeding events.
支架植入术后患者的血小板聚集监测是预防支架血栓形成和出血的一种很有前景的方法。本研究的目的是验证在择期经皮冠状动脉植入患者中，通过多电极血小板功能分析仪（德国慕尼黑Dynabyte公司）测定的氯吡格雷（ADP检测）和阿司匹林（ASP检测）反应是否能预测支架血栓形成或其他缺血性不良事件及出血的风险。在这项前瞻性观察研究中，对697例择期经皮冠状动脉植入患者进行了分析。ASP检测的中位数为86 AU·min。在69例（9.9%）患者中，观察到ASPI结果超过203 AU·min。ADP依赖性血小板聚集的中位数为212 AU·min。在36例（5.2%）患者中，结果至少为468 AU·min。Cox回归分析显示，1年时明确或可能的支架血栓形成和心源性死亡的预后因素为较高的ASP检测结果[比值比（OR）1.006，95%置信区间（CI）1.004 - 1.008，P < 0.001]、ASPI超过203 AU·min（OR 7.61，95% CI 2.83 - 20.43，P < 0.001）、较高的ADP检测结果（OR 1.005，95% CI 1.003 - 1.007，P < 0.001）以及ADP检测至少468 AU·min（OR 12.54，95% CI 4.56 - 35.53，P < 0.001）。反过来，ADP检测188 AU·min或更低预测GUSTO量表的严重和中度出血（OR 4.15，95% CI 1.12 - 15.32，P = 0.033）。对于ASP检测低于35 AU·min（最低五分位数），严重和中度出血发生率也有升高的强烈趋势 - （OR 3.04，95% CI 0.96 - 9.58，P = 0.058）。较低的肌酐清除率和较低的血红蛋白水平与缺血性和出血性并发症均相关。本研究结果表明，通过多电极血小板功能分析仪测定的血小板对氯吡格雷和阿司匹林的反应受损会导致支架血栓形成和心源性死亡风险增加。此外，研究表明对氯吡格雷反应增加与严重和中度出血事件有关。
