Puurunen Marja K, Hwang Shih-Jen, O'Donnell Chris J, Tofler Geoffrey, Johnson Andrew D
Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA.
Framingham Heart Study of Boston University School of Medicine and NHLBI, Framingham, MA, USA; Population Sciences Branch, Division of Intramural Research, NHLBI, NIH, Bethesda, MD, USA.
Thromb Res. 2017 Mar;151:57-62. doi: 10.1016/j.thromres.2017.01.010. Epub 2017 Jan 25.
The relationship of venous thromboembolism (VTE) with platelet reactivity is unclear. Platelet function plays a key role in arterial thrombosis. Evidence suggests antiplatelet agents also effects in reducing VTE. Our aim is to describe the role of baseline platelet function in development of VTE in the community-based Framingham Heart Study (FHS) cohort.
Participants in the Framingham Offspring cohort fifth examination and Omni cohort first examination were eligible. We used light transmission aggregometry to measure platelet aggregation in response to collagen and a range of ADP and epinephrine doses. The study population consisted of 2831 participants [average age 54.3years; 57% female].
During a median follow-up of 20.4years, we observed 138 incident VTE events. In age-, sex- and cohort-adjusted analysis an increase in collagen lag time was associated with increased risk for incident VTE (HR 1.01 [1.00-1.02]; p=0.049). Increased maximal aggregation to low dose epinephrine (1.0μM) was associated with lower VTE risk (HR 0.84 [0.71-0.99]; p=0.042]). However, additional multivariable analyses attenuated the collagen-VTE and epinephrine-VTE associations to trends, primarily due to adjustment for baseline body mass index (BMI), a VTE risk factor and potential modifier of platelet function. Secondary analyses considering varying follow-up periods, cancer incidence and interim aspirin use did not dramatically affect the collagen and epinephrine trends observed. Baseline platelet aggregability was only weakly associated with incident VTE, and in a paradoxical direction, in a community-based population. Other markers of platelet function and hemostasis could prove to be more useful predictors.
静脉血栓栓塞症（VTE）与血小板反应性之间的关系尚不清楚。血小板功能在动脉血栓形成中起关键作用。有证据表明抗血小板药物在降低VTE方面也有作用。我们的目的是在基于社区的弗雷明汉心脏研究（FHS）队列中描述基线血小板功能在VTE发生中的作用。
弗雷明汉后代队列第五次检查和全人群队列第一次检查的参与者符合条件。我们使用光透射聚集法测量血小板对胶原蛋白以及一系列不同剂量二磷酸腺苷（ADP）和肾上腺素的聚集反应。研究人群包括2831名参与者[平均年龄54.3岁；57%为女性]。
在中位随访20.4年期间，我们观察到138例VTE事件。在年龄、性别和队列调整分析中，胶原蛋白滞后时间增加与VTE事件风险增加相关（风险比1.01[1.00 - 1.02]；p = 0.049）。对低剂量肾上腺素（1.0μM）的最大聚集增加与较低的VTE风险相关（风险比0.84[0.71 - 0.99]；p = 0.042）。然而，进一步的多变量分析将胶原蛋白与VTE以及肾上腺素与VTE的关联减弱为趋势，主要是由于对基线体重指数（BMI）进行了调整，BMI是VTE的一个风险因素以及血小板功能的潜在调节因素。考虑不同随访期、癌症发病率和临时阿司匹林使用情况的二次分析并未显著影响所观察到的胶原蛋白和肾上腺素趋势。在基于社区的人群中，基线血小板聚集性与VTE事件仅存在微弱关联，且方向相反。血小板功能和止血的其他标志物可能被证明是更有用的预测指标。
