Samoš Matej, Stančiaková Lucia, Duraj Lukáš, Kovář František, Fedor Marián, Šimonová Radoslava, Bolek Tomáš, Galajda Peter, Staško Ján, Kubisz Peter, Mokáň Marián
Department of Internal Medicine I National Centre of Haemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin, Slovak Republic.
Medicine (Baltimore). 2017 Feb;96(6):e6045. doi: 10.1097/MD.0000000000006045.
Rotation thromboelastometry (ROTEM) is a viscoelastometric point-of-care-test for the complex evaluation of changes in hemostasis, performed in whole blood. However, no prospective study evaluating the efficacy of the antiplatelet therapy using ROTEM was performed.Fifty-six patients (34 men, 22 women, mean age 67.75 years, and age range 34-88 years) with acute ST-elevation myocardial infarction (STEMI), treated with dual antiplatelet therapy, undergoing urgent coronary angiography and percutaneous coronary intervention (PCI) of culprit coronary lesion were included. Three blood samples were taken (sample 1 taken before the urgent coronary angiography, sample 2 in 24 hours after the admission, and sample 3 in 30 days after acute STEMI). Twenty-one healthy blood donors (17 men, 4 women, mean age 50.38 years, and age range 40-74 years) were recruited as the control group. Blood samples were tested with ROTEM Gamma (Pentapharm GmbH, Munich, Germany) and light transmission aggregometry (LTA).Clotting time (CT) was significantly prolonged and maximum clot firmness (MCF) was significantly higher in patients compared to controls. Mean platelet aggregation after the induction with arachidonic acid (33.2% vs 74.6% in sample 1 and 21.1% vs 74.6% in sample 2), as well as adenosine diphosphate (51.4% vs 72.7% in sample 1 and 37.1% vs 72.7% in sample 2), were significantly lower in patients with acute STEMI.Significantly prolonged CT and increased MCF was found in patients with acute STEMI. This study confirmed the ability of ROTEM to identify changes in hemostasis in ACS patients on antithrombotic therapy.
旋转血栓弹力图（ROTEM）是一种用于在全血中对止血变化进行综合评估的粘弹性即时检测方法。然而，尚未进行过评估使用ROTEM进行抗血小板治疗疗效的前瞻性研究。纳入了56例急性ST段抬高型心肌梗死（STEMI）患者（34例男性，22例女性，平均年龄67.75岁，年龄范围34 - 88岁），这些患者接受双联抗血小板治疗，并行紧急冠状动脉造影及对罪犯冠状动脉病变进行经皮冠状动脉介入治疗（PCI）。采集三份血样（样本1在紧急冠状动脉造影前采集，样本2在入院后24小时采集，样本3在急性STEMI后30天采集）。招募了21名健康献血者（17例男性，4例女性，平均年龄50.38岁，年龄范围40 - 74岁）作为对照组。血样用ROTEM Gamma（德国慕尼黑Pentapharm GmbH公司）和光透射聚集法（LTA）进行检测。与对照组相比，患者的凝血时间（CT）显著延长，最大血凝块硬度（MCF）显著更高。急性STEMI患者用花生四烯酸诱导后的平均血小板聚集率（样本1中为33.2%对74.6%，样本2中为21.1%对74.6%）以及用二磷酸腺苷诱导后的平均血小板聚集率（样本1中为51.4%对72.7%，样本2中为37.1%对72.7%）均显著更低。急性STEMI患者的CT显著延长且MCF升高。本研究证实了ROTEM识别接受抗栓治疗的急性冠状动脉综合征（ACS）患者止血变化的能力。
