Bath Philip M, May Jane, Flaherty Katie, Woodhouse Lisa J, Dovlatova Natalia, Fox Sue C, England Timothy J, Krishnan Kailash, Robinson Thompson G, Sprigg Nikola, Heptinstall Stan
Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, UK.
Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK.
Stroke Res Treat. 2017;2017:7365684. doi: 10.1155/2017/7365684. Epub 2017 May 24.
The TARDIS trial assessed the safety and efficacy of intensive versus guideline antiplatelet agents given for one month in patients with acute stroke or TIA. The aim of this substudy was to assess the effect of antiplatelet agents taken at baseline on platelet function reactivity and activation.
Platelet function, assessed by remotely measured surface expression of P-selectin, was assessed in patients at their time of randomisation. Data are median fluorescence values.
The aspirin P-selectin test demonstrated that platelet expression was lower in 494 patients taking aspirin than in 162 patients not: mean 210 (SD 188) versus 570 (435), difference 360.3 (95% CI 312.2-408.4) (2 < 0.001). Aspirin did not suppress P-selectin levels below 500 units in 23 (4.7%) patients. The clopidogrel test showed that platelet reactivity was lower in 97 patients taking clopidogrel than in 585 patients not: 655 (296) versus 969 (315), difference 314.5 (95% CI 247.3-381.7) (2 < 0.001). Clopidogrel did not suppress P-selectin level below 860 units in 24 (24.7%) patients.
Aspirin and clopidogrel suppress stimulated platelet P-selectin, although one-quarter of patients on clopidogrel have high on-treatment platelet reactivity. Platelet function testing may be performed remotely in the context of a large multicentre trial. Trial registration ISRCTN47823388.
TARDIS试验评估了在急性卒中或短暂性脑缺血发作（TIA）患者中，强化抗血小板药物与指南推荐的抗血小板药物治疗1个月的安全性和疗效。本亚组研究的目的是评估基线时服用的抗血小板药物对血小板功能反应性和活化的影响。
在患者随机分组时评估血小板功能，通过远程测量P-选择素的表面表达来进行评估。数据为中位荧光值。
阿司匹林P-选择素试验表明，494例服用阿司匹林的患者血小板表达低于162例未服用阿司匹林的患者：均值分别为210（标准差188）和570（435），差值为360.3（95%置信区间312.2 - 408.4）（P<0.001）。23例（4.7%）患者服用阿司匹林后P-选择素水平未降至500单位以下。氯吡格雷试验表明，97例服用氯吡格雷的患者血小板反应性低于585例未服用氯吡格雷的患者：分别为655（296）和969（315），差值为314.5（95%置信区间247.3 - 381.7）（P<0.001）。24例（24.7%）患者服用氯吡格雷后P-选择素水平未降至860单位以下。
阿司匹林和氯吡格雷可抑制刺激后的血小板P-选择素表达，尽管四分之一服用氯吡格雷的患者治疗期间血小板反应性较高。在大型多中心试验中，血小板功能检测可通过远程方式进行。试验注册号：ISRCTN47823388
