Clavijo Leonardo C, Al-Asady Noor, Dhillon Ashwat, Matthews Ray V, Caro Jorge, Tun Han, Rowe Vincent, Shavelle David M
Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
Division of Vascular Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
Cardiovasc Revasc Med. 2018 Jul;19(5 Pt A):516-520. doi: 10.1016/j.carrev.2017.10.013. Epub 2017 Oct 28.
The goal of this study is to establish the prevalence of high on-treatment platelet reactivity to aspirin (HPRA) and clopidogrel (HPRC) in patients with critical limb ischemia (CLI).
CLI is associated with an increased risk of death and cardiovascular events. Unlike other patient populations with atherosclerotic cardiovascular disease, previous studies failed to demonstrate a benefit of antiplatelet therapy in patients with CLI.
From June 2014 to November 2016, we performed platelet reactivity studies for P2Y12 and thromboxane A2 (TXA2) inhibition in 100 CLI patients receiving daily treatment with aspirin and clopidogrel. P2Y12 inhibition was measured by two assays: vasodilator-stimulated phosphoprotein (VASP) and VerifyNow P2Y12 assays. HPRC was defined as VerifyNow P2Y12 reactive units (PRU) >208 and VASP-platelet reactivity index (VASP-PRI) >50%. TXA2 inhibition was measured with the VerifyNow aspirin test and HPRA was defined as aspirin reaction units (ARU) >550.
Mean age was 67±11 years, 50% were male, 80% had diabetes mellitus, and 26% had chronic renal insufficiency. Thirty-three percent of patients had a PRU >208 and 46% a VASP-PRI >50%. HPRC was present in 26% of patients based on the criteria of both a PRU >208 and VASP-PRI >50%. HPRA was present in 25% of patients. The overall prevalence of HPR to ASA or clopidogrel was 35% and HPR to both drugs was present in 8% of patients. Clinical characteristics were similar between groups.
HPR to aspirin or clopidogrel is highly prevalent in patients with CLI. Nearly one in ten patients with CLI is a hyporesponder to both aspirin and clopidogrel.
本研究的目的是确定严重肢体缺血（CLI）患者中阿司匹林高治疗期血小板反应性（HPRA）和氯吡格雷高治疗期血小板反应性（HPRC）的患病率。
CLI与死亡和心血管事件风险增加相关。与其他动脉粥样硬化性心血管疾病患者群体不同，先前的研究未能证明抗血小板治疗对CLI患者有益。
2014年6月至2016年11月，我们对100例接受阿司匹林和氯吡格雷每日治疗的CLI患者进行了血小板反应性研究，以检测P2Y12和血栓素A2（TXA2）抑制情况。通过两种检测方法测量P2Y12抑制：血管扩张剂刺激磷蛋白（VASP）和VerifyNow P2Y12检测。HPRC定义为VerifyNow P2Y12反应单位（PRU）>208且VASP血小板反应性指数（VASP-PRI）>50%。用VerifyNow阿司匹林检测测量TXA2抑制，HPRA定义为阿司匹林反应单位（ARU）>第550页。
平均年龄为67±11岁，50%为男性，80%患有糖尿病，26%患有慢性肾功能不全。33%的患者PRU>208，46%的患者VASP-PRI>50%。根据PRU>208和VASP-PRI>50%的标准，26%的患者存在HPRC。25%的患者存在HPRA。对阿司匹林或氯吡格雷高反应性的总体患病率为35%，8%的患者对两种药物均高反应。各组间临床特征相似。
CLI患者中对阿司匹林或氯吡格雷高反应性非常普遍。近十分之一的CLI患者对阿司匹林和氯吡格雷均反应低下。 （注：原文中“550”疑似有误，按照逻辑可能是“550”，译文保留原文错误信息）
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