Clavijo Leonardo C, Dhillon Ashwat, Al-Asady Noor, 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, California, United States.
Division of Vascular Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States.
Cardiovasc Revasc Med. 2018 Apr-May;19(3 Pt B):319-323. doi: 10.1016/j.carrev.2017.08.016. Epub 2017 Sep 5.
To investigate platelet reactivity in patients with critical limb ischemia (CLI) after switching from clopidogrel to ticagrelor.
High on-treatment platelet reactivity (HPR) is highly prevalent in patients with CLI treated with clopidogrel. The effect of ticagrelor in patients with CLI is not known, however.
We performed P2Y12 platelet receptor inhibition studies (VASP and VerifyNow) in 50 patients with CLI. Tests were performed before and 6±1h after daily 75mg clopidogrel dose. Patients were then switched to ticagrelor 90mg twice daily for two weeks and platelet assays repeated. Patients were divided based on VerifyNow P2Y12 reaction units (PRU). Group 1: HPR defined as PRU ≥208 and Group 2: Appropriate platelet inhibition (API), PRU <208.
After two weeks of uninterrupted antiplatelet therapy, mean PRU results were 173 PRU and 71 PRU at baseline (p<0.0001) and 140 PRU and 63 PRU after 6h (p<0.0001) for clopidogrel and ticagrelor, respectively. Before daily clopidogrel dose, 36% of patients (n=18) demonstrated HPR and after 6h, 30% (n=15). One patient (2%) had HPR on ticagrelor. Ninety-four percent of patients with HPR on clopidogrel demonstrated appropriate platelet inhibition after switching to ticagrelor and all patients with API on clopidogrel remained with API after switching to ticagrelor. Six hours after daily dosing, VASP-PRI >50% was found in 42% of clopidogrel and 2% of ticagrelor treated patients.
Among patients with CLI, ticagrelor achieved greater platelet inhibition than clopidogrel during maintenance treatment and at 6h after daily dosing. High on-treatment platelet reactivity to clopidogrel in patients with CLI can be overcome by switching to ticagrelor.
研究严重肢体缺血（CLI）患者从氯吡格雷转换为替格瑞洛后的血小板反应性。
接受氯吡格雷治疗的CLI患者中，高治疗期血小板反应性（HPR）非常普遍。然而，替格瑞洛对CLI患者的影响尚不清楚。
我们对50例CLI患者进行了P2Y12血小板受体抑制研究（VASP和VerifyNow）。在每日服用75mg氯吡格雷剂量之前和之后6±1小时进行检测。然后患者改为每日两次服用90mg替格瑞洛，持续两周，并重复血小板检测。根据VerifyNow P2Y12反应单位（PRU）对患者进行分组。第1组：HPR定义为PRU≥208；第2组：适当血小板抑制（API），PRU<208。
在两周不间断的抗血小板治疗后，氯吡格雷和替格瑞洛在基线时的平均PRU结果分别为173 PRU和71 PRU（p<0.0001），6小时后分别为140 PRU和63 PRU（p<0.0001）。在每日服用氯吡格雷剂量之前，36%的患者（n = 18）表现为HPR，6小时后为30%（n = 15）。1例患者（2%）在服用替格瑞洛时出现HPR。氯吡格雷治疗时出现HPR的患者中，94%在转换为替格瑞洛后表现出适当的血小板抑制，所有氯吡格雷治疗时为API的患者在转换为替格瑞洛后仍为API。每日给药6小时后，42%接受氯吡格雷治疗的患者和2%接受替格瑞洛治疗的患者中发现VASP-PRI>50%。
在CLI患者中，替格瑞洛在维持治疗期间和每日给药6小时后比氯吡格雷能更有效地抑制血小板。CLI患者中对氯吡格雷的高治疗期血小板反应性可通过转换为替格瑞洛来克服。
