a Department of Cardiology and Department of Medical and Health Sciences , Linköping University , Linköping , Sweden.
b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.
Platelets. 2019;30(5):572-578. doi: 10.1080/09537104.2018.1479519. Epub 2018 Jun 5.
There is a large inter-individual variation in response to clopidogrel treatment, and previous studies have indicated higher risk of thrombotic events in those with high residual platelet reactivity (HPR). Less is known about individual variation over time. The aim of this prospective cohort study was to investigate intra-individual variation in platelet reactivity. Platelet aggregation in whole blood was assessed in 77 patients, at 3 days, 8 days and 6 months after admission for acute myocardial infarction and loading dose of clopidogrel. All patients were treated with aspirin and clopidogrel through 6-month follow-up. We found a significant increase in median ADP-stimulated aggregation from third to eighth day (195 vs. 250 AUmin, p-value = 0.001) but not from day 8 to 6 months (250 vs. 223 AUmin, p-value = 0.666). There was no significant change in the overall rate of HPR (15.6% vs 20.8%, p-value 0.503) or low platelet reactivity (LPR) (37.7% vs 33.8%, p-value = 0.609) from day 8 to 6-month follow-up. In contrast, more than one in four changed HPR status, 15.6% from non-HPR to HPR and 10.4% HPR to non-HPR. A shift in LPR status appeared even more frequent, occurring in about one of three patients. In spite of similar median aggregation and rate of HPR during 6-month follow-up, about one in four of the patients changed HPR status and one in three changed LPR status. This may be important information for a concept of risk stratification based on a single aggregation value early after an acute coronary syndromes.
在氯吡格雷治疗反应中存在较大的个体间差异，先前的研究表明，残留血小板反应性高（HPR）的患者发生血栓形成事件的风险更高。关于随时间的个体内变化则知之甚少。本前瞻性队列研究旨在研究血小板反应性的个体内变化。在急性心肌梗死入院后 3 天、8 天和 6 个月，对 77 例患者的全血血小板聚集进行了评估，并给予氯吡格雷负荷剂量。所有患者在 6 个月的随访期间均接受阿司匹林和氯吡格雷治疗。我们发现 ADP 刺激的聚集中位数从第三天到第八天显著增加（195 对 250 AUmin，p 值=0.001），但从第八天到 6 个月没有增加（250 对 223 AUmin，p 值=0.666）。HPR（15.6%对 20.8%，p 值 0.503）或低血小板反应性（LPR）（37.7%对 33.8%，p 值=0.609）的总体发生率从第八天到 6 个月的随访期没有显著变化。相比之下，超过四分之一的患者改变了 HPR 状态，从非 HPR 变为 HPR 的占 15.6%，HPR 变为非 HPR 的占 10.4%。LPR 状态的转变似乎更为频繁，约三分之一的患者出现这种情况。尽管在 6 个月的随访期间，中位聚集和 HPR 率相似，但仍有四分之一的患者改变了 HPR 状态，三分之一的患者改变了 LPR 状态。这对于基于急性冠状动脉综合征后早期单一聚集值的风险分层概念可能是重要信息。
