Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
Clinical Chemistry, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
Platelets. 2019;30(7):915-922. doi: 10.1080/09537104.2018.1535707. Epub 2018 Nov 13.
Residual high on-treatment platelet reactivity (HTPR) despite dual antiplatelet therapy (DAPT) has emerged as a predictor of major ischemic events in patients undergoing percutaneous coronary interventions (PCIs), especially after an acute cardiovascular event. However, its determinants are still poorly defined. Therefore, the aim of the present study was to evaluate the role of the percentage of reticulated platelets on HTPR in patients on DAPT with ASA (100-160 mg) and prasugrel (10 mg). Platelet reactivity and the reticulated platelets fraction (immature platelets fraction [IPF]) were assessed at 30-90 days after an acute coronary syndrome. Aggregation was assessed by multiple-electrode aggregometry. HTPR was defined as ADP test > 417 AU × min. Our population is represented by 180 ACS patients undergoing stent implantation, divided according to median values of IPF (< or ≥ 2.8%). Higher IPF values were associated to lower platelet count ( < 0.001) and a higher rate of active smokers ( = 0.02). No difference was observed platelet reactivity, with different activating stimuli. The prevalence of HTPR on prasugrel did not significantly differ in patients with IPF < or ≥ 2.8% (8%vs. 11.8%, = 0.46; adjusted OR [95% CI] = 1.89 [0.66-5.4], = 0.24). Our study showed that in patients treated with prasugrel after PCI for ACS, the immature platelet fraction neither platelet reactivity nor the rate of HTPR.
尽管双联抗血小板治疗（DAPT）后仍存在残余高血小板反应性（HTPR），但它已成为接受经皮冠状动脉介入治疗（PCI）的患者，尤其是急性心血管事件后的主要缺血事件的预测因素。然而，其决定因素仍未得到明确界定。因此，本研究旨在评估在接受 DAPT 治疗的患者中，ASA（100-160mg）和普拉格雷（10mg）的网织血小板百分比对 HTPR 的作用。在急性冠状动脉综合征后 30-90 天评估血小板反应性和网织血小板（不成熟血小板分数[IPF]）。通过多电极聚集仪评估聚集。HTPR 定义为 ADP 测试>417 AU × min。我们的人群代表了 180 名接受支架植入术的 ACS 患者，根据 IPF（<2.8%或≥2.8%）的中位数进行分组。较高的 IPF 值与较低的血小板计数相关（<0.001），且吸烟者的比例较高（=0.02）。在用不同激活刺激物时，未观察到血小板反应性有差异。在 IPF <2.8%或≥2.8%的患者中，普拉格雷的 HTPR 发生率无显著差异（8%vs. 11.8%，=0.46；调整后的 OR [95%CI]为 1.89 [0.66-5.4]，=0.24）。我们的研究表明，在接受 ACS 后 PCI 治疗的普拉格雷患者中，不成熟血小板分数既不影响血小板反应性，也不影响 HTPR 的发生率。
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