Winter Max-Paul, Schneeweiss Theresia, Cremer Rolf, Biesinger Benedikt, Hengstenberg Christian, Prüller Florian, Wallner Markus, Kolesnik Ewald, von Lewinski Dirk, Lang Irene M, Siller-Matula Jolanta M
Department of Cardiology, Medical University of Vienna, Vienna, Austria.
Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
Eur J Clin Invest. 2019 Jun;49(6):e13102. doi: 10.1111/eci.13102. Epub 2019 Mar 29.
The aim of the present study was to investigate the patterns of platelet reactivity and discriminators of therapeutic response to dual antiplatelet therapy (DAPT) with aspirin and ticagrelor or prasugrel in patients with acute coronary syndrome (ACS).
In this multicentre prospective observational study, 492 patients with ACS were enrolled. Platelet aggregation was determined by multiple electrode aggregometry after stimulation with adenosine diphosphate (ADP) or arachidonic acid (AA) as agonists in the maintenance phase of treatment with prasugrel or ticagrelor.
Age emerged as the strongest variable influencing aspirin response status: The mean AA-induced platelet aggregation in patients <49 years of age was 49% higher than in those >49 years (13.1 U vs 8.8 U; P = 0.011). The second strongest discriminator of aspirin response was sex: Male patients had a 40% higher AA-induced platelet aggregation values than female patients (9.5 U vs 6.8 U; P = 0.026). Platelet count emerged as the only variable influencing ADP antagonists response status showing that patients with platelet count >320 g/L displayed higher ADP-induced platelet aggregation. About 12% of patients had high on-treatment platelet reactivity (HTPR) to aspirin, 3% and 4% a HTPR to prasugrel and ticagrelor, respectively, and only 2% displayed HTPR to dual antiplatelet therapy.
When potent platelet inhibitors as prasugrel and ticagrelor are administered with aspirin, HTPR to DAPT plays only a marginal role.
本研究旨在调查急性冠状动脉综合征（ACS）患者使用阿司匹林与替格瑞洛或普拉格雷进行双联抗血小板治疗（DAPT）时的血小板反应模式及治疗反应的鉴别因素。
在这项多中心前瞻性观察研究中，纳入了492例ACS患者。在使用普拉格雷或替格瑞洛治疗的维持阶段，以二磷酸腺苷（ADP）或花生四烯酸（AA）作为激动剂刺激后，通过多电极聚集测定法测定血小板聚集情况。
年龄是影响阿司匹林反应状态的最强变量：年龄<49岁患者的平均AA诱导血小板聚集比>49岁患者高49%（13.1 U对8.8 U；P = 0.011）。阿司匹林反应的第二强鉴别因素是性别：男性患者的AA诱导血小板聚集值比女性患者高40%（9.5 U对6.8 U；P = 0.026）。血小板计数是影响ADP拮抗剂反应状态的唯一变量，表明血小板计数>320 g/L的患者显示出更高的ADP诱导血小板聚集。约12%的患者对阿司匹林有高治疗期血小板反应性（HTPR），对普拉格雷和替格瑞洛有HTPR的患者分别为3%和4%，而对双联抗血小板治疗有HTPR的仅2%。
当使用普拉格雷和替格瑞洛等强效血小板抑制剂与阿司匹林联用时，HTPR对DAPT的影响很小。
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