Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Research Institute, Fujimori Kogyo Co., Yokohama, Kanagawa, Japan.
Thromb Haemost. 2019 Oct;119(10):1554-1562. doi: 10.1055/s-0039-1693411. Epub 2019 Jul 22.
Various antithrombotic agents are clinically used to inhibit the cascade of arterial or venous thrombosis in cardiovascular diseases. Dual antiplatelet therapy with aspirin and P2Y inhibitors is prescribed in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). Direct oral anticoagulants (DOACs) are widely used for the prevention or treatment of thromboembolism in patients with atrial fibrillation (AF) and venous thromboembolism. However, there has been no definitive tool to simultaneously monitor the antithrombotic effects of these drugs. The Total Thrombus-Formation Analysis System (T-TAS), a microchip-based flow chamber system that mimics in vivo conditions for evaluating whole blood thrombogenicity, was developed for the quantitative analysis of thrombus formation in whole blood specimens. The utility of T-TAS has been evaluated in CAD patients treated with antiplatelet therapies. The T-TAS PL chip area under the flow pressure curve (AUC) accurately assesses primary hemostasis and is sensitive to the therapeutic effects of various antiplatelet therapies. In addition, low AUC results are a significant predictor of periprocedural bleeding events in CAD patients undergoing PCI. The T-TAS AR chip AUC result is useful for assessing the efficacy of DOACs and warfarin in AF patients undergoing catheter ablation, and it is also a potential independent predictor of periprocedural bleeding events and avoidance of thrombosis in patients having undergone total knee arthroplasty. In conclusion, T-TAS is a useful index for evaluating the total antithrombotic effects of combination antithrombotic agents in patients with various cardiovascular diseases.
临床上有多种抗血栓药物被用于抑制心血管疾病中的动脉或静脉血栓形成级联反应。接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者需要进行阿司匹林和 P2Y 抑制剂的双联抗血小板治疗。直接口服抗凝剂（DOAC）广泛用于预防或治疗房颤（AF）和静脉血栓栓塞症患者的血栓栓塞。然而，目前尚无明确的工具可以同时监测这些药物的抗血栓作用。全血栓形成分析系统（T-TAS）是一种基于微芯片的流动室系统，可模拟体内条件以评估全血血栓形成性，用于全血标本中血栓形成的定量分析。T-TAS 在接受抗血小板治疗的 CAD 患者中的应用已经得到了评估。T-TAS PL 芯片在血流压力曲线下的面积（AUC）可准确评估初级止血功能，并且对各种抗血小板治疗的疗效敏感。此外，在接受 PCI 的 CAD 患者中，AUC 值较低是围手术期出血事件的显著预测指标。T-TAS AR 芯片 AUC 结果可用于评估 AF 患者接受导管消融术时 DOAC 和华法林的疗效，也是围手术期出血事件和避免接受全膝关节置换术患者血栓形成的潜在独立预测指标。总之，T-TAS 是评估各种心血管疾病患者联合抗血栓药物总体抗血栓作用的有用指标。
