高血小板反应性残留阿司匹林治疗非 ST 段抬高急性冠状动脉综合征患者：初始和晚期阶段的比较。
High Residual Platelet Reactivity during Aspirin Therapy in Patients with Non-St Segment Elevation Acute Coronary Syndrome: Comparison Between Initial and Late Phases.
机构信息
Hospital da Bahia - Instituto de Ensino e Pesquisa, Salvador, BA - Brazil.
Sinai Hospital of Baltimore - Sinai Center for Thrombosis Research, Baltimore - EUA.
出版信息
Arq Bras Cardiol. 2019 Aug 15;113(3):357-363. doi: 10.5935/abc.20190146. eCollection 2019.
BACKGROUND
High platelet reactivity (HPR) during therapy with acetylsalicylic acid (ASA) is a poor prognostic factor in acute coronary syndromes (ACS). The prevalence of HPR during ACS is greater than that reported in stable diseases. However, it is unclear whether this prevalence of HPR is a transient phenomenon or a characteristic of this high-risk population.
OBJECTIVE
The main objective is to compare the effects of ASA on platelet function in the initial and late phases of ACS in a single population. Secondary objectives are: correlation between the tests between themselves and the relationship between the tests and the variation of the inflammatory markers (C-reactive protein and interleukin-6).
METHODS
Seventy patients with non-ST segment elevation (NSTE) ACS in use of 100-200 mg of ASA per day for at least 7 days were prospectively studied. Platelet function was assessed in the first 48 hours and subsequently after 3 months using four methods: VerifyNow™ (VFN), whole blood platelet aggregation (WBPA) with arachidonic acid (AA) and collagen as agonists, and platelet function analyzer (PFA). The level of statistical significance considered was < 0.05.
RESULTS
According to the more specific methods (WBPA with AA and VFN), the incidence of HPR was significantly higher in the early phase than in the late phase: WBPA with AA: 31% versus 13%, p = 0.015; VFN: 32% versus 16%, p = 0.049. The other methods tested, which were less specific for ASA, did not show significant differences between phases. The correlation between the methods was weak or moderate (r ranging from 0.3 to 0.5, p < 0.05), and there were no significant associations between HPR and inflammatory markers.
CONCLUSION
The prevalence of HPR during AAS therapy, assessed by specific methods for cyclooxygenase 1 (COX-1), is higher during the acute phase than in the late phase of NSTE ACS.
背景
在急性冠脉综合征（ACS）的治疗中，阿司匹林（ASA）的高血小板反应性（HPR）是一个预后不良的因素。ACS 期间 HPR 的发生率高于稳定疾病中报告的发生率。然而，尚不清楚这种 HPR 的发生率是一种短暂现象还是这种高危人群的特征。
目的
主要目的是在单一人群中比较 ACS 初始和晚期 ASA 对血小板功能的影响。次要目标是：自身试验之间的相关性以及试验与炎症标志物（C 反应蛋白和白细胞介素 6）变化之间的关系。
方法
前瞻性研究了 70 例非 ST 段抬高型 ACS（NSTE-ACS）患者，每天使用 100-200mg 的 ASA，至少使用 7 天。在最初的 48 小时内和随后的 3 个月内使用四种方法评估血小板功能：VerifyNow（VFN），以花生四烯酸（AA）和胶原作为激动剂的全血血小板聚集（WBPA），和血小板功能分析仪（PFA）。认为具有统计学意义的水平为 <0.05。
结果
根据更特异的方法（AA 的 WBPA 和 VFN），早期 HPR 的发生率明显高于晚期：AA 的 WBPA：31%比 13%，p=0.015；VFN：32%比 16%，p=0.049。其他测试方法，对 ASA 的特异性较低，两阶段之间无显著差异。方法之间的相关性较弱或中等（r 范围为 0.3 至 0.5，p<0.05），HPR 与炎症标志物之间无显著关联。
结论
通过 COX-1 特异性方法评估，NSTE-ACS 急性期 ASA 治疗期间 HPR 的发生率高于晚期。
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