The Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA.
The Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA.
J Vet Intern Med. 2020 May;34(3):1198-1205. doi: 10.1111/jvim.15759. Epub 2020 Apr 4.
Glucocorticoids cause hypercoagulability, but it is unknown if they counteract clopidogrel's antiplatelet effects.
HYPOTHESIS/OBJECTIVES: Determine the effects of clopidogrel and prednisone on platelet function.
Twenty-four healthy dogs.
Double-blinded, placebo-controlled randomized trial. Platelet function was evaluated using a platelet function analyzer and impedance aggregometry (days 0, 14, and 28) for dogs treated with placebo, clopidogrel (2-3 mg/kg/d), prednisone (2 mg/kg/d), or prednisone with clopidogrel PO for 28 days. Results were categorized as nonresponder versus responder (platelet function analyzer), and inadequate, ideal, or excessive response (aggregometry). Results were compared using mixed model, split-plot repeated measures analysis of variance and generalized estimating equation proportional odds models. P < .05 was considered significant.
Closure times differed by treatment (F [3, 20] = 10.5; P < .001), time (F [2, 40] = 14.3; P < .001), and treatment-by-time (F [6, 40] = 3.4; P = .01). Area under the curve (AUC) differed by treatment (F [3, 20] = 19.6; P < .001), time (F [2, 40] = 35.4; P < .001), and treatment-by-time (F [6, 40] = 13.5; P < .001). Based on closure times, 5/6 dogs each in the clopidogrel and prednisone/clopidogrel groups were responders. All dogs in the prednisone/clopidogrel group were overcontrolled based on AUC (days 14 and 28), whereas 5/6 (day 14) and 2/6 (day 28) dogs treated with clopidogrel were overcontrolled. Compared to clopidogrel, dogs receiving prednisone/clopidogrel were 11 times (P = .03) more likely to have an excessive response.
Administration of clopidogrel/prednisone increases platelet dysfunction in healthy dogs.
糖皮质激素可导致高凝状态，但尚不清楚其是否会对抗氯吡格雷的抗血小板作用。
假设/目的：确定氯吡格雷和泼尼松对血小板功能的影响。
24 只健康犬。
双盲、安慰剂对照随机试验。用血小板功能分析仪和阻抗聚集法（第 0、14 和 28 天）评估接受安慰剂、氯吡格雷（2-3mg/kg/d）、泼尼松（2mg/kg/d）或泼尼松联合氯吡格雷 PO 治疗 28 天的犬的血小板功能。将结果分为无反应者与反应者（血小板功能分析仪）和反应不足、理想或过度（聚集仪）。采用混合模型、分割区组重复测量方差分析和广义估计方程比例优势模型比较结果。P<.05 被认为具有统计学意义。
不同治疗方法的闭合时间存在差异（F [3, 20] = 10.5；P<.001），时间（F [2, 40] = 14.3；P<.001）和治疗-时间（F [6, 40] = 3.4；P =.01）也存在差异。曲线下面积（AUC）因治疗（F [3, 20] = 19.6；P<.001）、时间（F [2, 40] = 35.4；P<.001）和治疗-时间（F [6, 40] = 13.5；P<.001）而异。根据闭合时间，氯吡格雷和泼尼松/氯吡格雷组各有 5/6 只犬为反应者。泼尼松/氯吡格雷组所有犬的 AUC 在第 14 和 28 天均过度控制，而氯吡格雷组 5/6 （第 14 天）和 2/6 （第 28 天）犬过度控制。与氯吡格雷相比，接受泼尼松/氯吡格雷治疗的犬出现过度反应的可能性高 11 倍（P =.03）。
在健康犬中，给予氯吡格雷/泼尼松会增加血小板功能障碍。
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