Shao Tengfei, Cheng Yue, Jin Jiali, Huang Lili, Yang Dan, Luo Caimei, Han Zhou, Wang Zhongyuan, Ge Weihong, Xu Yun
Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
J Clin Neurosci. 2020 Aug;78:91-96. doi: 10.1016/j.jocn.2020.06.004. Epub 2020 Jul 3.
Predicting the effectiveness of antiplatelet drugs is critical to precision antiplatelet therapy. However, there is a lack of an acceptable method, although there are a variety of methods for detecting platelet function. In this study, we compared three major platelet function tests to assess their performance and found better methods for platelet function evaluation after aspirin or clopidogrel treatment in ischemic stroke patients by comparative study. A total of 249 ischemic stroke patients were enrolled who were treated with aspirin or clopidogrel or both. Three platelet function tests including light transmittance aggregometry (LTA), thromboelastography (TEG), platelet function analyzer (PFA) were performed as well as CYP2C19 genotype determination. Correlation analyses and kappa statistics were used. All three methods were effective in evaluating aspirin function. However, only LTA and TEG had good correlation and consistency (r = -0.37, kappa = 0.634). TEG-ADP was the least sensitive for clopidogrel, as the platelet inhibition ratio did not differ between the clopidogrel-user group and the control (P = 0.074), while LTA and PFA were sensitive (P ＜ 0.001). Correlations between platelet assays were poor for clopidogrel (the absolute value of r range from 0.13 to 0.35) and so was the agreement (Kappa from 0.232 to 0.314). LTA and PFA have a good correlation with CYP2C19 genotyping (P = 0.034 and 0.014). In conclusion, all three tests were able to evaluate aspirin effect, LTA-AA and TEG-AA had a good correlation. TEG perform badly for clopidogrel effect detection. The fair-to-modest agreement among assays indicated further study was indispensable.
预测抗血小板药物的疗效对于精准抗血小板治疗至关重要。然而，尽管有多种检测血小板功能的方法，但仍缺乏一种可接受的方法。在本研究中，我们比较了三种主要的血小板功能测试以评估其性能，并通过对比研究找到了在缺血性中风患者中评估阿司匹林或氯吡格雷治疗后血小板功能的更好方法。共纳入249例接受阿司匹林或氯吡格雷或两者治疗的缺血性中风患者。进行了三项血小板功能测试，包括透光率聚集法（LTA）、血栓弹力图（TEG）、血小板功能分析仪（PFA）以及CYP2C19基因分型测定。采用了相关性分析和kappa统计。所有三种方法在评估阿司匹林功能方面均有效。然而，只有LTA和TEG具有良好的相关性和一致性（r = -0.37，kappa = 0.634）。TEG-ADP对氯吡格雷最不敏感，因为氯吡格雷使用者组和对照组之间的血小板抑制率无差异（P = 0.074），而LTA和PFA敏感（P ＜ 0.001）。氯吡格雷的血小板检测之间相关性较差（r绝对值范围为0.13至0.35），一致性也较差（Kappa为0.232至0.314）。LTA和PFA与CYP2C19基因分型具有良好的相关性（P = 0.034和0.014）。总之，所有三项测试都能够评估阿司匹林的效果，LTA-AA和TEG-AA具有良好的相关性。TEG在检测氯吡格雷效果方面表现不佳。各检测方法之间的一致性一般，表明进一步研究必不可少。
