Unitat d'Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau.
Hematology Department, Fundació Puigvert, Barcelona, Spain.
Blood Coagul Fibrinolysis. 2021 Mar 1;32(2):122-131. doi: 10.1097/MBC.0000000000001006.
The aim of the study was to determine whether platelet hyperaggregability correlates with short closure times (PFA-100) and if hyperaggregability is associated with the risk of venous thrombosis in a Spanish population. Case--control study (RETROVE project) involving 400 patients with venous thrombosis and 400 healthy controls. We determined platelet aggregation in platelet-rich plasma (PRP) by light transmission aggregometry. Various concentrations of two aggregation agonists [ADP and epinephrine (EPI)] were tested to determine the percentage of maximal aggregation and the percentage area under the curve (AUC). Venous thrombosis risk associated with platelet hyperaggregability was calculated by logistic regression. We estimated the crude and adjusted (by sex and age) odds ratios (OR) for venous thrombosis risk. An agonist concentration of 0.5 μmol/l differentiated between hypo-responders and hyper-responders at the following AUC cut-off values: EPI: the 50th percentile for aggregation with 0.5 μmol/l of EPI (EPI_AUC) was 22.53% (>22.53% = hyper-EPI); the crude risk for venous thrombosis was statistically significant (OR = 1.37; 95% CI 1.03-1.82); ADP: the 75th percentile for aggregation with 0.5 μmol/l of ADP (ADP_AUC) was 29.6% (>29.6% = hyper-ADP), with a significant crude risk for venous thrombosis (OR = 1.44; 95% CI 1.05-1.98). However, after adjustment for confounders (age), the ORs for EPI or ADP aggregation were no longer significant. EPI_AUC and PFA-100 values with the EPI agonist were significantly correlated (R = -0.342, P < 0.01). Only 12% of the PFA-100 values were explained by platelet aggregation. In this case--control study, platelet hyperaggregability was not associated with the risk of developing venous thrombosis.
本研究旨在确定血小板高聚集性是否与短的闭合时间（PFA-100）相关，以及在西班牙人群中血小板高聚集性是否与静脉血栓形成的风险相关。病例对照研究（RETROVE 项目），共纳入 400 例静脉血栓形成患者和 400 例健康对照者。我们通过光传输聚集仪测定富含血小板的血浆（PRP）中的血小板聚集。测试了两种聚集激动剂[二磷酸腺苷（ADP）和肾上腺素（EPI）]的不同浓度，以确定最大聚集的百分比和曲线下面积（AUC）的百分比。通过 logistic 回归计算与血小板高聚集性相关的静脉血栓形成风险。我们估计了静脉血栓形成风险的粗比值比（OR）和调整后的比值比（按性别和年龄调整）。在以下 AUC 截断值下，0.5μmol/l 的激动剂浓度可区分低反应者和高反应者：EPI：EPI 浓度为 0.5μmol/l 时的 50%聚集（EPI_AUC）为 22.53%（>22.53%=高 EPI）；静脉血栓形成的风险具有统计学意义（OR=1.37；95%CI 1.03-1.82）；ADP：ADP 浓度为 0.5μmol/l 时的 75%聚集（ADP_AUC）为 29.6%（>29.6%=高 ADP），静脉血栓形成的风险具有统计学意义（OR=1.44；95%CI 1.05-1.98）。然而，在校正混杂因素（年龄）后，EPI 或 ADP 聚集的 OR 不再显著。EPI 激动剂的 EPI_AUC 和 PFA-100 值显著相关（R=-0.342，P<0.01）。PFA-100 值仅 12%可由血小板聚集解释。在本病例对照研究中，血小板高聚集性与静脉血栓形成风险无关。
