Department of Vascular Surgery, St. Josef Hospital, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany.
Department of Neurology, St. Josef Hospital, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany.
PLoS One. 2020 Dec 29;15(12):e0244330. doi: 10.1371/journal.pone.0244330. eCollection 2020.
Reduced antiplatelet activity of aspirin (ALR) or clopidogrel (CLR) is associated with an increased risk of thromboembolic events. The reported prevalence data for low-responders vary widely and there have been few investigations in vascular surgery patients even though they are at high risk for thromb-embolic complications. The aim of this prospective observational monocentric study was to elucidate possible changes in ALR or CLR after common vascular procedures.
Activity of aspirin and clopidogrel was measured by impedance aggregometry using a multiple electrode aggregometer (Multiplate®). Possible risk factors for ALR or CLR were identified by demographical, clinical data and laboratory parameters. In addition, a follow-up aggregometry was performed after completion of the vascular procedure to identify changes in antiplatelet response.
A total of 176 patients taking antiplatelet medications aspirin and/or clopidogrel with peripheral artery disease (PAD) and/or carotid stenosis (CS) were included in the study. The prevalence of ALR was 13.1% and the prevalence of CLR was 32% in the aggregometry before vascular treatment. Potential risk factors identified in the aspirin group were concomitant insulin medication (p = 0.0006) and elevated C-reactive protein (CRP) (p = 0.0021). The overall ALR increased significantly postoperatively to 27.5% (p = 0.0006); however, there was no significant change in CLR that was detected. In a subgroup analysis elevation of the platelet count was associated with a post-procedure increase of ALR incidence.
The incidence of ALR in vascular surgery patients increases after vascular procedures. An elevated platelet count was detected as a risk factor. Further studies are necessary to analyse this potential influence on patency rates of vascular reconstructions.
阿司匹林（ALR）或氯吡格雷（CLR）的抗血小板活性降低与血栓栓塞事件的风险增加有关。低反应者的报告患病率数据差异很大，尽管血管外科患者发生血栓栓塞并发症的风险很高，但针对该人群的研究很少。本前瞻性观察性单中心研究旨在阐明常见血管手术后 ALR 或 CLR 可能发生的变化。
使用阻抗聚集仪（Multiplate®）通过多电极聚集仪测量阿司匹林和氯吡格雷的活性。通过人口统计学、临床数据和实验室参数确定 ALR 或 CLR 的可能危险因素。此外，在血管手术后进行随访聚集试验，以确定抗血小板反应的变化。
共纳入 176 例接受抗血小板药物阿司匹林和/或氯吡格雷治疗的外周动脉疾病（PAD）和/或颈动脉狭窄（CS）患者。在血管治疗前的聚集试验中，ALR 的患病率为 13.1%，CLR 的患病率为 32%。在阿司匹林组中确定的潜在危险因素包括同时使用胰岛素药物（p = 0.0006）和 C 反应蛋白升高（p = 0.0021）。术后总体 ALR 显著升高至 27.5%（p = 0.0006）；然而，未检测到 CLR 的显著变化。在亚组分析中，血小板计数升高与术后 ALR 发生率增加相关。
血管外科患者的 ALR 发生率在血管手术后增加。检测到血小板计数升高是一个危险因素。需要进一步研究来分析这种对血管重建通畅率的潜在影响。
