Kuliczkowski Wiktor, Cielecka-Prynda Magdalena, Karolko Bożena, Kaaz Konrad, Adamik Barbara, Bednarczyk Dawid, Kobusiak-Prokopowicz Małgorzata, Mysiak Andrzej
Department and Clinic of Cardiology, Wroclaw Medical University, Wroclaw, Poland.
Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland.
Postepy Kardiol Interwencyjnej. 2020 Dec;16(4):418-421. doi: 10.5114/aic.2020.101766. Epub 2020 Dec 29.
There are limited data on platelet reactivity and response to antiplatelet drugs in patients with cardiogenic shock.
To assess platelet reactivity on dual antiplatelet therapy with acetylsalicylic acid (ASA) and ticagrelor, a novel potent P2Y12 receptor inhibitor, in patients with cardiogenic shock in the course of acute coronary syndrome (ACS) who received invasive treatment.
We enrolled 12 consecutive patients with ACS complicated by cardiogenic shock. To assess response to antiplatelet therapy during cardiogenic shock, only patients with symptoms persisting for at least 3 days and who completed a 5-day follow-up were included in the study. Patients received a loading dose of ASA (300 mg) and ticagrelor (180 mg), followed by a maintenance dose (ASA, 1 × 75 mg; ticagrelor, 2 × 90 mg). Blood samples for platelet function tests were collected. Platelet aggregation was assessed with a Multiplate whole-blood impedance aggregometer. Arachidonic acid (AA), adenosine diphosphate (ADP), and thrombin receptor-activating peptide (TRAP) were used as aggregation agonists.
Response to antiplatelet therapy assessed by aggregometry showed numerically higher on-ASA platelet reactivity on day one and statistically significant higher on-ticagrelor platelet reactivity on day one in comparison with following days. There were 2 patients with high on ASA platelet reactivity and 3 with high on ticagrelor platelet reactivity, but only on the day one.
Some patients with cardiogenic shock in the course of ACS treated invasively show a lower response to ASA and ticagrelor only on the first day after invasive treatment, with a good response on subsequent days.
关于心源性休克患者的血小板反应性及对抗血小板药物的反应的数据有限。
评估在接受侵入性治疗的急性冠状动脉综合征（ACS）过程中发生心源性休克的患者，使用乙酰水杨酸（ASA）和新型强效P2Y12受体抑制剂替格瑞洛进行双重抗血小板治疗时的血小板反应性。
我们连续纳入了12例并发心源性休克的ACS患者。为评估心源性休克期间对抗血小板治疗的反应，仅纳入症状持续至少3天且完成5天随访的患者。患者接受ASA（300mg）和替格瑞洛（180mg）的负荷剂量，随后接受维持剂量（ASA，1×75mg；替格瑞洛，2×90mg）。采集用于血小板功能测试的血样。使用多电极全血阻抗聚集仪评估血小板聚集。花生四烯酸（AA）、二磷酸腺苷（ADP）和凝血酶受体激活肽（TRAP）用作聚集激动剂。
通过聚集测定法评估的抗血小板治疗反应显示，与随后几天相比，第1天的ASA血小板反应性在数值上更高，第1天的替格瑞洛血小板反应性在统计学上显著更高。有2例患者ASA血小板反应性高，3例替格瑞洛血小板反应性高，但仅在第1天。
一些在ACS过程中发生心源性休克且接受侵入性治疗的患者仅在侵入性治疗后的第一天对ASA和替格瑞洛的反应较低，而在随后几天反应良好。
