经皮冠状动脉介入治疗患者应用血栓形成分析系统测量的血液透析相关低血栓形成性。
Hemodialysis-related low thrombogenicity measured by total thrombus-formation analysis system in patients undergoing percutaneous coronary intervention.
机构信息
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
出版信息
Thromb Res. 2021 Apr;200:141-148. doi: 10.1016/j.thromres.2021.02.004. Epub 2021 Feb 6.
BACKGROUND
Established antithrombotic therapies can increase bleeding risk, especially in hemodialysis (HD) patients. The Total Thrombus-formation Analysis System (T-TAS) is useful for evaluating thrombogenicity. The aim of this study was to examine the relationship between HD and thrombogenicity, or bleeding events in patients undergoing percutaneous coronary intervention (PCI).
METHODS
In this retrospective cohort study, 300 patients undergoing elective PCI were enrolled between April 2017 and March 2019. Blood samples obtained on the day of PCI were analyzed with T-TAS to compute the thrombus formation area under the curve (AUC; PL-AUC for platelet chip; AR-AUC for atheroma chip). The patients were divided into three groups according to estimated glomerular filtration rate (eGFR): 33 HD patients, 124 non-HD patients with eGFR <60 mL/min/1.73m, and 143 non-HD patients with eGFR ≥60. We examined the thrombogenicity and spontaneous bleeding events within 1-year post-PCI.
RESULTS
HD was significantly associated with both low PL-AUC and AR-AUC levels determined by T-TAS. Bleeding events defined by the Bleeding Academic Research Consortium criteria types 2, 3, or 5 occurred during follow-up in 27 patients (9.0%): 7 in HD, 10 in non-HD with eGFR <60, and 10 in non-HD with eGFR ≥60. Both T-TAS parameters in the patients with bleeding were lower compared with those in the patients without bleeding, and HD was significantly associated with 1-year bleeding events.
CONCLUSIONS
The results suggested that HD patients undergoing PCI might be a predictor for low thrombogenicity measured by T-TAS and 1-year bleeding risk.
背景
已确立的抗血栓治疗会增加出血风险，尤其是在血液透析（HD）患者中。全血栓形成分析系统（T-TAS）可用于评估血栓形成性。本研究旨在探讨 HD 与血栓形成性或经皮冠状动脉介入治疗（PCI）患者出血事件之间的关系。
方法
在这项回顾性队列研究中，纳入了 2017 年 4 月至 2019 年 3 月期间接受择期 PCI 的 300 例患者。在 PCI 当天采集的血液样本通过 T-TAS 进行分析，计算血栓形成曲线下面积（AUC；血小板芯片的 PL-AUC；动脉粥样硬化芯片的 AR-AUC）。根据估计肾小球滤过率（eGFR）将患者分为三组：33 例 HD 患者、124 例 eGFR <60 mL/min/1.73m 的非 HD 患者和 143 例 eGFR ≥60 的非 HD 患者。我们检查了 PCI 后 1 年内的血栓形成和自发性出血事件。
结果
T-TAS 测定的 HD 与低 PL-AUC 和 AR-AUC 水平显著相关。根据 Bleeding Academic Research Consortium 标准，27 例患者在随访期间发生出血事件（9.0%）：7 例在 HD 患者中，10 例在 eGFR <60 的非 HD 患者中，10 例在 eGFR ≥60 的非 HD 患者中。有出血事件的患者的 T-TAS 参数均低于无出血事件的患者，HD 与 1 年出血事件显著相关。
结论
结果表明，接受 PCI 的 HD 患者可能是 T-TAS 测量的低血栓形成性和 1 年出血风险的预测因素。
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