Department of Radiology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
Department of Neurology, Hacettepe University Hospitals, Ankara, Turkey.
Clin Neuroradiol. 2021 Dec;31(4):1159-1165. doi: 10.1007/s00062-021-01011-7. Epub 2021 Apr 12.
Although point-of-care tests are used extensively to test platelet function before endovascular aneurysm treatment, their use and validity are still debated. We compared the results of two point-of-care tests (VerifyNow® and Multiplate®) for assessing patients treated with stents and flow diverters and determined their relation to periprocedural complications.
All patients undergoing treatment of intracranial aneurysms were tested using both methods and were retrospectively evaluated. Patients with acute subarachnoid hemorrhage and those who had to be maintained on anticoagulants for unrelated diseases were excluded. An acceptable level of platelet inhibition was required on both tests to commence with treatment, otherwise antiplatelet medication was adjusted to reach this level.
Mean PRU (platelet reactivity units) and ADP AUC (adenosine diphosphate area under the aggregation curve) were 68 ± 66 and 23 ± 15, respectively, in 295 patients. Both tests showed a good correlation (r = 0.45). Both tests were able to predict hemorrhagic events but not ischemic events. When patients with very low reactivity (PRU < 60) were compared to the rest of the group, there were more hemorrhagic events in the first group but the overall rate of complications were similar (p = 0.27).
In this largest study comparing two widely used commercial platelet function tests, the correlation between the tests were less than ideal; however, the very low platelet reactivity attained by the help of dual platelet testing did not result in an increased overall complication rate.
尽管在血管内动脉瘤治疗前广泛使用即时检测（point-of-care test，POCT）来检测血小板功能，但它们的使用和有效性仍存在争议。我们比较了两种用于评估接受支架和血流导向装置治疗的患者的即时检测方法（VerifyNow®和Multiplate®）的结果，并确定了它们与围手术期并发症的关系。
所有接受颅内动脉瘤治疗的患者均使用这两种方法进行检测，并进行回顾性评估。排除了急性蛛网膜下腔出血患者和因其他疾病需要维持抗凝治疗的患者。两种检测方法均需要达到可接受的血小板抑制水平才能开始治疗，否则需要调整抗血小板药物以达到该水平。
在 295 例患者中，平均血小板反应单位（platelet reactivity units，PRU）和 ADP 面积（adenosine diphosphate area under the aggregation curve，ADP AUC）分别为 68±66 和 23±15。两种检测方法均显示出良好的相关性（r=0.45）。两种检测方法均能预测出血事件，但不能预测缺血事件。与其余患者相比，PRU<60 的极低反应性患者的出血事件更多，但总体并发症发生率相似（p=0.27）。
在这项比较两种广泛使用的商业血小板功能检测方法的最大研究中，检测方法之间的相关性不理想；然而，通过双重血小板检测获得的极低血小板反应性并未导致总体并发症发生率增加。
