Graduate school, Tianjin Medical University.
Department of Cardiology, Tianjin Union Medical Center.
Medicine (Baltimore). 2021 Apr 23;100(16):e25601. doi: 10.1097/MD.0000000000025601.
There is controversy in clinical application of antiplatelet drugs by monitoring platelet function. Therefore, we explored whether early and dynamic medication could bring better clinical outcomes for patients under the guidance of platelet function tests (PFT).In this retrospective cohort study, we analyzed the prognostic events of 1550 patients with acute coronary syndrome (ACS) at Tianjin People's Hospital in China. They received dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) from January 2017 to December 2018. The primary endpoint was based on the Bleeding Academic Research Consortium (BARC) 3 or 5 major bleeding. Secondary endpoints included MACCE (all-cause death, nonfatal myocardial infarction, stroke, stent thrombosis, and unplanned target vessel reconstruction) and BARC 1 to 2 minor bleeding. The endpoint events within 1 year after PCI were recorded. Patients were divided into a guided group and a control group according to the drug adjustment by PFT results. After the propensity scores matched, the end points of 2 groups were compared, and subgroup analysis was performed on major bleeding events.After propensity score matching, there were 511 cases in the guided group and the control group, respectively. The primary endpoint events occurred in 10 patients (1.96%) in the guided group and 23 patients (4.5%) in the control group (HR: 0.45; 95% CI, 0.21-0.95; P = .037). After the guided group adjusted drug doses, the risk of major bleeding was lower than standard DAPT of the control group. Although some patients in the guided group reduced doses earlier, the incidence of MACCE events did not increase in the guided group compared with the control group (4.89% vs 6.07%; P = .41). There was no statistical difference in BARC 1 to 2 minor bleeding (P = .22). Subgroup analysis showed that PFT was more effective in patients with diabetes and multivessel disease.Early observation of dynamic PFT in ACS patients after PCI can guide individualized antiplatelet therapy to reduce the risk of major bleeding without increasing the risk of ischemia.
在血小板功能监测的临床应用中存在争议。因此，我们探索了在血小板功能试验（PFT）的指导下，早期和动态用药是否能为患者带来更好的临床结局。
在这项回顾性队列研究中，我们分析了中国天津市人民医院 1550 例急性冠脉综合征（ACS）患者的预后事件。他们于 2017 年 1 月至 2018 年 12 月接受经皮冠状动脉介入治疗（PCI）后的双联抗血小板治疗（DAPT）。主要终点是基于出血学术研究联合会（BARC）3 或 5 级大出血。次要终点包括 MACCE（全因死亡、非致死性心肌梗死、卒中和支架血栓形成及计划外靶血管重建）和 BARC 1 至 2 级轻度出血。记录 PCI 后 1 年内的终点事件。根据 PFT 结果调整药物后，患者被分为指导组和对照组。在进行倾向评分匹配后，比较了两组的终点，并对大出血事件进行了亚组分析。
在倾向评分匹配后，指导组和对照组分别有 511 例和 511 例。指导组的主要终点事件发生在 10 例患者（1.96%）中，对照组发生在 23 例患者（4.5%）中（HR：0.45；95%CI，0.21-0.95；P=0.037）。在指导组调整药物剂量后，与对照组标准 DAPT 相比，大出血的风险较低。尽管指导组中的一些患者更早地减少了剂量，但与对照组相比，指导组的 MACCE 事件发生率并没有增加（4.89%比 6.07%；P=0.41）。BARC 1 至 2 级轻度出血无统计学差异（P=0.22）。亚组分析显示，PFT 对糖尿病和多血管疾病患者更有效。
PCI 后 ACS 患者早期观察动态 PFT 可指导个体化抗血小板治疗，降低大出血风险，而不会增加缺血风险。
