Zhang Yang, Peng Rui, Li Xiaojuan, Cheng Gaowa, Wang Ximing, Yu Jinxing, Hua Muxing, Chen Xi, Zhou Zhou
Diagnostic Laboratory Service, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China.
Department of Laboratory Medicine, Yunnan Fuwai Cardiovascular Hospital, Kunming, 650000, China.
Thromb J. 2021 Dec 7;19(1):97. doi: 10.1186/s12959-021-00350-2.
Knowledge on the pharmacodynamic effects of antiplatelet drugs including clopidogrel and ticagrelor on Asian patients is scarce. We aim to evaluate the effects of the two drugs on platelet reactivity in the treatment of Chinese patients who underwent percutaneous coronary intervention (PCI), using two platelet function tests (PFT). Meanwhile, the relationship between mean platelet volume (MPV), a routine index of platelet size, and high on-treatment platelet reactivity (HPR) is also investigated.
Patients receiving dual antiplatelet therapy (DAPT) were scheduled for the assessment of platelet reactivity at 2-3 days after PCI. Two PFTs, light transmission aggregometry (LTA) and vasodilator-stimulated phosphoprotein (VASP)-FCM assay, were applied in the evaluation of platelet reactivity. The MPV was measured simultaneously with EDTA plasma using a Sysmex XN 2000 automated hematology analyzer.
The final study population included the aspirin + clopidogrel group (n = 46) and the aspirin + ticagrelor group (n = 66). In the aspirin + ticagrelor group, the maximal light transmittance (LT) changes in response to 5 μM ADP assessed by LTA was obviously lower than that in the aspirin + clopidogrel group (P < 0.001). The platelet reactivity index (PRI) level in the VASP test was also markedly lower in the group given aspirin and ticagrelor (P < 0.001). There was a significant difference in HPR between the two groups. MPV showed a potent ability to predict the presence of HPR at VASP assay (AUC = 0.788, 95% CI: 0.701-0.875, P < 0.001) in receiver-operating characteristic curve analysis.
Compared with clopidogrel, ticagrelor has dramatically greater antiplatelet effect, with a superiority in suppressing platelet function and a lower HPR rate. In addition, there existed a significant independent association between MPV and high prevalence of HPR in the VASP assay.
关于包括氯吡格雷和替格瑞洛在内的抗血小板药物对亚洲患者药效学作用的知识匮乏。我们旨在使用两种血小板功能测试（PFT）评估这两种药物对接受经皮冠状动脉介入治疗（PCI）的中国患者血小板反应性的影响。同时，还研究了血小板大小的常规指标平均血小板体积（MPV）与高治疗期血小板反应性（HPR）之间的关系。
接受双联抗血小板治疗（DAPT）的患者计划在PCI术后2 - 3天评估血小板反应性。两种PFT，即光透射聚集法（LTA）和血管扩张剂刺激磷蛋白（VASP）-流式细胞术检测，用于评估血小板反应性。使用Sysmex XN 2000全自动血液分析仪与乙二胺四乙酸（EDTA）血浆同时测量MPV。
最终研究人群包括阿司匹林 + 氯吡格雷组（n = 46）和阿司匹林 + 替格瑞洛组（n = 66）。在阿司匹林 + 替格瑞洛组中，通过LTA评估的对5 μM二磷酸腺苷（ADP）反应的最大光透射率（LT）变化明显低于阿司匹林 + 氯吡格雷组（P < 0.001）。在给予阿司匹林和替格瑞洛的组中，VASP测试中的血小板反应性指数（PRI）水平也明显更低（P < 0.001）。两组之间的HPR存在显著差异。在受试者操作特征曲线分析中，MPV显示出在VASP检测中预测HPR存在的强大能力（曲线下面积[AUC] = 0.788，95%置信区间[CI]：0.701 - 0.875，P < 0.001）。
与氯吡格雷相比，替格瑞洛具有显著更强的抗血小板作用，在抑制血小板功能方面具有优势且HPR率更低。此外，在VASP检测中，MPV与HPR的高发生率之间存在显著的独立关联。
