Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Via Álvaro del Portillo, 200-00128, Rome, Italy.
J Thromb Thrombolysis. 2022 Jul;54(1):15-19. doi: 10.1007/s11239-022-02657-x. Epub 2022 Apr 21.
Evidence assessing potential diurnal variations of platelet reactivity in patients on clopidogrel treated with elective percutaneous coronary intervention (PCI) for chronic coronary syndrome (CCS) are currently lacking. We prospectively enrolled 15 patients affected by stable coronary artery disease (CAD) previously treated with elective PCI and on clopidogrel for at least 8 days (administered at 8 a.m.). A significant heterogeneity in diurnal levels of ADP-dependent platelet aggregation was found (p = 0.0004), with a peak of platelet reactivity occurring at the 6 a.m. assessment, which resulted significantly increased compared to the afternoon (6 p.m.) evaluation (255 ± 66 vs 184 ± 67, p = 0.002). In addition, at the early-morning evaluation a considerably high proportion of patients with high platelet reactivity (53.3%) were observed. In conclusion, clopidogrel-induced platelet inhibition in patients with CCS after elective PCI follows a circadian rhythm, thus suggesting that a consistent and durable antiplatelet inhibition is often failed with standard clopidogrel administration at morning.
目前缺乏评估接受择期经皮冠状动脉介入治疗（PCI）的慢性冠状动脉综合征（CCS）患者氯吡格雷治疗后血小板反应性潜在昼夜变化的证据。我们前瞻性纳入了 15 例先前接受择期 PCI 治疗和氯吡格雷治疗至少 8 天（每天上午 8 点给药）的稳定型冠状动脉疾病（CAD）患者。ADP 依赖性血小板聚集的昼夜水平存在显著异质性（p=0.0004），血小板反应性峰值出现在早上 6 点评估时，与下午（6 点）评估相比显著升高（255±66 对 184±67，p=0.002）。此外，在清晨评估时，观察到相当比例的患者存在高血小板反应性（53.3%）。总之，CCS 患者接受择期 PCI 后氯吡格雷诱导的血小板抑制呈昼夜节律变化，因此提示在早晨给予标准氯吡格雷治疗时，往往无法实现持续和持久的抗血小板抑制。
