Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2022 Jun 1;20:eAO7001. doi: 10.31744/einstein_journal/2022AO7001. eCollection 2022.
Low platelet reactivity levels are associated with higher risk of bleeding in patients receiving dual antiplatelet therapy relative to patients with optimal platelet blockade. This study set out to evaluate the prevalence of low platelet reactivity in patients with acute myocardial infarction treated with ticagrelor and aspirin.
Patients admitted with acute myocardial infarction who were already undergoing dual antiplatelet therapy with aspirin and ticagrelor were enrolled. Blood samples were collected 1 hour before and 2 hours after the maintenance dose of ticagrelor to investigate trough and the peak effects of the drug respectively. Platelet reactivity was measured by three methods: Multiplate®, PFA-100® with Innovance® PFA-P2Y cartridge and PFA-100® with Collagen/ADP cartridge. Platelet reactivity was assessed in the presence of peak levels of ticagrelor and defined according to previously validated cut-offs for each method (<19 AUC, >299 seconds and >116 seconds respectively). The level of significance was set at p<0.05.
Fifty patients were enrolled (44% with ST-elevation). Median duration of DAPT was 3 days (interquartile range, 2-5 days). On average, peak and trough platelet reactivity were markedly low and did not differ between different methods. Low platelet reactivity was common, but varied according to analytic method (PFA-100®/Innovance®PFA-P2Y: 86%; Multiplate®: 74%; PFA-100®/Collagen/ADP: 48%; p<0.001).
Low platelet reactivity was very common in patients with acute myocardial infarction submitted to dual antiplatelet therapy with ticagrelor and aspirin. Findings of this study justify the investigation of less intensive platelet inhibition strategies aimed at reducing the risk of bleeding in this population, such as lower dose regimens or monotherapy with P2Y12 inhibitors.
与血小板最佳抑制的患者相比，接受双联抗血小板治疗的患者血小板反应性水平较低与出血风险增加相关。本研究旨在评估接受替格瑞洛和阿司匹林治疗的急性心肌梗死患者中低血小板反应性的发生率。
入选已接受双联抗血小板治疗（阿司匹林和替格瑞洛）的急性心肌梗死患者。在替格瑞洛维持剂量前 1 小时和后 2 小时采集血样，分别评估药物的谷值和峰值效应。采用三种方法测量血小板反应性：Multiplate®、PFA-100®与 Innovance® PFA-P2Y 检测盒和 PFA-100®与胶原/ADP 检测盒。在替格瑞洛峰值水平下评估血小板反应性，并根据每种方法的验证切点进行定义（分别为<19 AUC、>299 秒和>116 秒）。显著性水平设为 p<0.05。
共入选 50 例患者（44%为 ST 段抬高）。DAPT 的中位持续时间为 3 天（四分位距 2-5 天）。平均而言，峰值和谷值血小板反应性均明显较低，且不同方法之间无差异。低血小板反应性很常见，但根据分析方法不同而有所不同（PFA-100®/Innovance®PFA-P2Y：86%；Multiplate®：74%；PFA-100®/胶原/ADP：48%；p<0.001）。
接受替格瑞洛和阿司匹林双联抗血小板治疗的急性心肌梗死患者中低血小板反应性非常常见。本研究结果证实了在该人群中探索较低强度血小板抑制策略的合理性，以降低出血风险，如降低剂量方案或 P2Y12 抑制剂单药治疗。
