Department of Neurology, Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Neurological Surgery, Feinberg School of Medicine, Chicago, Illinois, USA.
Ann Clin Transl Neurol. 2024 Jun;11(6):1535-1540. doi: 10.1002/acn3.52070. Epub 2024 Apr 23.
Hematoma expansion (HE) predicts disability and death after acute intracerebral hemorrhage (ICH). Aspirin and anticoagulants have been associated with HE. We tested the hypothesis that P2Y12 inhibitors predict subsequent HE in patients. We explored laboratory measures of P2Y12 inhibition and dual antiplatelet therapy with aspirin (DAPT).
We prospectively identified patients with ICH. Platelet activity was measured with the VerifyNow-P2Y12 assay. Hematoma volumes for initial and follow-up CTs were calculated using a validated semi-automated technique. HE was defined as the difference between hematoma volumes on the initial and follow-up CT scans. Nonparametric statistics were performed with Kruskal-Wallis H, and correction for multiple comparisons performed with Dunn's test.
In 194 patients, 15 (7.7%) were known to take a P2Y12 inhibitor (clopidogrel in all but one). Patients taking a P2Y12 inhibitor had more HE compared to patients not taking a P2Y12 inhibitor (3.5 [1.2-11.9] vs. 0.1 [-0.8-1.4] mL, p = 0.004). Patients taking DAPT experienced the most HE (7.2 [2.6-13.8] vs. 0.0 [-1.0-1.1] mL, p = 0.04). The use of P2Y12 inhibitors was associated with less P2Y12 activity (178 [149-203] vs. 288 [246-319] P2Y12 reaction units, p = 0.005).
Patients taking a P2Y12 inhibitor had more HE and less P2Y12 activity. The effect was most pronounced in patients on DAPT, suggesting a synergistic effect of P2Y12 inhibitors and aspirin with respect to HE. Acute reversal of P2Y12 inhibitors in acute ICH requires further study.
血肿扩大（HE）可预测急性脑出血（ICH）后的残疾和死亡。阿司匹林和抗凝剂与 HE 有关。我们检验了这样一个假设，即 P2Y12 抑制剂可预测患者随后发生的 HE。我们探索了实验室测量的 P2Y12 抑制作用和阿司匹林双联抗血小板治疗（DAPT）。
我们前瞻性地确定了 ICH 患者。使用 VerifyNow-P2Y12 测定法测量血小板活性。使用一种经过验证的半自动技术计算初始和随访 CT 上的血肿体积。HE 的定义为初始和随访 CT 扫描上血肿体积之间的差异。采用 Kruskal-Wallis H 进行非参数统计，并用 Dunn 检验进行多重比较校正。
在 194 名患者中，已知有 15 名（7.7%）服用 P2Y12 抑制剂（除 1 名外均为氯吡格雷）。服用 P2Y12 抑制剂的患者与未服用 P2Y12 抑制剂的患者相比，HE 更多（3.5 [1.2-11.9] vs. 0.1 [-0.8-1.4] mL，p=0.004）。服用 DAPT 的患者经历了最多的 HE（7.2 [2.6-13.8] vs. 0.0 [-1.0-1.1] mL，p=0.04）。使用 P2Y12 抑制剂与较低的 P2Y12 活性相关（178 [149-203] vs. 288 [246-319] P2Y12 反应单位，p=0.005）。
服用 P2Y12 抑制剂的患者 HE 更多，P2Y12 活性更低。在接受 DAPT 的患者中，这种作用最为明显，表明 P2Y12 抑制剂和阿司匹林在 HE 方面具有协同作用。急性 ICH 中 P2Y12 抑制剂的快速逆转需要进一步研究。
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