Karczmarska-Wódzka Aleksandra, Wszelaki Patrycja, Szymoniuk Szymon, Pstrągowski Krzysztof, Sikora Joanna
Research and Education Unit for Experimental Biotechnology, Department of Transplantology and General Surgery, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland.
Department of Cardiology and Internal Medicine, Antoni Jurasz University Hospital No. 1 in Bydgoszcz, 85-094 Bydgoszcz, Poland.
J Clin Med. 2025 Aug 26;14(17):6026. doi: 10.3390/jcm14176026.
In the last decade, several studies revealed individual response variability to different antiplatelet agents, and patients who have no response to these drugs are considered poor responders. Some studies explored platelet function during antiplatelet treatment to identify those patients with "high on-treatment platelet reactivity" (HPR), which exposes them to increased risk of major adverse cardiovascular events (MACE). We conducted a study with patients with ST-elevation myocardial infarction (STEMI) treated with dual antiplatelet therapy (DAPT) with ticagrelor and aspirin, including long-term follow-up after 5 years. We used thromboelastography, the total thrombus formation analysis system, and vasodilator-stimulated phosphoprotein phosphorylation assay (VASP) to analyze HPR with different methods; selected laboratory parameters were measured during hospitalization to check significant correlations. We identified STEMI patients treated with DAPT with HPR as a risk group for MACE in a 5-year follow-up. Additionally, we have shown that HPR is associated with atherosclerosis by analyzing lipid profile parameters. High on-treatment platelet reactivity (HPR) increases the risk of major adverse cardiovascular events in the long term, especially with elevated C-reactive protein or an atherogenic lipid profile. Standardizing HPR assessment is crucial for optimizing individualized antiplatelet therapy and improving patient outcomes post-STEMI.
在过去十年中，多项研究揭示了个体对不同抗血小板药物的反应变异性，对这些药物无反应的患者被视为反应不佳者。一些研究探讨了抗血小板治疗期间的血小板功能，以识别那些具有“治疗期间高血小板反应性”（HPR）的患者，这使他们面临主要不良心血管事件（MACE）风险增加。我们对接受替格瑞洛和阿司匹林双重抗血小板治疗（DAPT）的ST段抬高型心肌梗死（STEMI）患者进行了一项研究，包括5年后的长期随访。我们使用血栓弹力图、全血栓形成分析系统和血管扩张剂刺激的磷蛋白磷酸化测定（VASP），用不同方法分析HPR；在住院期间测量选定的实验室参数以检查显著相关性。我们在5年随访中确定接受DAPT且有HPR的STEMI患者为MACE风险组。此外，通过分析血脂谱参数，我们表明HPR与动脉粥样硬化有关。治疗期间高血小板反应性（HPR）长期增加主要不良心血管事件的风险，尤其是在C反应蛋白升高或存在致动脉粥样硬化血脂谱的情况下。标准化HPR评估对于优化个体化抗血小板治疗和改善STEMI后患者结局至关重要。
