Komiya T, Kudo M, Urabe T, Mizuno Y
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
Stroke. 1994 Dec;25(12):2337-42. doi: 10.1161/01.str.25.12.2337.
Antiplatelet therapy is currently one of the methods for preventing transient ischemic attacks and cerebral thrombosis. Because antiplatelet agents are generally administered on a long-term basis, patient compliance is an important factor. The purpose of this study was to determine the compliance of patients during antiplatelet therapy by testing platelet aggregation.
To establish the conditions for measuring platelet aggregation, the platelet aggregation test was performed in patients taking 81 mg/d aspirin or 200 mg/d ticlopidine at the following final concentrations of aggregation-inducing agents: 0.5, 1, 2, and 4 mumol/L ADP and 0.5 and 2 micrograms/mL collagen. The optimum measurement conditions for assessing patient compliance were determined. Under the conditions determined in the first study, platelet aggregation was assessed, and the effects of treatment were studied in 159 outpatients and 79 inpatients undergoing antiplatelet therapy. If the antiplatelet effect was insufficient, compliance was checked by interview.
The agents used and the final concentrations found to be optimum for assessing platelet aggregation were 2 micrograms/mL collagen for patients taking aspirin 81 mg/day and 2 mumol/L ADP for patients taking ticlopidine 200 mg/d. In 17 (10%) of the 159 outpatients, platelet aggregation was not adequately reduced because of noncompliance with their antiplatelet therapy.
This study indicated that monitoring of compliance is important for outpatients on antiplatelet therapy. It is best if platelet aggregation can be checked, but when this is impossible it is necessary to assess compliance periodically and provide patient guidance.
抗血小板治疗是目前预防短暂性脑缺血发作和脑血栓形成的方法之一。由于抗血小板药物通常需要长期服用，患者的依从性是一个重要因素。本研究的目的是通过检测血小板聚集来确定患者在抗血小板治疗期间的依从性。
为确定测量血小板聚集的条件，对服用81mg/d阿司匹林或200mg/d噻氯匹定的患者进行血小板聚集试验，诱导剂的最终浓度如下：0.5、1、2和4μmol/L ADP以及0.5和2μg/mL胶原。确定了评估患者依从性的最佳测量条件。在第一项研究确定的条件下，评估血小板聚集情况，并对159例门诊患者和79例接受抗血小板治疗的住院患者的治疗效果进行研究。如果抗血小板效果不足，则通过访谈检查依从性。
对于服用81mg/d阿司匹林的患者，发现评估血小板聚集的最佳诱导剂及其最终浓度为2μg/mL胶原；对于服用200mg/d噻氯匹定的患者，为2μmol/L ADP。在159例门诊患者中，有17例（10%）因未遵医嘱进行抗血小板治疗，血小板聚集未得到充分降低。
本研究表明，对于接受抗血小板治疗的门诊患者，监测依从性很重要。最好能检查血小板聚集情况，但如果无法做到这一点，则有必要定期评估依从性并为患者提供指导。
