目的联合VerifyNow-Aspirin与尿11-脱氢-血栓烷B2测定,评估阿司匹林抗血小板效应及其影响因素。方法选择规律服用阿司匹林至少两周的冠心病患者264例,年龄33～86(65.31±10.23)岁,其中男147例(55.7%),女117例(44.3%)。阿司匹林标准...目的联合VerifyNow-Aspirin与尿11-脱氢-血栓烷B2测定,评估阿司匹林抗血小板效应及其影响因素。方法选择规律服用阿司匹林至少两周的冠心病患者264例,年龄33～86(65.31±10.23)岁,其中男147例(55.7%),女117例(44.3%)。阿司匹林标准剂量组(100mg/d)241例,低剂量组(25～75mg/d)23例。采用VerifyNow-aspirin系统测定服用阿司匹林后血小板残余活性(用ARU表示),酶联免疫吸附法检测尿11-脱氢-血栓烷B2(11-DH-TXB2)浓度,并记录入选人群的基线资料及心血管疾病危险因素。结果以ARU≥550为切割值定义阿司匹林低反应性(ALR)人群,标准剂量组人群中ALR发生率为8.6%(23例)。ALR人群尿11-DH-TXB2显著高于正常反应组,差异有统计学意义(2.85±0.73pg/ml vs 2.51±0.49pg/ml,P<0.05),但二者之间相关性较差(r=0.18,P=0.04)。女性、高血压及糖尿病均为ARU升高的预测因素(均P<0.05),但其组间尿11-DH-TXB2水平差异无统计学意义(均P>0.05)。与阿司匹林标准剂量组比较,低剂量组人群残余血小板活性显著增强,同时伴有尿11-DH-TXB2升高(均P<0.05)。结论阿司匹林抗血小板效应存在个体差异,且具有一定量效关系,而VerifyNow和尿11-DH-TXB2对评估阿司匹林抗血小板效应及其发生机制具有一定互补性。展开更多
目的探讨VerifyNow法和血栓弹力图(TEG)对不同CYP2C19基因型的ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入(PCI)后服用双联抗血小板药物诱发出血事件的预测价值。方法 选取2016年9月—2018年4月在我院心血管内科住院并顺利完成PC...目的探讨VerifyNow法和血栓弹力图(TEG)对不同CYP2C19基因型的ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入(PCI)后服用双联抗血小板药物诱发出血事件的预测价值。方法 选取2016年9月—2018年4月在我院心血管内科住院并顺利完成PCI术的STEMI患者350例。检测CYP2C19基因型,并分为快代谢组、中间代谢组以及慢代谢组。同时采用VerifyNow法检测血小板聚集反应单位(PRU),TEG法检测二磷酸腺苷(ADP)抑制率,对PRU值和ADP抑制率进行Spearman相关性分析。随访1年,建立受试者工作特征(ROC)曲线确定PRU值和ADP抑制率对出血事件的预测价值。结果 通过基因多态性检测,123例患者为CYP2C19快代谢基因型,165例患者为CYP2C19中间代谢基因型,62例患者为CYP2C19慢代谢基因型。3组不同基因型患者PRU值和ADP抑制率比较,差异有显著性( P <0.05)。CYP2C19基因快代谢型和中间代谢型患者PRU值和ADP抑制率呈线性负相关( r =-0.359、-0.446, P<0.05 )。在慢代谢组患者中,9例发生出血事件的患者PRU值明显低于未出血患者,且ADP抑制率高于未出血患者( P <0.05)。PRU值对慢代谢型患者预测出血事件的ROC曲线的曲线下面积为0.704(95% CI =0.591~0.817, P<0.05 ),截断值为212.0。结论 VerifyNow法和TEG法在CYP2C19基因快代谢型和中间代谢型患者中的检测结果呈负相关性,且VerfiNow检测PRU值可用于预测慢代谢型患者出血事件的发生风险。展开更多
Background: The platelet inhibitory response of clopidogrel is substantially variable among patients, and numerous studies have shown that post-percutaneous intervention, patients with high on-treatment platelet react...Background: The platelet inhibitory response of clopidogrel is substantially variable among patients, and numerous studies have shown that post-percutaneous intervention, patients with high on-treatment platelet reactivity have an increase in risk of major adverse cardiovascular events. No published studies to date have utilized platelet function monitoring assays prior to coronary artery bypass graft (CABG) surgery, but determination of patients’ antiplatelet effects prior to surgery may decrease time to surgery and length of hospital stay. The purpose of the study was to evaluate the clinical outcomes of non-elective CABG patients analyzed by the VerifyNow P2Y12 platelet-function monitoring assay prior to surgery compared to a similar set of patients not analyzed by the VerifyNow P2Y12 assay. Methods: This was a retrospective, single center, cohort study. The primary endpoints of this study were time to surgery and length of hospital stay. Results: From March 2013 to July 2013, 60 patient charts were reviewed and included in this study. 49 patients were analyzed by the VerfiyNow P2Y12 assay, and 16 of these patients underwent non-elective CABG surgery. Eleven patients underwent non-elective CABG surgery and were not analyzed by the VerifyNow P2Y12 assay. There was no difference between groups regarding time to surgery (p = 0.75) or length of stay (p = 0.42). Based on the assay’s P2Y12 reaction unit results, 69% of VerifyNow P2Y12 patients went to surgery sooner than the institution’s recommendations which generated more bleeding events, half of which were considered major bleeds. Conclusions: Utilization of the VerifyNow P2Y12 assay prior to non-elective CABG surgery does not shorten time to surgery or overall length of hospital stay. However, insufficient P2Y12 reaction units prior to surgery may lead to more bleeding events, thus the application of platelet function monitoring assays prior to procedures may be beneficial as a bleeding risk-assessment tool.展开更多
Objectives:We sought to determine whether high posttreatment platelet reactivity(HPPR)to a 600 mg loading dose of clopidogrel affects outcomes in Chinese patients with acute coronary syndrome(ACS)following percutaneou...Objectives:We sought to determine whether high posttreatment platelet reactivity(HPPR)to a 600 mg loading dose of clopidogrel affects outcomes in Chinese patients with acute coronary syndrome(ACS)following percutaneous coronary intervention(PCI)and to investigate whether there is a relationship between the number of platelet reactivity units(PRUs)and the characteristics of the patients.Background:Although impaired platelet response to clopidogrel is a strong predictor of unfavorable outcome after PCI,the impact of HPPR to a 600 mg loading dose of clopidogrel in Chinese patients with ACS undergoing PCI is still unknown.Methods:We performed observational research on 134 unselected patients with ACS undergoing urgent or planned PCI with a 600 mg loading dose of clopidogrel.Platelet activation was expressed as the PRU value measured by the VerifyNow assay.Results:Among the 134 patients(mean age 60.62 years[standard deviation 9.13 years],60.4%male),there were 46 patients with HPPR(34.3%)and 88 patients without HPPR(65.7%).At a mean follow-up of 6 months(standard deviation 1 month),the rates of cardiac death,unstable angina,and rehospitalization for target lesion revascularization were higher in the HPPR group(19.6%vs.6.8%,P=0.029).Multivariate analysis identifi ed hemoglobin level and sex as independent predictors of the PRU value(y=456.355−1.736 x 1−31.880 x 2,P<0.05).On receiver operating characteristic curve analysis,PRU values could signifi cantly discriminate between patients with and patients without cardiac death,unstable angina,and rehospitalization for target lesion revascularization(area under the curve 0.758,95%confi dence interval 0.62–0.85,P=0.001,P<0.05).Conclusion:In patients with ACS,HPPR to a 600 mg loading dose of clopidogrel is associated with worse outcomes after PCI.There is some relationship between the PRU value and the hemoglobin level and sex.PRU values can predict the prognosis.展开更多
Background：Platelet function tests are widely used in clinical practice to guide personalized antiplatelet therapy.In China,the thromboelastography （TEG） test has been well accepted in clinics,whereas VerifyNow,mai...Background：Platelet function tests are widely used in clinical practice to guide personalized antiplatelet therapy.In China,the thromboelastography （TEG） test has been well accepted in clinics,whereas VerifyNow,mainly used for scientific research,has not been used in routine clinical practice.The aim of the current study was to compare these two point-of-care platelet function tests and to analyze the consistency between the two tests for evaluating on-clopidogrel platelet reactivity in Chinese acute myocardial infarction patients undergoing percutaneous coronary intervention （PCI）.Methods：A total of 184 patients admitted to Fuwai Hospital between August 2014 and May 2015 were enrolled in the study.On-clopidogrel platelet reactivity was assessed 3 days after PCI by TEG and VerifyNow using adenosine diphosphate as an agonist.Based on the previous reports,an inhibition of platelet aggregation （IPA） 〈30% for TEG or a P2Y12 reaction unit （PRU） 〉230 for VerifyNow was defined as high on-clopidogrel platelet reactivity （HPR）.An IPA 〉70% or a PRU 〈178 was defined as low on-clopidogrel platelet reactivity （LPR）.Correlation and agreement between the two methods were analyzed using the Spearman correlation coefficient （r） and kappa value （κ）,respectively.Results：Our results showed that VerifyNow and TEG had a moderate but significant correlation in evaluating platelet reactivity （r =-0.511）.A significant although poor agreement （κ =0.225） in identifying HPR and a significantly moderate agreement in identifying LPR （κ =0.412） were observed between TEG and VerifyNow.By using TEG as the reference for comparison,the cutoffvalues of VerifyNow for the Chinese patients in this study were identified as PRU 〉205 for HPR and PRU 〈169 for LPR.Conclusions：By comparing VerifyNow to TEG which has been widely used in clinics,VerifyNow could be an attractive alternative to TEG for monitoring on-clopidogrel platelet reactivity in Chinese patients.展开更多
文摘目的联合VerifyNow-Aspirin与尿11-脱氢-血栓烷B2测定,评估阿司匹林抗血小板效应及其影响因素。方法选择规律服用阿司匹林至少两周的冠心病患者264例,年龄33～86(65.31±10.23)岁,其中男147例(55.7%),女117例(44.3%)。阿司匹林标准剂量组(100mg/d)241例,低剂量组(25～75mg/d)23例。采用VerifyNow-aspirin系统测定服用阿司匹林后血小板残余活性(用ARU表示),酶联免疫吸附法检测尿11-脱氢-血栓烷B2(11-DH-TXB2)浓度,并记录入选人群的基线资料及心血管疾病危险因素。结果以ARU≥550为切割值定义阿司匹林低反应性(ALR)人群,标准剂量组人群中ALR发生率为8.6%(23例)。ALR人群尿11-DH-TXB2显著高于正常反应组,差异有统计学意义(2.85±0.73pg/ml vs 2.51±0.49pg/ml,P<0.05),但二者之间相关性较差(r=0.18,P=0.04)。女性、高血压及糖尿病均为ARU升高的预测因素(均P<0.05),但其组间尿11-DH-TXB2水平差异无统计学意义(均P>0.05)。与阿司匹林标准剂量组比较,低剂量组人群残余血小板活性显著增强,同时伴有尿11-DH-TXB2升高(均P<0.05)。结论阿司匹林抗血小板效应存在个体差异,且具有一定量效关系,而VerifyNow和尿11-DH-TXB2对评估阿司匹林抗血小板效应及其发生机制具有一定互补性。
文摘目的探讨VerifyNow法和血栓弹力图(TEG)对不同CYP2C19基因型的ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入(PCI)后服用双联抗血小板药物诱发出血事件的预测价值。方法 选取2016年9月—2018年4月在我院心血管内科住院并顺利完成PCI术的STEMI患者350例。检测CYP2C19基因型,并分为快代谢组、中间代谢组以及慢代谢组。同时采用VerifyNow法检测血小板聚集反应单位(PRU),TEG法检测二磷酸腺苷(ADP)抑制率,对PRU值和ADP抑制率进行Spearman相关性分析。随访1年,建立受试者工作特征(ROC)曲线确定PRU值和ADP抑制率对出血事件的预测价值。结果 通过基因多态性检测,123例患者为CYP2C19快代谢基因型,165例患者为CYP2C19中间代谢基因型,62例患者为CYP2C19慢代谢基因型。3组不同基因型患者PRU值和ADP抑制率比较,差异有显著性( P <0.05)。CYP2C19基因快代谢型和中间代谢型患者PRU值和ADP抑制率呈线性负相关( r =-0.359、-0.446, P<0.05 )。在慢代谢组患者中,9例发生出血事件的患者PRU值明显低于未出血患者,且ADP抑制率高于未出血患者( P <0.05)。PRU值对慢代谢型患者预测出血事件的ROC曲线的曲线下面积为0.704(95% CI =0.591~0.817, P<0.05 ),截断值为212.0。结论 VerifyNow法和TEG法在CYP2C19基因快代谢型和中间代谢型患者中的检测结果呈负相关性,且VerfiNow检测PRU值可用于预测慢代谢型患者出血事件的发生风险。
文摘Background: The platelet inhibitory response of clopidogrel is substantially variable among patients, and numerous studies have shown that post-percutaneous intervention, patients with high on-treatment platelet reactivity have an increase in risk of major adverse cardiovascular events. No published studies to date have utilized platelet function monitoring assays prior to coronary artery bypass graft (CABG) surgery, but determination of patients’ antiplatelet effects prior to surgery may decrease time to surgery and length of hospital stay. The purpose of the study was to evaluate the clinical outcomes of non-elective CABG patients analyzed by the VerifyNow P2Y12 platelet-function monitoring assay prior to surgery compared to a similar set of patients not analyzed by the VerifyNow P2Y12 assay. Methods: This was a retrospective, single center, cohort study. The primary endpoints of this study were time to surgery and length of hospital stay. Results: From March 2013 to July 2013, 60 patient charts were reviewed and included in this study. 49 patients were analyzed by the VerfiyNow P2Y12 assay, and 16 of these patients underwent non-elective CABG surgery. Eleven patients underwent non-elective CABG surgery and were not analyzed by the VerifyNow P2Y12 assay. There was no difference between groups regarding time to surgery (p = 0.75) or length of stay (p = 0.42). Based on the assay’s P2Y12 reaction unit results, 69% of VerifyNow P2Y12 patients went to surgery sooner than the institution’s recommendations which generated more bleeding events, half of which were considered major bleeds. Conclusions: Utilization of the VerifyNow P2Y12 assay prior to non-elective CABG surgery does not shorten time to surgery or overall length of hospital stay. However, insufficient P2Y12 reaction units prior to surgery may lead to more bleeding events, thus the application of platelet function monitoring assays prior to procedures may be beneficial as a bleeding risk-assessment tool.
基金the Science Fund for Distinguished Young Scholars from the Fourth Affi liated Hospital of Harbin Medical University(no.HYDSYJQ201504)The funders had no role in the study design,data collection and analysis,decision to publish,or preparation of the manuscriptThe clinical trial is registered as ChiCTR-IOR-17013665。
文摘Objectives:We sought to determine whether high posttreatment platelet reactivity(HPPR)to a 600 mg loading dose of clopidogrel affects outcomes in Chinese patients with acute coronary syndrome(ACS)following percutaneous coronary intervention(PCI)and to investigate whether there is a relationship between the number of platelet reactivity units(PRUs)and the characteristics of the patients.Background:Although impaired platelet response to clopidogrel is a strong predictor of unfavorable outcome after PCI,the impact of HPPR to a 600 mg loading dose of clopidogrel in Chinese patients with ACS undergoing PCI is still unknown.Methods:We performed observational research on 134 unselected patients with ACS undergoing urgent or planned PCI with a 600 mg loading dose of clopidogrel.Platelet activation was expressed as the PRU value measured by the VerifyNow assay.Results:Among the 134 patients(mean age 60.62 years[standard deviation 9.13 years],60.4%male),there were 46 patients with HPPR(34.3%)and 88 patients without HPPR(65.7%).At a mean follow-up of 6 months(standard deviation 1 month),the rates of cardiac death,unstable angina,and rehospitalization for target lesion revascularization were higher in the HPPR group(19.6%vs.6.8%,P=0.029).Multivariate analysis identifi ed hemoglobin level and sex as independent predictors of the PRU value(y=456.355−1.736 x 1−31.880 x 2,P<0.05).On receiver operating characteristic curve analysis,PRU values could signifi cantly discriminate between patients with and patients without cardiac death,unstable angina,and rehospitalization for target lesion revascularization(area under the curve 0.758,95%confi dence interval 0.62–0.85,P=0.001,P<0.05).Conclusion:In patients with ACS,HPPR to a 600 mg loading dose of clopidogrel is associated with worse outcomes after PCI.There is some relationship between the PRU value and the hemoglobin level and sex.PRU values can predict the prognosis.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 81470486）.
文摘Background：Platelet function tests are widely used in clinical practice to guide personalized antiplatelet therapy.In China,the thromboelastography （TEG） test has been well accepted in clinics,whereas VerifyNow,mainly used for scientific research,has not been used in routine clinical practice.The aim of the current study was to compare these two point-of-care platelet function tests and to analyze the consistency between the two tests for evaluating on-clopidogrel platelet reactivity in Chinese acute myocardial infarction patients undergoing percutaneous coronary intervention （PCI）.Methods：A total of 184 patients admitted to Fuwai Hospital between August 2014 and May 2015 were enrolled in the study.On-clopidogrel platelet reactivity was assessed 3 days after PCI by TEG and VerifyNow using adenosine diphosphate as an agonist.Based on the previous reports,an inhibition of platelet aggregation （IPA） 〈30% for TEG or a P2Y12 reaction unit （PRU） 〉230 for VerifyNow was defined as high on-clopidogrel platelet reactivity （HPR）.An IPA 〉70% or a PRU 〈178 was defined as low on-clopidogrel platelet reactivity （LPR）.Correlation and agreement between the two methods were analyzed using the Spearman correlation coefficient （r） and kappa value （κ）,respectively.Results：Our results showed that VerifyNow and TEG had a moderate but significant correlation in evaluating platelet reactivity （r =-0.511）.A significant although poor agreement （κ =0.225） in identifying HPR and a significantly moderate agreement in identifying LPR （κ =0.412） were observed between TEG and VerifyNow.By using TEG as the reference for comparison,the cutoffvalues of VerifyNow for the Chinese patients in this study were identified as PRU 〉205 for HPR and PRU 〈169 for LPR.Conclusions：By comparing VerifyNow to TEG which has been widely used in clinics,VerifyNow could be an attractive alternative to TEG for monitoring on-clopidogrel platelet reactivity in Chinese patients.
