Relationship between ADP-induced platelet-fibrin clot strength and anti-platelet responsiveness in ticagrelor treated ACS patients  

作　　者：Dan-Dan LI Xu-Yun WANG Shao-Zhi XI Jia LIU Liu-An QIN Jing JING Tong YIN Yun-Dai CHEN 

机构地区：[1]Department of Cardiology, Chinese PLA General Hospital, Beijing China

出　　处：《Journal of Geriatric Cardiology》2016年第4期282-289,共8页老年心脏病学杂志（英文版）

基　　金：This work was supported by grants from the Beijing Natural Science Foundation of China （No. 7152129） and National Natural Science Foundation of China （No. 30971259）, the Clinical Research Supportive Fund General Hospital of Chinese People＇s Liberation Army （No. 2012FC-TSYS-3042）. There are no potential conflicts of interest to declare.

摘　　要：Background Ticagrelor provides enhanced antiplatelet efficacy but increased risk of bleeding and dyspnea. This study aimed to display the relationship between ADP-induced platelet-fibrin clot strength （MAADP） and clinical outcomes in acute coronary syndrome （ACS） patients treated by ticagrelor. Methods Consecutive Chinese-Han patients with ACS who received maintenance dose ofticagrelor on top of aspirin were recruited. After 5-day ticagrelor maintenance treatment, MAADP measured by thrombelastography （TEG） were recorded for the evaluation of ticagrelor anti-platelet reactivity. Pre-specified cutoffs of MAADP 〉 47 mm for high on-treatment platelet reactivity （HTPR） and MAADP 〈 31 mm for low on-treatment platelet reactivity （LTPR） were applied for evaluation. The occurrences of primary ischemic cardiovascular events （including a composite of cardiac death, non-fatal myocardial infarction and stroke）, the Thrombolysis in Myocardial Infarction （TIMI） defined bleeding events, and ticagrelor related dyspnea were recorded after a follow-up of three months. Results Overall, 176 ACS patients （Male： 79.55%, Age： 59.91 ±10.54 years） under ticagrelor maintenance treatment were recruited. The value of MAADP ranged from 4.80% to 72.90% （21.27% ± 12.07% on average）, with the distribution higher skewed towards the lower values. Using the pre-specific cutoffs for HTPR and LTPR, seven patients （3.98%） were identified as HTPR and 144 patients （81.82%） as LTPR. After a follow-up of three months in 172 patients, major cardiovascular events occurred in no patient, but TIMI bleeding events in 81 （47.09%） with major bleedings in three patients. All patients with major bleedings were classified as LTPR. Ticagrelor related dyspnea occurred in 31 （18.02%） patients, with 30 （21.28%） classified as LTPR and no one as HTPR （P = 0.02）. Conclusions In ticagrelor treated ACS patients, MAADP measured by TEG might be valuable for the prediction of major bleeding and ticagrelor re

关 键 词：Clinical outcomes Platelet reactivity THROMBELASTOGRAPHY Ticagrelor 

分 类 号：Q592.1[生物学—生物化学] TU528.042[建筑科学—建筑技术科学]