科研之友
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摘要
BACKGROUND: Aspirin-resistant platelet activation in whole blood is attributable to a transcellular pathway not detected by isolated platelet aggregometry. Aspirin resistance as defined by urinary thromboxane levels is associated with increased risk for myocardial infarction or cardiac death. Whole blood point-of-care assays may also detect aspirin resistance. METHODS: We compared PlateletMapping (R) with VerifyNow (R) for detecting aspirin resistance in 200 patients undergoing invasive cardiac procedures. This included 10 patients not receiving aspirin therapy for comparison. The assay results were correlated with urinary 11-dehydro-thromboxane B-2 collected 2 to 8 hours after the procedure. RESULTS: Platelet Mapping detected aspirin resistance in 32% of patients. Verify Now detected aspirin resistance in 6% of patients. A patient's compliance with aspirin therapy was confirmed by a < 20% aggregation response to arachidonic acid by light transmission aggregometry. Aspirin-resistant patients as determined by Platelet Mapping had significantly (P < 0.001) higher urinary 11-dehydro-thromboxane B-2 levels than aspirin-sensitive patients but significantly (P = 0.001) lower levels than patients not receiving aspirin therapy. There was no significant difference in urinary 11-dehydro-thromboxane B-2 for aspirin-resistant compared with aspirin-sensitive patients as determined by Verify Now, but the confidence intervals were wide. There was no significant correlation of resistance as defined by Platelet Mapping with aspirin dose. However, there was significant increased aspirin sensitivity with clopidogrel (0.0006) or statin (0.004) cotherapies. There also was a significant correlation of smoking with aspirin resistance. CONCLUSIONS: These results indicate that Platelet Mapping could be a useful point-of-care assay to identify aspirin-resistant patients for better perioperative risk stratification and management. (Anesth Analg 2013;116:282-6)
- 出版日期2013-2
