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Comparative Measurements of Platelet Responsiveness to Antiplatelet Agents in Patients with Percutaneous Coronary Intervention: The Feasibility Study of Platelet Function in Clinical Practice
동아의대 순환기내과¹ , 진단검사의학과²
박선이¹, 김무현¹, Long-Hao Yu¹, 김정환¹, 박태호¹, 차광수¹, 김영대¹, 고리영² , 한진영²
Background: Point-of-care analyses might be helpful to guide tailored individual antiplatelet treatment in patients undergoing percutaneous intervention (PCI) with drug-eluting stents due to interindividual variation of platelet responsiveness to thienopyridines. Methods and Results: We collected 36 healthy volunteers and 113 consecutive patients undergoing PCI from Dec. 2008 to Jul. 2009. Platelet function tests were performed according to serial time points, various loading and maintenance doses by light transmission aggregometry (Chrono-Log, Havertown, PA, USA), VerifyNow® system assay (Accumetrics, San Diego, CA, USA) and Multiple electrode aggregometry (Dynabyte, Munich, Germany). In PCI patients, adjunctive loading dose of 200 mg-cilostazol to aspirin and clopidogrel versus traditional treatment improved platelet responsiveness to antiplatelet agents (table). Additional loading of 200 mg cilostazol to 300 mg clopidogrel had a similiar inhibitory effect with clopidogrel 600 mg loading dose after 6 hours (figure). Parameters among three devices of platelet function testing had strong correlations. Conclusion: Laboratory responsiveness to antiplatelet agents depended upon loading doses and timing. Therefore, the monitoring of platelet reactivity by point-of-care analysis might be important in clinical practice.

Table1. Comparison of post-treatment platelet reactivity in both groups after loading and before PCI

Variables

Group Ⅰ (n=54)

Group Ⅱ (n=59)

p-value

MEA-ADPtest (AUC)

14.0±6.4

13.2±6.1

0.488

MEA-ASPItest (AUC)

7.5±8.3

3.7±4.7

0.003

LTA-10 µM ADP (%)

43.3±13.9

32.4±16.4

0.000

LTA-5 mM AA (%)

7.7±16.4

4.4±8.8

0.190

P2Y12 reaction units

300.1±80.7

247.8±85.8

0.001

Aspirin reaction units

468.8±82.6

423.1±66.5

0.002

Group 1: Loading doses of 300 mg aspirin and 300 mg clopidogrel;  Group 2: Loading doses of 300 mg aspirin, 300 mg clopidogrel and 200 cilostazol.

 

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