Abstract:Objective To explore the value of thromboelastography (TEG) in evaluating the effect of antiplatelet drugs after percutaneous coronary intervention (PCI) in patients with diabetic nephropathy (DN) maintenance hemodialysis. Methods A total of 46 patients with maintenance hemodialysis who were treated at the People′s Hospital of Zhejiang Province from May 2013 to March 2016 and received aspirin combined with clopidogrel within 1 year after PCI were included. According to whether end-stage renal disease caused by DN started maintenance hemodialysis, all patients were divided into DN group (20 cases) and NDN group (26 cases), and TEG test was performed. The maximum thrombus (MA), arachidonic acid (AA) pathway inhibition rate, and adenosine diphosphate (ADP) receptor inhibition rate were used to evaluate drug resistance and analyze clinical significance. Results The MA value in DN group was higher than that in group B, and the difference was statistically significant (P < 0.05). The resistance rate of double platelet aggregation in DN group was higher than that in NDN group, and the difference was statistically significant (P < 0.05). There were no significant differences in the aspirin resistance rate and clopidogrel resistance rate between the two groups of patients (P < 0.05). Conclusion Patients with DN have a higher risk of thrombosis after PCI compared with NDN patient. Both DN and NDN patients have resistance to dual antiplatelet drugs, and patients with DN are very resistant, suggesting that platelet function to guide the adjustment of the drug may be required in such high-risk patients.
金钦阳1 朱勤2 叶羡云3 管斌亚4. 血栓弹力图在糖尿病肾病维持性血液透析患者抗血小板药物反应性中的评估价值[J]. 中国医药导报, 2020, 17(4): 94-97.
JIN Qinyang1 ZHU Qin2 YE Xianyun3 GUAN Binya4. The value of thromboelastography for the antiplatelet drug reactivity in patients with diabetic nephropathy undergoing maintenance hemodialysis. 中国医药导报, 2020, 17(4): 94-97.
[1] Wang L,Gao P,Zhang M,et al. Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013 [J]. JAMA,2017,317(24):2515-2523.
[2] Lin X,Tao L,Tang D. Gene therapy,a targeted treatment for diabetic kidney disease [J]. Curr Med Chem,2013,20(30):3774-3784.
[3] Saely C,Zanolin D,Vonbank A,et al. Impaired kidney function is a diabetes risk equivalent in patients with established coronary artery disease [J]. J Am Coll Cardiol,2015, 65(10):A1504.
[4] Swallow RA,Agarwala RA,Dawkins KD,et al. Thromboelastography:potential bedside tool to assess the effects of antiplatelet therapy? [J]. Platelets,2006,17(6):385-392.
[5] 王丽丽,李群,康林,等.应用血栓弹力图评估ACS患者替格瑞洛与氯吡格雷抗血小板的疗效[J].中国循证心血管医学杂志,2014,6(3):281-284.
[6] McCrath DJ,Cerboni E,Frumento RJ,et al. Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction [J]. Anesth Analg,2005,100(6):1576-1583.
[7] Tantry US,Bliden KP,Gurbel PA. Overestimation of platelet aspirin resistance detection by thrombelastograph platelet mapping and validation by conventional aggregometry using arachidonic acid stimulation [J]. J Ame Coll Cardiol,2005,46(9):1705-1709.
[8] Bliden KP,Tantry U,Zaman K,et al. High platelet reactivity is a risk factor for post-discharge ischemic complications following elective coronary stenting [J]. J Am Coll Cardiol,2005,45:33A-34A.
[9] Sarnak MJ,Levey AS,Schoolwerth AC,et al. Kidney disease as a risk factor for development of cardiovascular disease:a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease,High Blood Pressure Research,Clinical Cardiology,and Epidemiology and Prevention [J]. Hypertension,2003,42(5):1050-1065.
[10] Gurbel PA,Bliden KP,Navickas IA,et al. Adenosine diphosphate-induced platelet-fibrin clot strength:a new thrombelastographic indicator of long-term poststenting ischemic events [J]. Am Heart J,2010,160(2):346-354.
[11] Rafiq S,Johansson PI,Zacho M,et al. Thrombelastographic haemostatic status and antiplatelet therapy after coronary artery bypass surgery(TEG-CABG trial):assessing and monitoring the antithrombotic effect of clopidogrel and aspirin versus aspirin alone in hypercoagulable patients:study protocol for a randomized controlled trial [J]. Trials,2012,13:48.
[12] 王媛媛,李月红,吴英凤,等.血栓弹力图中血栓最大幅度值与急性冠状动脉综合征患者冠状动脉血栓病变的关系[J].中国循环杂志,2016,31(11):1069-1073.
[13] Shechter M,Merz CN,Paul-Labrador MJ,et al. Blood glucose and platelet-dependent thrombosis in patients with coronary artery disease [J]. J Am Coll Cardiol,2000, 35(2):300-307.
[14] Alexopoulos D,Panagiotou A,Xanthopoulou I,et al. Antiplatelet effects of prasugrel vs. double clopidogrel in patients on hemodialysis and with high on-treatment platelet reactivity [J]. J Thromb Haemost,2011,9(12):2379-2385.
[15] Franchi F,Rollini F,Angiolillo DJ. Defining the Link Between Chronic Kidney Disease,High Platelet Reactivity,and Clinical Outcomes in Clopidogrel-Treated Patients Undergoing Percutaneous Coronary Intervention [J]. Circ Cardiovasc Interv,2015,8(6):e002760.
[16] Franchi F,Rollini F,Cho JR,et al. Platelet function testing in contemporary clinical and interventional practice [J]. Curr Treat Options Cardiovasc Med,2014,16(5):300.
[17] Stone GW,Witzenbichler B,Weisz G,et al. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES):a pro-spective multicentre registry study [J]. Lancet,2013,382(9892):614.
[18] Konishi A,Shinke T,Otake H,et al. Impact of residual platelet reactivity under clopidogrel treatment for lesions and the clinical outcome after drug-eluting stent implantation in patients with hemodialysis [J]. J Cardiol,2016,67(6):531-537.
[19] Alexopoulos D,Panagiotou A,Xanthopoulou I,et al. Antiplatelet effects of prasugrel vs. double clopidogrel in patients on hemodialysis and with high on-treatment platelet reactivity [J]. J Thromb Haemost,2011,9(12):2379-2385.
[20] Jeong KH,Cho JH,Woo JS,et al. Platelet reactivity after receiving clopidogrel compared with ticagrelor in patients with kidney failure treated with hemodialysis:a randomized crossover study [J]. Am J Kidney Dis,2015,65(6):916-924.