Kontrolle der Thrombozytenaggregationshemmung unter Therapie mit Azetylsalizylsäure und/oder Clopidogrel mit einem modifizierten Thrombozytenaggregationstest

C. Eder; U. Funke; M. Schulze; G. Lutze; M. Zimmermann; T. Praße; G. Töpfer

doi:10.1055/s-0037-1616907

Hämostaseologie, Table of Contents

Hamostaseologie 2007; 27(03): 163-176
DOI: 10.1055/s-0037-1616907

Orginal Articles

Schattauer GmbH

Kontrolle der Thrombozytenaggregationshemmung unter Therapie mit Azetylsalizylsäure und/oder Clopidogrel mit einem modifizierten Thrombozytenaggregationstest

Modified platelet aggregation test in patients on ASA and/or clopidogrel

C. Eder

¹Klinik für Innere Medizin (Priv.-Doz. Dr. M. Schulze)

,

U. Funke

²Institut für Laboratoriumsmedizin (Dipl.-Chem. T. Praße), Klinikum Löbau-Zittau

,

M. Schulze

¹Klinik für Innere Medizin (Priv.-Doz. Dr. M. Schulze)

,

G. Lutze

³Institut für Klinische Chemie (Prof. Dr. C. Luley), Otto-von-Guericke-Universität Magdeburg

,

M. Zimmermann

²Institut für Laboratoriumsmedizin (Dipl.-Chem. T. Praße), Klinikum Löbau-Zittau

,

T. Praße

²Institut für Laboratoriumsmedizin (Dipl.-Chem. T. Praße), Klinikum Löbau-Zittau

,

G. Töpfer

⁴Zentrallabor (Dr. G. Töpfer), Städtisches Klinikum Görlitz GmbH

› Author Affiliations

Abstract

Zusammenfassung

Patienten mit Atherothrombose erhalten prophylaktisch ASS und/oder Clopidogrel zur Hemmung der Plättchenaggregation. Es wurde untersucht, ob ein aggregometrisches Verfahren den Effekt aggregationshemmender Substanzen (ASS 30, 50, 100, 300 mg/d, Clopidogrel 75 mg/d oder ASS 100 + Clopidogrel 75 mg/d) abbilden kann. Ein modifizierter Plättchenaggregationstest diente der Bestimmung der maximalen Aggregation nach Induktion mit ADP, Kollagen, Adrenalin und Arachidonsäure. Aus Werten eines gesunden Kollektivs wurden Referenzwerte abgeleitet und ein einfaches System zur Detektion inadäquater Plättchenhemmung entwickelt. Im Vergleich zur Kontrollgruppe zeigte sich eine signifikante Hemmung der maximalen Aggregation mit allen Induktoren bei Patienten unter ASS und der Kombination ASS + Clopidogrel. Bei Patienten unter Clopidogrel fand sich eine Hemmung der Aggregation nach Induktion mit ADP, Kollagen und Arachidonsäure. Unter 100 mg ASS/d trat eine ungenügende Hemmung bei 27%, unter 75 mg Clopidogrel/d bei 26% und unter der Kombinationstherapie bei 7% der Patienten auf. Die Ergebnisse zeigen, dass bei vielen Patienten mit arteriellen Thrombosen eine inadäquate Plättchenhemmung vorliegt.

Summary

Therapy with acetylsalicylic acid (ASA) and/or clopidogrel is used to achieve prophylactic inhibition of platelet aggregation in patients with arterial thrombosis. We examined if aggregometry can be used to see the effect of antiplatelet drugs (ASA 30, 50, 100, 300 mg/d, clopidogrel 75mg/d or ASA 100 + clopidogrel 75 mg/d). A modified platelet aggregation test was used to investigate maximum aggregation in response to ADP, collagen, adrenalin and arachidonic acid. Reference values were established based on healthy individuals. We devised a simple scoring system for detection of inadequate platelet inhibition. Compared with the control group, we detected a significant delay of maximum aggregation in response to all agonists in patients on ASA and combination therapy ASA + clopidogrel. Patients on clopidogrel alone were found to have prolonged aggregation when induced with ADP, collagen and arachidonic acid. The failure rate to achieve adequate platelet inhibition on 100 mg/d ASA, 75 mg/d clopidogrel or combination therapy was 27%, 26% and 7%, respectively. Our results demonstrate that platelet inhibition in aggregometry is inadequate in many patients with arterial thrombosis.

Schlüsselwörter

Thrombozytenaggregationstest - Aggregationshemmung - ASS - Clopidogrel

Keywords

Platelet aggregation test - platelet inhibition - ASA - clopidogrel

Full Text

References

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