中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

阿司匹林抵抗与先天性心脏病患儿术后血栓发生的相关性研究

查看全文

目的 评估先天性心脏病(先心病)术后阿司匹林抵抗现象及其与血栓发生的相关性。 方法 纳入我院 2016 年 8 月至 2017 年 12 月 52 例术后口服阿司匹林抗栓的先心病患儿,服药后第 3~5 d 行血栓弹力图血小板图检测,根据花生四烯酸(AA)抑制率<50%和≥50%,分为阿司匹林抵抗组 14 例和阿司匹林敏感组 38 例。随访出院 3 个月内血栓发生情况。 结果 阿司匹林抵抗发生率 26.9%,血栓事件 3 例(5.9%)。14 例阿司匹林抵抗的患者中,3 例住院期间增加剂量后复测,结果显示 1 例转为阿司匹林敏感。单因素分析未发现阿司匹林抵抗的危险因素,且阿司匹林抵抗和血栓事件的相关性差(r=0.04,P=0.8)。 结论 先心病患儿术后阿司匹林抵抗发生率较高,但未发现其与血栓形成有相关性。部分患者增加剂量后抵抗消失,提示可能剂量不足。

Objective To determine the prevalence of aspirin (ASA) resistance in pediatric patients with congenital heart disease and evaluate whether postoperative thrombosis is associated with aspirin resistance in this patient population. Methods A total of 52 patients undergoing high-risk congenital cardiac surgery were recruited in a prospective cohort study at Fuwai Hospital from October 2016 to December 2017. The response to aspirin was determined using the thromboelastography with platelet mapping (TEG-PM) system several days after administration. According to the arachidonic acid (AA) inhibition< 50% or not, they were divided into an ASA resistance group (n=14) and an ASA sensitive group (n=38). Risk factors of ASA resistance were identified using univariate and multivariate analysis. Patients were monitored prospectively for three months for the development of a thrombosis event. Results Of 52 children analyzed, 14 (26.9%) were ASA resistance. The prevalence of thrombosis after ASA antiplatelet therapy was 5.9%. Dose escalation based on aspirin testing was performed in 3 of 14 patients, and the ASA sensitivity was observed in 1 patient. No correlation was found between ASA resistance and postoperative thrombosis (r=0.04, P=0.8). Conclusion Postoperative thrombosis is not associated with aspirin resistance in this patient population. Our findings also suggest that resistance may be due to lack of aspirin doses, monitoring of aspirin therapy and consideration of dose adjustment or alternative agents for unresponsive patients may be justified and warrants further investigation in a prospective trial.

关键词: 先天性心脏病; 阿司匹林; 血小板抑制; 血栓; 血栓弹力图

Key words: Congenital heart disease; aspirin; platelet inhibition; thrombosis; thromboelastograph

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Silvey M, Brandão LR. Risk Factors, Prophylaxis, and Treatment of Venous Thromboembolism in Congenital Heart Disease Patients. Front Pediatr, 2017, 5: 146.
2. Monagle P, Cochrane A, Roberts R, et al. A multicenter, randomized trial comparing heparin/warfarin and acetylsalicylic acid as primary thromboprophylaxis for 2 years after the Fontan procedure in children. J Am Coll Cardiol, 2011, 58(6): 645-651.
3. Manlhiot C, Menjak IB, Brandão LR, et al. Risk, clinical features, and outcomes of thrombosis associated with pediatric cardiac surgery. Circulation, 2011, 124(14): 1511-1519.
4. Monagle P, Chan AKC, Goldenberg NA, et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e737S-e801S.
5. Giglia TM, Massicotte MP, Tweddell JS, et al. Prevention and treatment of thrombosis in pediatric and congenital heart disease: a scientific statement from the American Heart Association. Circulation, 2013, 128(24): 2622-2703.
6. 龚艳君, 邱林, 屈晨雪, 等. 血栓弹力图评价冠状动脉介入治疗术后抗血小板药物疗效及与预后的关系. 中华全科医学, 2016, 14(8): 1289-1292.
7. Patrono C. Aspirin resistance: definition, mechanisms and clinical read-outs. J Thromb Haemost, 2003, 1(8): 1710-1713.
8. 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 抗血小板药物治疗反应多样性临床检测和处理的中国专家建议. 中华心血管病杂志, 2014, 42(12): 986-991.
9. Heistein LC, Scott WA, Zellers TM, et al. Aspirin resistance in children with heart disease at risk for thromboembolism: prevalence and possible mechanisms. Pediatr Cardiol, 2008, 29(2): 285-291.
10. Schmugge M, Speer O, Kroiss S, et al. Aspirin resistance in children after interventional cardiac catheterization. ASH Annual Meeting, 2008, 112(11): 691.
11. Cholette JM, Mamikonian L, Alfieris GM, et al. Aspirin resistance following pediatric cardiac surgery. Thromb Res, 2010, 126(3): 200-206.
12. Emani S, Trainor B, Zurakowski D, et al. Aspirin unresponsiveness predicts thrombosis in high-risk pediatric patients after cardiac surgery. J Thorac Cardiovasc Surg, 2014, 148(3): 810-814.
13. Emani S, Zurakowski D, Mulone M, et al. Platelet testing to guide aspirin dose adjustment in pediatric patients after cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(5): 1723-1730.
14. Paniccia R, Priora R, Liotta AA, et al. Platelet function tests: a comparative review. Vasc Health Risk Manag, 2015, 11: 133-148.
15. Madsen EH, Saw J, Kristensen SR, et al. Long-term aspirin and clopidogrel response evaluated by light transmission aggregometry, VerifyNow, and thrombelastography in patients undergoing percutaneous coronary intervention. Clin Chem, 2010, 56(5): 839-847.