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Association Between Residual Platelet Reactivity on Clopidogrel Treatment and Severity of Coronary Atherosclerosis: Intrinsic Hypercoagulability as a Mediator 期刊论文

编号：

9dee8541-17e4-4faf-88d6-a170cce74151
作者：

Zhao, Xin(赵昕)#^[1]Wu, Hongyi(吴鸿谊)#^[1]Xu, Huajie^[2];Shen, Li^[1];Fan, Bing(樊冰)*^[1]Ge, Junbo(葛均波)*^[1]
语种：

英文
期刊：

ADVANCES IN THERAPY ISSN：0741-238X 2019 年 36 卷 9 期 (2296 - 2309) ; SEP
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关键词：

Antiplatelet agents Clot strength Fibrinogen Intrinsic coagulability Three-vessel disease
摘要：

Introduction High on-treatment residual platelet reactivity (HRPR) was associated with greater atherosclerosis burden. We examined whether intrinsic hypercoagulability (IHC) could be attributed to that association in patients treated by drug-eluting stents. Methods This retrospective observation enrolled a total of 891 coronary artery disease (CAD) subjects. Platelet and coagulant reactivity was measured by thrombelastography. At least 24 h after a 300-mg dose of clopidogrel, adenosine diphosphate (ADP)-induced maximum amplitude of clot strength (MA(adp)) > 47 mm represented HRPR. Thrombin-induced platelet-fibrin clot strength (MA(thrombin)) and blood fibrinogen surrogated intrinsic coagulability. Using mediation analysis to evaluate the effect of IHC on the relationship between the number of narrowed coronaries and HRPR on clopidogrel. Results More HRPR on clopidogrel and higher intrinsic coagulability were observed in more severe coronary atherosclerosis, especially in the three-vessel disease. After adjustment for confounding factors, the number of narrowed coronaries (ORadj = 1.343, 95% CI 1.063-1.695, p = 0.013), MA(thrombin) (ORadj = 1.106, 95% CI 1.058-1.157, p < 0.001), and fibrinogen (ORadj = 1.003, 95% CI 1.001-1.005, p = 0.012) were all independent positive predictors for HRPR. MA(thrombin) and fibrinogen were meaningful mediators for the significant positive association of the number of narrowed vessels and HRPR on clopidogrel, which were enhanced by around 30% and 43%, respectively, for this effect. Conclusions This is the first study to demonstrate that the positive correlation between the number of stenotic coronaries and HRPR on clopidogrel may be partly attributed to IHC, which may enhance the risk stratification, guide more precise coagulation in multi-vessel disease after drug-eluting stents, and therefore deserve further study.
推荐引用方式
GB/T 7714：

Zhao Xin,Wu Hongyi,Xu Huajie, et al. Association Between Residual Platelet Reactivity on Clopidogrel Treatment and Severity of Coronary Atherosclerosis: Intrinsic Hypercoagulability as a Mediator [J].ADVANCES IN THERAPY,2019,36(9):2296-2309.
APA：

Zhao Xin,Wu Hongyi,Xu Huajie,Shen Li,&Ge Junbo.(2019).Association Between Residual Platelet Reactivity on Clopidogrel Treatment and Severity of Coronary Atherosclerosis: Intrinsic Hypercoagulability as a Mediator .ADVANCES IN THERAPY,36(9):2296-2309.
MLA：

Zhao Xin, et al. "Association Between Residual Platelet Reactivity on Clopidogrel Treatment and Severity of Coronary Atherosclerosis: Intrinsic Hypercoagulability as a Mediator" .ADVANCES IN THERAPY 36,9(2019):2296-2309.
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