老年患者对强效P2Y12抑制剂反应过度

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-02-01 DOI:10.1016/j.rpth.2025.102704

David Mutschlechner , Maximilian Tscharre , Patricia Pia Wadowski , Silvia Lee , Joseph Pultar , Constantin Weikert , Simon Panzer , Thomas Gremmel

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引用次数: 0

摘要

近年来，衰老与二磷酸腺苷（adenosine diphosphate， ADP）作用下的基础血小板活化和血小板高反应性增加有关，但与未接受抗血小板治疗的个体对凝血酶受体刺激的血小板反应降低有关。目的探讨老年患者（≥70岁）联合强效P2Y12抑制剂双重抗血小板治疗时血小板对激动剂刺激的反应。方法采用多电极聚集法观察79例普拉格雷和77例替卡格雷治疗的急性经皮冠状动脉介入治疗3天后花生四烯酸（AA）、ADP、胶原蛋白、蛋白酶激活受体-1激动剂SFLLRN和蛋白酶激活受体-4激动剂AYPGKF对血小板聚集的影响。结果在总体研究人群（N = 156）中，年龄≥70岁的患者（N = 33）对AA、ADP和SFLLRN的血小板聚集低于年轻患者(P <；. 05)。在接受普拉格雷治疗的患者（n = 79）中，年龄≥70岁的患者（n = 13）对所有激动剂的血小板聚集反应均低于年轻患者(P <；. 05)。相反，在替格瑞洛治疗的患者（n = 77）中，年龄≥70岁的患者（n = 20）只有adp诱导的血小板聚集低于年轻患者（P = 0.03），而老年和年轻患者对AA、胶原、SFLLRN和AYPGKF的血小板聚集反应相似(均P >；. 05)。在年龄≥70岁的患者中，接受普拉格雷治疗的患者对AA、胶原蛋白和AYPGKF的血小板聚集率低于接受替格瑞洛治疗的患者(P <；. 05)。结论≥70岁的患者使用强效P2Y12抑制剂对adp诱导的血小板聚集的抑制作用增强。此外，服用普拉格雷的老年患者对AA、胶原、SFLLRN和AYPGKF的反应低于年轻患者。

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Elderly patients are hyperresponsive to potent P2Y12 inhibitors

Background

Aging has recently been associated with increased basal platelet activation and platelet hyperreactivity in response to adenosine diphosphate (ADP) but with decreased platelet response to thrombin receptor stimulation in individuals without antiplatelet therapy.

Objectives

To investigate platelet response to agonist stimulation in elderly patients (≥70 years) on dual antiplatelet therapy with potent P2Y12 inhibitors.

Methods

Platelet aggregation in response to arachidonic acid (AA), ADP, collagen, the protease-activated receptor-1 agonist SFLLRN, and the protease-activated receptor-4 agonist AYPGKF was assessed by multiple electrode aggregometry in 79 prasugrel- and 77 ticagrelor-treated patients 3 days after acute percutaneous coronary intervention.

Results

In the overall study population (N = 156), patients aged ≥70 years (n = 33) had lower platelet aggregation in response to AA, ADP, and SFLLRN than younger patients (all P < .05). In prasugrel-treated patients (n = 79), those aged ≥70 years (n = 13) showed lower platelet aggregation in response to all agonists than younger patients (all P < .05). In contrast, in ticagrelor-treated patients (n = 77), those aged ≥70 years (n = 20) only had lower ADP-inducible platelet aggregation than younger patients (P = .03), whereas platelet aggregation in response to AA, collagen, SFLLRN, and AYPGKF was similar between elderly and younger patients (all P > .05). Among patients aged ≥70 years, prasugrel-treated patients showed lower platelet aggregation in response to AA, collagen, and AYPGKF than those receiving ticagrelor (all P < .05).

Conclusion

Patients aged ≥70 years on potent P2Y12 inhibitors exhibit increased inhibition of ADP-inducible platelet aggregation. In addition, elderly patients on prasugrel show a lower response to AA, collagen, SFLLRN and AYPGKF than younger patients.

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