클로피도그렐 또는 티카그렐러로 치료받는 환자에서 혈소판 수와 특성이 혈소판 반응성에 미치는 영향 = Effects of Platelet Number and Platelet Indices on Platelet Reactivity in Patients Treated with Clopidogrel or Ticagrelor

다국어 초록 (Multilingual Abstract)

Background/Aims: Platelet counts and characteristics can influence platelet reactivity during antiplatelet therapy. We compared the effects of both platelet count and indices on platelet reactivity between patients who were treated with either clopodogrel or ticagrelor.
Methods: Patients with coronary artery disease who underwent percutaneous coronary intervention were randomly assigned to either the clopidogrel (n = 63) or ticagrelor (n = 65) groups. Platelet count, platelet indices (including mean platelet volume, platelet distribution width, platelet large cell ratio, and immature platelet fraction), and platelet reactivity were measured before intervention,and 48 hours and 30 days post-intervention. High on-treatment platelet reactivity (HPR) was defined as ≥ 47 unit as assessed by multiple electrode platelet aggregometry.
Results: Baseline platelet reactivity was similar between the two groups; however, at 48 hours and 30 days, platelet reactivity was significantly lower in the ticagrelor group than in the clopidogrel group. Platelet count, mean platelet volume, platelet distribution width, platelet large cell ratio, and immature platelet fraction were significantly correlated with platelet reactivity in the clopidogrel group; however, these correlations were attenuated in the ticagrelor group. The use of clopodogrel (hazard ratio [HR] 4.1, 95% confidence interval [CI] 1.4-11.9; p = 0.010) and platelet count (HR 9.7, 95% CI 2.9-32.7; p = 0.001) were independent predictors for 30 day HPR. Platelet count was an independent predictor of HPR in the clopidogrel group but not in the ticagrelor group.
Conclusions: Platelet count and indices are significantly correlated with platelet reactivity. However, antiplatelet treatment with ticagrelor could overcome these associations.

국문 초록 (Abstract)

목적: 혈소판의 수와 특성은 항혈소판제의 혈소판 반응성에 영향을 미칠 수 있다. 본 연구는 클로피도그렐과 티카그렐러 치료를 받는 관상동맥 질환 환자를 대상으로 혈소판 지표들과 혈소판 반응성과의 관계를 비교하였다.
방법: 관상동맥 질환으로 중재시술을 받는 환자들을 대상으로 클로피도그렐군(63명), 티카그렐러군(65명)으로 나누어약물을 투여하였다. 약물 투여 전, 시술 후 48시간째, 30일째혈액을 채취하여 혈소판 수, 평균혈소판용적, 혈소판분포폭, 혈소판 거대세포 비율, 미숙혈소판분획 그리고 혈소판 반응성을 측정하였다. 높은 치료 중 혈소판 반응성(HPR)은 자동혈소판 응집 측정장치에서 측정값 47 U 이상인 경우로 정의하였다.
결과: 기저 혈소판 반응성은 두 군 간의 차이가 없었으나48시간째, 30일째 혈소판 반응성은 티카그렐러군에서 유의하게 낮았다. 30일째 혈소판 반응성과의 상관관계는 클로피도그렐군에서 백혈구 수, 혈소판 수, 평균혈소판용적, 혈소판분포폭, 혈소판 거대세포 비율 그리고 미숙혈소판분획 모두에서 유의한 상관관계를 보였으나 티카그렐러군에서는 상관관계가 없어지거나 작아졌다. 전체 환자에서 클로피도그렐의 사용(HR 4.1, 95% CI 1.4-11.9, p = 0.010)과 혈소판 수(HR 9.7, 95% CI 2.9-32.7, p = 0.001)가 30일째 HPR을 예측하는 독립적인 위험 요인이었다. 클로피도그렐군에서는 혈소판 수가 독립적인 위험 인자였으나 티카그렐러군에서는 위험 인자가 되지 못하였다.
결론: 혈소판 수와 특성들은 혈소판 반응성과 연관성이있으나, 티카그렐러로 치료받는 환자에서는 영향을 주지 못한다.

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