Blood:三种阿司匹林治疗方案在优化特发性血小板增多症患者抗血小板治疗比较

2020-04-08 MedSci原创 MedSci原创

目前推荐的用于心血管预防的75-100mg od的阿司匹林治疗方案在绝大多数ET患者中减少血小板活化方面存在较大的不足。小剂量阿司匹林的抗血小板效应可通过缩短给药间隔至12小时得到明显改善。

特发性血小板增多症(ET)的特征是巨核细胞生成异常和血栓风险增加。每日一次(od)小剂量阿司匹林是推荐的抗血栓治疗方案,但血小板生成加速可能缩短血小板环氧化酶(COX)-1抑制的时间。

近日,血液病领域权威杂志Blood上发表了一篇研究文章,研究人员进行了一项多中心、双盲试验,以探究三种阿司匹林治疗方案在优化血小板COX-1抑制的同时保留COX-2依赖性血管抗凝血功能的疗效。245例长期od低剂量阿司匹林患者随机(1:1)接受100 mg 阿司匹林,od、每日2次(bid)或每日3次(tid),连续服用2周。研究人员分别在随机化分组和2周后测定受试者血清血栓素B2 (sTXB2)(血小板COX-1活性的有效生物标志物)和尿前列环素代谢物(PGIM)的排泄量,作为疗效和安全性的主要替代终点。尿液中TX代谢物(TXM)排泄、胃肠道耐受性和ET相关的症状也被调查。

研究人员发现bid和tid治疗方案的患者个体间变异性显著降低,并且sTXB2的中位数较低,od组(n=85)、bid组 (n=79)和tid组 (n=79)sTXB2分别为:19.3[9.7-40]、4[2.1-6.7]和2.5[1.4-5.65]ng/ml。三组患者尿液PGIM水平相当。两组实验组患者的尿液中TXM均显著降低了35%。tid组患者腹部不适评分较高。

总之,目前推荐的用于心血管预防的75-100mg od的阿司匹林治疗方案在绝大多数ET患者中减少血小板活化方面存在较大的不足。小剂量阿司匹林的抗血小板效应可通过缩短给药间隔至12小时得到明显改善,而进一步减少给药间隔则无益处。

原始出处:

Bianca Rocca.et al.A randomized, double-blind trial of three aspirin regimens to optimize antiplatelet therapy in essential thrombocythemia.Blood.2019.https://doi.org/10.1182/blood.2019004596

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