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Abstract：
OBJECTIVE: Provision of pulmonary blood flow with a systemic-to-pulmonary artery shunt is essential in some patients with cyanotic congenital heart disease. Traditionally, aspirin (ASA) has been used to prevent thrombosis. We evaluated ASA dosing with 2 separate antiplatelet monitoring tests for accuracy and reliability.
METHODS: This is a retrospective, pre-post intervention single center study. Two cohorts were evaluated; the pre-intervention group used thromboelastography platelet mapping (TPM) and post-intervention used VerifyNow aspirin reactivity unit (ARU) monitoring. The primary endpoint was to compare therapeutic effect of TPM and ARU with regard to platelet inhibition. Inadequate platelet inhibition was defined as TPM <50% inhibition and ARU >550.
RESULTS: Data from 49 patients were analyzed: 25 in the TPM group and 24 in the ARU group. Baseline characteristics were similar amongst the cohorts. The TPM group had significantly more patients with inadequate platelet inhibition (14 [56%] vs 2 [8%]; p = 0.0006) and required escalation with additional thromboprophylaxis (15 [60%] vs 5 [21%]). There was no difference in shunt thrombosis (1 [2%] vs 0 [0%]; p = 0.32), cyanosis requiring early re-intervention (9 [36%] vs 14 [58%]; p = 0.11), or bleeding (15 [60%] vs 14 [58%]; p = 0.66).
CONCLUSIONS: With similar cohorts and the same ASA-dosing nomogram, ARU monitoring resulted in a reduced need for escalation of care and concomitant thromboprophylaxis with no difference in adverse outcomes. Our study suggests ARU monitoring compared with TPM may be a more reliable therapeutic platelet inhibition test for determining ASA sensitivity in children with congenital heart disease requiring systemic-to-pulmonary artery shunt.
METHODS: This is a retrospective, pre-post intervention single center study. Two cohorts were evaluated; the pre-intervention group used thromboelastography platelet mapping (TPM) and post-intervention used VerifyNow aspirin reactivity unit (ARU) monitoring. The primary endpoint was to compare therapeutic effect of TPM and ARU with regard to platelet inhibition. Inadequate platelet inhibition was defined as TPM <50% inhibition and ARU >550.
RESULTS: Data from 49 patients were analyzed: 25 in the TPM group and 24 in the ARU group. Baseline characteristics were similar amongst the cohorts. The TPM group had significantly more patients with inadequate platelet inhibition (14 [56%] vs 2 [8%]; p = 0.0006) and required escalation with additional thromboprophylaxis (15 [60%] vs 5 [21%]). There was no difference in shunt thrombosis (1 [2%] vs 0 [0%]; p = 0.32), cyanosis requiring early re-intervention (9 [36%] vs 14 [58%]; p = 0.11), or bleeding (15 [60%] vs 14 [58%]; p = 0.66).
CONCLUSIONS: With similar cohorts and the same ASA-dosing nomogram, ARU monitoring resulted in a reduced need for escalation of care and concomitant thromboprophylaxis with no difference in adverse outcomes. Our study suggests ARU monitoring compared with TPM may be a more reliable therapeutic platelet inhibition test for determining ASA sensitivity in children with congenital heart disease requiring systemic-to-pulmonary artery shunt.
摘要：
目的：在一些紫红色先天性心脏病患者中，通过全身向肺动脉分流提供肺血流是必不可少的。传统上,阿司匹林（ASA）已被用于预防血栓形成。我们用2个独立的抗血小板监测试验评估了ASA给药的准确性和可靠性。
方法：这是一个回顾性研究，干预前单中心研究。评估了两个队列；干预前的组使用了血栓弹力图血小板标测（TPM），干预后使用了VerifyNow阿司匹林反应性单位（ARU）监测。主要终点是比较TPM和ARU在血小板抑制方面的治疗效果。不充分的血小板抑制定义为TPM<50%抑制和ARU>550。
结果：分析了49例患者的数据：TPM组25例，ARU组24例。队列中的基线特征相似。TPM组有明显更多的患者血小板抑制不足（14[56％]vs2[8％];p=0.0006），需要增加额外的血栓预防（15[60％]vs5[21％]）。分流血栓形成无差异(1[2%]vs0[0%];p=0.32),需要早期再干预的紫癜（9[36%]对14[58%]；p=0.11），或出血（15[60%]对14[58%]；p=0.66）。
结论：在相似的队列和相同的ASA剂量列线图中，ARU监测导致对护理升级和伴随的血栓预防的需求减少，不良结局没有差异。我们的研究表明，与TPM相比，ARU监测可能是一种更可靠的治疗性血小板抑制试验，用于确定需要全身至肺动脉分流的先天性心脏病患儿的ASA敏感性。
方法：这是一个回顾性研究，干预前单中心研究。评估了两个队列；干预前的组使用了血栓弹力图血小板标测（TPM），干预后使用了VerifyNow阿司匹林反应性单位（ARU）监测。主要终点是比较TPM和ARU在血小板抑制方面的治疗效果。不充分的血小板抑制定义为TPM<50%抑制和ARU>550。
结果：分析了49例患者的数据：TPM组25例，ARU组24例。队列中的基线特征相似。TPM组有明显更多的患者血小板抑制不足（14[56％]vs2[8％];p=0.0006），需要增加额外的血栓预防（15[60％]vs5[21％]）。分流血栓形成无差异(1[2%]vs0[0%];p=0.32),需要早期再干预的紫癜（9[36%]对14[58%]；p=0.11），或出血（15[60%]对14[58%]；p=0.66）。
结论：在相似的队列和相同的ASA剂量列线图中，ARU监测导致对护理升级和伴随的血栓预防的需求减少，不良结局没有差异。我们的研究表明，与TPM相比，ARU监测可能是一种更可靠的治疗性血小板抑制试验，用于确定需要全身至肺动脉分流的先天性心脏病患儿的ASA敏感性。
