徐曼曼;徐运;
XU Man-man;XU Yun;Department of Neurology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School;

• 1:南京大学医学院附属鼓楼医院神经内科

摘要(Abstract)：

部分患者对抗血小板药物表现为低反应性或无反应,接受抗血小板规范治疗后仍发生心脑血管事件。本例患者为63岁女性,长期服用阿司匹林和氯吡格雷,多次出现肢体乏力,行头颅磁共振扫描均提示急性脑梗死。后经血小板聚集试验、闭合试验及基因检测证实,该患者存在阿司匹林和氯吡格雷低反应性。改服西洛他唑,随访1年余,未再发生心脑血管事件。
In some patients who have low or no response to antiplatelet drugs,cardiovascular and cerebrovascular events still happen with standard antiplatelet therapy. In this case report,a 63-year-old woman appeared repeated episodes of limb weakness,although she had taken antiplatelet drugs,i. e. aspirin and clopidogrel,for a long time. Every time,magnetic resonance imaging showed that she had a fresh cerebral infarction; and at the same time,platelet aggregation test,clotting test,and gene test indicated clopidogrel and aspirin resistance,which meant low or no response to antiplatelet therapy. We changed immediately to cilostazol and followed up for more than 1 year. This patient had no recurrence of cardiovascular and cerebrovascular events anymore.

关键词(KeyWords)： 缺血性卒中;氯吡格雷低反应性;阿司匹林低反应性
ischemic stroke;clopidogrel low response;aspirin low response

Abstract:

Keywords:

基金项目(Foundation): 江苏省科技厅医学重点项目(BE2016610);; 江苏省医学重点学科(ZDXKA2016020)

作者(Authors): 徐曼曼;徐运;
XU Man-man;XU Yun;Department of Neurology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School;

参考文献(References)：

• [1]Esenwa C,Gutierrez J.Secondary stroke prevention:challenges and solutions[J].Vasc Health Risk Manag,2015,11:437-450.
• [2]Lee PN,Thornton AJ,Forey BA,et al.Environmental Tobacco Smoke Exposure and Risk of Stroke in Never Smokers:An Updated Review with Meta-Analysis[J].J Stroke Cerebrovascular Dis,2017,26:204-216.
• [3]SPSS3 Study Group,Benavente OR,Coffey CS,et al.Blood-pressure targets in patients with recent lacunar stroke:the SPS3 randomised trial[J].Lancet,2013,382:507-515.
• [4]Lin MP,Ovbiagele B,Markovic D,et al.Association of Secondhand Smoke with Stroke Outcomes[J].Stroke,2016,47:2828-2835.
• [5]Fu J,Tang J,Yang J,et al.Adding computed tomography and transcranial Doppler findings to the ABCD2 score to predict long-term risk of stroke after transient ischaemic attack or minor stroke[J].Eur J Neurol,2015,22:520-526.
• [6]Chadha DS,Sumana B,Karthikeyan G,et al.Prevalence of aspirin resistance in Asian-Indian patients with stable coronary artery disease[J].Catheter Cardiovasc Interv,2016,88:E126-E131.
• [7]Jia DM,Chen ZB,Zhang MJ,et al.CYP2C19 polymorphisms and antiplatelet effects of clopidogrel in acute ischemic stroke in China[J].Stroke,2013,44:1717-1719.
• [8]Cattaneo M,Cerletti C,Harrison P,et al.Recommendations for the Standardization of Light Transmission Aggregometry:AConsensus of the Working Party from the Platelet Physiology Subcommittee of SSC/ISTH[J].J Thromb Haemost,2013,11:1183-1189.
• [9]Chen HY,Chou P.PFA-100-measured aspirin resistance is the predominant risk factor for hospitalized cardiovascular events in aspirin-treated patients:A 5-year cohort study[J].J Clin Pharm Ther,2018,43:249-255.
• [10]Quarterman C,Shaw M,Johnson I,et al.Intra-and intercentre standardisation of thromboelastography(TEG)[J].Anaesthesia,2014,69:883-890.
• [11]Fu Z,Dong W,Shen M,et al.Relationship between hyporesponsiveness to clopidogrel measured by thrombelastography and in stent restenosis in patients undergoing percutaneous coronary intervention[J].Clin Biochem,2014,47:197-202.
• [12]Lin YJ,Li JW,Zhang MJ,et al.The association between CYP2C19 genotype and of in-stent restenosis among patients with vertebral artery stent treatment[J].CNS Neurosci Ther,2014,20:125-130.
• [13]Pan Y,Chen W,Xu Y,et al.Genetic Polymorphisms and Clopidogrel Efficacy for Acute Ischemic Stroke or Transient Ischemic Attack:A Systematic Review and Meta-Analysis[J].Circulation,2017,135:21-33.
• [14]Wang Y,Zhao X,Lin J,et al.Association Between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack[J].JAMA,2016,316:70-78.
• [15]Anderson CD,Biffi A,Greenberg SM,et al.Personalized approaches to clopidogrel therapy:are we there yet?[J].Stroke,2010,41:2997-3002.