Impact of Red Blood Cell Transfusion on Platelet Aggregation and Inflammatory Response in Anemic Coronary and Noncoronary Patients: The TRANSFUSION-2 Study (Impact of Transfusion of Red Blood Cell on Platelet Activation and Aggregation Studied With Flow Cytometry Use and Light Transmission Aggregometry)

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• 作者：Johanne Silvain ; MD ; PhD^&lowast ; ; Jé ; ré ; mie Abtan ; MD^&lowast ; ; Mathieu Kerneis ; MD^&lowast ; ; Ré ; jane Martin ; BCh^&lowast ; ; Jonathan Finzi ; PharmD^&lowast ; ; Jean-Baptiste Vignalou ; MD^&lowast ; ; Olivier Barthé ; lé ; my ; MD^&lowast ; ; Stephen A. O'Connor ; MD^&lowast ; ; Charles-Edouard Luyt ; MD ; PhD^&dagger ; ; Nicolas Brechot ; MD ; PhD^&dagger ; ; Anne Mercadier ; MD ; PhD^&Dagger ; ; Delphine Brugier ; PhD^&lowast ; ; Sophie Galier ; BCh^&lowast ; ; Jean-Philippe Collet ; MD ; PhD^&lowast ; ; Jean Chastre ; MD ; PhD^&dagger ; ; Gilles Montalescot ; MD ; PhD^&lowast ; ; ^{gilles.montalescot@psl.aphp.fr" class="auth_mail}
• 关键词：ACS ; clopidogrel ; platelet response ; transfusion
• 刊名：Journal of the American College of Cardiology
• 出版年：8 April, 2014
• 年：2014
• 卷：63
• 期：13
• 页码：1289-1296
• 全文大小：526 K

文摘

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Objectives

This study sought to determine whether red blood cell (RBC) transfusion increases in聽vivo platelet aggregation and inflammation in coronary and noncoronary patients.

Background

RBC transfusion increases in聽vitro platelet activation and aggregation in healthy volunteers, providing a possible explanation for the increase in recurrent ischemic events and mortality reported after RBC transfusion in patients with acute coronary syndromes (ACS).

Methods

Platelet reactivity was measured before and after RBC transfusion in 61 patients (33 with ACS patients and 28 without ACS). Relative changes between baseline and post-transfusion measurements of maximal and residual platelet aggregation were considered with different agonists as well as changes in vasodilator-stimulated phosphoprotein platelet reactivity index and P-selectin expression. Inflammatory and thrombotic biomarkers were also measured before and after transfusion.

Results

After RBC transfusion, platelet reactivity was increased when measured using adenosine diphosphate-induced light transmission aggregometry (11.6% relative increase in maximal platelet aggregation, p聽= 0.004; 10.8% increase in residual platelet aggregation, p聽= 0.005) and vasodilator-stimulated phosphoprotein platelet reactivity index (20.7% relative increase, p聽= 0.002), and there was a nonsignificant trend toward an increase in P-selectin expression. Similar results were found with the nonspecific agonist thrombin receptor-activated peptide (relative increases of 11.7% for maximal platelet aggregation, p聽= 0.04, and 12.7% for residual platelet aggregation, p聽= 0.02) but not with collagen or arachidonic acid agonists. There were no significant differences in inflammatory and thrombotic biomarkers before and after transfusion.

Conclusions

After RBC transfusion, there is an increase in platelet reactivity, especially with tests measuring the adenosine diphosphate-P2Y₁₂ receptor pathway, without significant variations in inflammatory or thrombotic biomarkers. This in聽vivo effect may account for the excess of ischemic events observed in the context of patients with ACS treated using percutaneous coronary intervention and P2Y₁₂ inhibitors.