冠状动脉支架植入术后氯吡格雷低反应患者短期替格瑞洛强化治疗研究
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国家自然科学基金(81170181);江苏省医学重点人才资助(ZDRCA2016013)


Short⁃term intensive treatment of ticagrelor for patients with low response to clopidogrel after percutaneous coronary intervention
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    摘要:

    目的:探讨经皮冠状动脉支架植入术(percutaneous coronary intervention,PCI)后氯吡格雷低反应(clopidogrel low response,CLR)患者短期替格瑞洛强化抗血小板治疗的临床疗效。方法:连续入选PCI术后经光学血小板聚集(light transmittance aggregation,LTA)法检出的CLR患者100例,随机分为氯吡格雷组(50例)和替格瑞洛组(50例)。氯吡格雷组予氯吡格雷75 mg/d;后者予替格瑞洛90 mg,2次/d,bid,强化1个月后改为氯吡格雷75 mg/d;两组患者均联合服用阿司匹林100 mg/d。治疗1个月后检测所有患者的血小板聚集率;随访6个月,比较两组心血管不良事件的发生情况。结果:两组患者随机治疗前二磷酸腺苷诱导的血小板聚集率(adenosine diphosphate-induced platelet aggregation,PLADP)及花生四烯酸诱导的血小板聚集率(arachidonic acid-induced platelet aggregation,PLAA)均无统计学差异(P > 0.05);治疗1个月时,替格瑞洛组PLADP显著低于氯吡格雷组[(21.27 ± 12.81)% vs.(48.72 ± 10.92)%,P < 0.01],两组患者PLAA无统计学差异(P > 0.05);6个月时随访,替格瑞洛组心源性再入院患者显著低于氯吡格雷组(6% vs. 20%,P < 0.05),但轻微出血增加(24% vs. 8%,P < 0.05)。结论:替格瑞洛的抗血小板聚集作用显著优于氯吡格雷,对CLR患者PCI术后替格瑞洛强化抗血小板治疗1个月可能减少心源性住院事件。

    Abstract:

    Objective:To investigate the clinical efficacy of short-term intensive antiplatelet treatment of ticagrelor for patients with low response to clopidogrel after percutaneous coronary intervention(PCI). Methods:A total of 100 cases who underwent PCI and were confirmed with low response to clopidogrel by light transmittance aggregation(LTA)were consecutively recruited and equally randomized into Clopidogrel(n=50)and Ticagrelor(n=50)groups. In Clopidogrel group,patients maintained clopidogrel 75 mg,gd in combination with aspirin 100 mg,gd;while in Ticagrelor group,patients were treated with ticagrelor 90 mg twice daily for 1 month,then switching to clopidogrel 75 mg,gd in combination with aspirin 100 mg,gd. The light transmission aggregations were determined for all patients 1 month after randomization;all participants were followed up and the adverse cardiovascular events were recorded for 6 months. Results:There were no significant differences between the two groups regarding both the adenosine diphosphate-induced platelet aggregation(PLADP)and the arachidonic acid-induced platelet aggregation(PLAA)prior to randomization(P > 0.05). At 1 month after randomization,PLADP in the Ticagrelor group was significantly lower than that in the Clopidogrel group[(21.27 ± 12.81)% vs.(48.72 ± 10.92)%](P < 0.01),while PLAA showed no significant difference between the two groups. The incidence of cardiogenic rehospitalization was significantly lower(6% vs. 20%,P < 0.05),although minimal bleeding was significantly higher(24% vs. 8%,P < 0.05)in the Ticagrelor group compared with that in the Clopidogrel group. Conclusion:The antiplatelet effect of ticagrelor is significantly more potent than that of clopidogrel,and 1-month intensive treatment of ticagrelor may reduce the cardiogenic rehospitalization in patients with CLR after PCI.

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范远生,王 飞,杨 璐,张 晶,徐 可,龚晓旋,李锦爽,应良红,纪矞钦,叶 森,李春坚.冠状动脉支架植入术后氯吡格雷低反应患者短期替格瑞洛强化治疗研究[J].南京医科大学学报(自然科学版),2018,(6):769-773

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  • 收稿日期:2018-01-17
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  • 在线发布日期: 2018-06-22
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