文章摘要
杨 璐,王 飞,李济民,朱 辉,张 晶,范远生,徐 可,徐 蕾,陈 俊,李春坚.不同强化抗血小板治疗对冠状动脉支架植入后氯吡格雷低反应患者的近期疗效及安全性研究[J].南京医科大学学报,2017,(6):697~702
不同强化抗血小板治疗对冠状动脉支架植入后氯吡格雷低反应患者的近期疗效及安全性研究
Short term efficacy and safety of different intensive anti-platelet treatments for patients with clopidogrel low response after percutaneous coronary stent implantation
投稿时间:2017-01-16  
DOI:10.7655/NYDXBNS20170609
中文关键词: 冠心病  氯吡格雷低反应性  血小板聚集率  替格瑞洛
英文关键词: coronary artery disease  clopidogrel low response  platelet aggregation  ticagrelor
基金项目:国家自然科学基金(81170181)
作者单位
杨 璐 南京医科大学第一附属医院心脏科江苏 南京 210029 
王 飞 南京医科大学第一附属医院心脏科江苏 南京 210029 
李济民 南京医科大学第一附属医院心脏科江苏 南京 210029 
朱 辉 南京医科大学第一附属医院心脏科江苏 南京 210029 
张 晶 南京医科大学第一附属医院心脏科江苏 南京 210029 
范远生 南京医科大学第一附属医院心脏科江苏 南京 210029 
徐 可 南京医科大学第一附属医院心脏科江苏 南京 210029 
徐 蕾 南京医科大学第一附属医院心脏科江苏 南京 210029 
陈 俊 南京医科大学第一附属医院心脏科江苏 南京 210029 
李春坚 南京医科大学第一附属医院心脏科江苏 南京 210029 
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中文摘要:
      目的:研究经皮冠状动脉介入治疗术(percutaneous coronary intervention, PCI)后氯吡格雷低反应(clopidogrel low response, CLR)患者接受不同强化抗血小板治疗方案的近期疗效及安全性。方法:采用光学血小板聚集仪(light transmittance aggregometer, LTA)筛选PCI术后CLR住院患者150例。将入选者随机分为3组:①常规治疗(A)组:服用阿司匹林(100 mg,每天1次)及氯吡格雷(75 mg,每天1次)持续1年;②强化治疗(B)组:服用阿司匹林(100 mg,每天1次)及氯吡格雷(150 mg,每天1次)强化1个月后改为上述常规治疗持续1年;③强化治疗(C)组:服用阿司匹林(100 mg,每天1次)及替格瑞洛(90 mg,每天2次)强化1个月后改为常规治疗持续1年;于术后1个月复查二磷酸腺苷诱导的血小板聚集率(adenosine diphosphate induced platelet aggregation,PLADP)和花生四烯酸诱导的血小板聚集率(arachidonic acid induced platelet aggregation,PLAA),并随访临床事件发生情况。结果:3组临床资料及理化指标差异均无统计学意义;3组患者治疗前PLADP差异无统计学意义(P=0.553),PLAA差异也无统计学意义(P=0.352);治疗1个月后B组、C组PLADP均显著低于同组基线值(P均 <0.001),C组PLADP显著低于A、B两组(P均 <0.001);3组PLAA差异无统计学意义。治疗1个月后随访,A、B、C组支架内血栓、靶血管重建以及心源性再入院的总发生率分别为20%、10%、4%(P=0.039),微小出血发生率分别为10%、14%、28%(P=0.044),C组呼吸困难的发生率为6%,显著高于A、B两组(P=0.01)。结论:氯吡格雷强化治疗、替格瑞洛抗血小板治疗均能改善CLR患者的血小板反应性;替格瑞洛强化治疗增加了微小出血与呼吸困难的发生,同时减少了术后1个月支架内血栓、靶血管重建及心源性再入院的总发生率。
英文摘要:
      Objective: To determine the short term efficacy and safety of different intensive anti-platelet treatments for patients who received percutaneous coronary intervention(PCI), but presented clopidogrel low response(CLR). Methods: The light transmittance aggregometer(LTA) was adopted to screen patients, who underwent PCI and presented CLR, and 150 clopidogrel low responders were consecutively recruited during their hospitalization. The included patients were randomized and assigned into three groups: ①the regular treatment group (Group A): taking aspirin 100 mg daily and clopidogrel 75 mg daily for one year; ②the intensive treatment group (Group B) : taking aspirin 100 mg daily and clopidogrel 150 mg daily for one month and then switched to regular anti-platelet treatment as group A for one year; ③the intensive treatment group (Group C): taking aspirin 100 mg daily and ticagrelor 90 mg twice daily for one month then turned to regular anti-platelet treatment as group A for one year. All recruited patients were followed up at one month after randomization, when the adenosine diphosphate induced platelet aggregation(PLADP) and arachidonic acid induced platelet aggregation(PLAA) was determined and clinical events were recorded. Results: There were no significant differences regarding the baseline clinical data and biochemical indexes among Groups A, B, and C, so were the baseline levels of PLADP(P=0.553), and the baseline levels of PLAA(P=0.352). At one month follow-up, the PLADP in Group B and Group C were both significantly lower than their baseline levels (P<0.001); and the PLADP level in Group C was significantly lower than that in Groups A and B; the PLAA levels of Groups A, B and C had no significant differences among the groups. The total incidences of in-stent thrombus, target vessel revascularization and cardiogenic hospitalization at 1 month were 20%, 10% and 4% in Group A, B and C, respectively(P=0.039). The incidences of minimal bleeding at 1 month were 10%, 14% and 8%, respectively in the three groups (P=0.044). The incidence of dyspnea in Group C was 6%, which was significantly higher compared to the other two groups(P=0.01). Conclusion: Double-dose clopidogrel or ticagrelor can effectively reduce the residual platelet aggregation for CLR patients; Ticagrelor can otherwise bring down the total incidences of in-stent thrombus, target vessel revascularization and cardiogenic hospitalization one month after the procedure, at the risk of increased dyspnea and minimal bleeding.
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