文章摘要
马 超,徐骁晗,刘 博,王 敏,吕 浩,王晓伟.运用血栓弹力图评价替格瑞洛用于非体外循环冠脉搭桥术后患者抗血小板效果及临床疗效[J].南京医科大学学报,2018,(10):1415~1420
运用血栓弹力图评价替格瑞洛用于非体外循环冠脉搭桥术后患者抗血小板效果及临床疗效
Study of antiplatelet efficacy of ticagrelor and clinical outcomes in patients after off⁃pump coronary artery bypass graft via thrombelastography test
投稿时间:2017-06-29  
DOI:10.7655/NYDXBNS20181018
中文关键词: 血栓弹力图  替格瑞洛  氯吡格雷  冠状动脉旁路移植术
英文关键词: thrombelastography  ticagrelor  clopidogrel  coronary artery bypass graft
基金项目:江苏省中医药局科技项目(LZ13217)
作者单位
马 超 常州市第一人民医院心胸外科江苏 常州 213003 
徐骁晗 南京医科大学第一附属医院心脏大血管外科江苏 南京 210029 
刘 博 南京医科大学第一附属医院心脏大血管外科江苏 南京 210029 
王 敏 常州市第一人民医院心胸外科江苏 常州 213003 
吕 浩 常州市第一人民医院心胸外科江苏 常州 213003 
王晓伟 南京医科大学第一附属医院心脏大血管外科江苏 南京 210029 
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中文摘要:
      目的:运用血栓弹力图评价替格瑞洛用于非体外循环冠脉搭桥(off?pump coronary artery bypass graft,OPCABG)术后患者抗血小板效果并观察其临床疗效。方法:2015年5月—2016年6月南京医科大学第一附属医院心脏大血管外科成功完成OPCABG术的患者90例随机分为A、B、C 3组。A组术后予以氯吡格雷75 mg,1次/d口服;B组术后予以替格瑞洛90 mg,2次/d口服;C组术后予以替格瑞洛半量45 mg,2次/d口服;3组均同时服用阿司匹林标准剂量(100 mg,1次/d)。比较各组服药后5~7 d二磷酸腺苷(adenosine diphosphate,ADP)和花生四烯酸(arachidonic acid,AA)诱导的血小板抑制率(PIADP和PIAA)、术后3~6个月的主要心血管不良事件(major adverse cardiac events,MACE)、出血事件的发生率及相关不良反应。结果:与A组比较,B、C组PIADP(%)均明显增大(83.8 ± 17.6 vs. 60.5 ± 25.6,P=0.001;77.9 ± 24.6 vs. 60.5 ± 25.6,P=0.013)。与B组比较,C组PIADP(%)无明显差异(77.9 ± 24.6 vs. 83.8 ± 17.6,P > 0.05)。3组均未见明显MACE。与A组比较,B组出血事件发生率有所增加,但差异无统计学意义(23.3% vs. 16.6%,P > 0.05)。结论:替格瑞洛用于冠状动脉旁路移植术后抗血小板效果优于氯吡格雷,是安全、有效的。
英文摘要:
      Objective:To evaluate the antiplatelet efficacy of ticagrelor in patients after off?pump coronary artery bypass graft(OPCABG)surgery and observe its clinical outcomes. Methods:A total of 90 patients undergoing OPCABG successfully in the First Affiliated Hospital of NMU during May 2015 to June 2016 were enrolled in this study. Patients were randomly divided into three groups. In the first day after surgery,group A was given clopidogrel(75 mg,1/day,oral);group B was given ticagrelor(90 mg,2/day,oral);group C was given half amount ticagrelor(45 mg,2/day,oral). The three groups took aspirin standard dose(100 mg,1/day)at the same time. In 5 to 7 days after OPCABG,platelet inhibition(PI)rate induced by arachidonic acid(AA)and adenosine diphosphate(ADP)(PIADP and PIAA)by TEG was monitored to compare antiplatelet efficacy of the three groups. Major adverse cardiac events(MACE),bleeding events and related adverse reactions were also compared between the groups to evaluate the clinical effect. Results:Compared with group A,PIADP(%)of group B and group C were significantly increased(83.8 ± 17.6 vs. 60.5 ± 25.6,P=0.001;77.9 ± 24.6 vs. 60.5 ± 25.6,P=0.013,respectively). There was no obvious difference of PIADP(%)between group B and group C(77.9 ± 24.6 vs. 83.8 ± 17.6,P > 0.05). The three groups were not seen obvious MACE. Compared with group A,incidence of bleeding events in group B was increased,but there was no statistically significant difference(23.3% vs. 16.6%,P > 0.05). Conclusion:Ticagrelor treatment as antiplatelet therapy in patients after OPCABG was effective and safe,and its antiplatelet efficacy was superior to clopidogrel.
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