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 re-sponse,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 transmit-tance 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。
Objective:To investigate the clinical efficacy of short-term intensive antiplatelet treatment of ticagrelor for patients withlow response to clopidogrel after percutaneous coronary intervention(PCI). Methods:A total of 100 cases who underwent PCI and wereconfirmed with low response to clopidogrel by light transmittance aggregation(LTA)were consecutively recruited and equallyrandomized into Clopidogrel(n=50)and Ticagrelor(n=50)groups. In Clopidogrel group,patients maintained clopidogrel 75 mg,gd incombination 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 determinedfor all patients 1 month after randomization;all participants were followed up and the adverse cardiovascular events were recorded for 6months. Results:There were no significant differences between the two groups regarding both the adenosine diphosphate-inducedplatelet aggregation(PLADP)and the arachidonic acid-induced platelet aggregation(PLAA)prior to randomization(P > 0.05). At 1 monthafter randomization,PLADPin 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 PLAAshowed no significant difference between the two groups. The incidence of cardiogenicrehospitalization 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 issignificantly more potent than that of clopidogrel,and 1-month intensive treatment of ticagrelor may reduce the cardiogenicrehospitalization in patients with CLR after PCI.
引文
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