氯吡格雷不同给药方案预防支架内血栓形成疗效观察

Prevention of in-stent thrombosis with different protocol of chlopidogrel therapy

目的 比较冠心病介入治疗中氯吡格雷两种给药方案预防支架内血栓形成的有效性和安全性.方法 对63例择期行冠状动脉介入治疗的患者进行回顾性分析.按照不同的氯吡格雷给药方案分为两组,观察组（29例）于术前48 h及24 h分别给予氯吡格雷300 mg、225 mg双重负荷量,以后按常规口服75 mg/d;对照组（34例）于术前6 h给予氯吡格雷300 mg单负荷量,以后口服75 mg/d.随访2～40个月,统计两组出现支架内急性、亚急性、晚期血栓形成以及出血并发症的情况.结果 观察组比对照组支架内血栓形成比例明显减少,差异有统计学意义（0/29比3/34,P＜0.05）.两组均未发生明显出血并发症.结论 冠心病患者行择期冠状动脉介入治疗时,术前给予双重负荷量氯吡格雷安全、有效,能显著降低支架内血栓形成的风险,是值得进一步研究的给药方案.

Objective To compare the effectiveness and safety of two different protocol of chlopidogrel therapy on intra-stent thrombus prevention in patients undergone coronary interventions. Methods Sixty-three consecutive patients underwent elective coronary interventions in Beijing Mining General Hospital were enrolled in this retrospective study. The patients were divided into two groups according to the protocol of chlopidogrel therapy. For the testing group （ n = 29）, 300 mg and 225 mg of chlopidogrel were given 48 hours and 24 hours prior to the intervention procedure respectively followed by 75 mg daily. And for the control group （n = 34 ）, 300 nag cholpidogrel were given 6 hours prior to the procedure followed by 75 nag daily. Acute, subacute and late in-stent thrombosis and bleeding were recorded during a 2 - 40 months follow-up. Results No in-stent thrombosis occurred in the testing group which, however, was recorded in 3 cases in the control group. The difference was statistically significant （ P 〈 0.05）. No obvious bleeding occurred in both groups. Conclusion For patients about to undergo elective coronary interventions, a dual-loading protocol of chlopidogrel therapy may be effective and safe for the prevention of in-stent thrombosis, which is worth fuaher studies to verify.