不同负荷剂量氯吡格雷对植入药物洗脱支架患者术后影响

Effect of different loading dose of clopidogrel on implantation of the drug-eluting stent

目的探讨药物洗脱支架(DES)植入后予不同剂量氯吡格雷的安全性及术后主要不良心脏事件(MACE)。方法176例接受DES植入患者随机进入氯吡格雷300、450、600、750mg负荷剂量组,术前6～24h服药,服药前及服药后4、24、48h监测血小板聚集率(PA),服药前、后24h监测血小板计数。临床随访6个月。结果氯吡格雷600、750mg组PA抑制明显,维持时间长,发生氯吡格雷抵抗病例少,MACE发生少;严重出血事件各组之间无差别,600、750mg组轻微出血事件增高,750mg组血小板计数明显下降。结论600、750mg组抑制PA效果更明显,作用时间更长,MACE发生更少;600mg负荷剂量优势更明显。

To observe the safety and major adverse cardiac event（MACE）of different loading dose of clopidogrel after implanting the drug eluting stent（DES）.Methods One hundred and seventy-six patients were randomly divided into 4 groups according to the different loading dose of clopidogrel after DES implantation：300 mg（n=45）,450 mg（n=41）,600 mg（n=47）and 750 mg（n=43）.Clopidogrel was administrated 6-24 h before DES implantation.Platelet aggregation（PA）was measured before and at 4,24,48 h after the drug administration.Platelet counts were measured before and at 24 hafter the drug administration.The patients were followed up for 6 months after operation.Results The time to the peak value of PA inhibition was lower in 600 mg and 750 mg groups than that in the other groups.The clopidogrel resistance was also lower in 600 mg and 750 mg groups.The MACE in 750 mg group was lower that than in the conventional loading dosage group（P〈0.05）.Safety end points were similar in the 4 groups.But minor bleeding was high in the 600 mg and 750 mg groups.The platelet counts were decreased sharply in 750 mg loading dosage group.Conclusion Pretreatment with 750,600 mg loading dosage of clopidogrel 4 to 24 hours before the procedure can significantly reduce PA and maintain for a longer time with less occurrence of MACE.The 600 mg may be the best.