冠状动脉介入术前高负荷量氯吡格雷预治疗的近期疗效

Clinical outcomes of high loading dose clopidogrel pretreatment before percutaneous coronary interventions

目的:对比观察拟行冠状动脉(冠脉)介入术患者术前服用高负荷剂量氯吡格雷600mg与常规负荷剂量300mg预治疗的有效性及安全性。方法:选取100例拟行冠脉介入术的患者,术前随机分别给予600mg(50例)或300mg(50例)负荷剂量氯吡格雷预治疗。分别检测2组服药前、服药后16、36h二磷酸腺苷(ADP)诱导的血小板最大凝集率(MPAR),随访术后30d和6个月主要临床心血管事件(包括死亡、心肌梗死、紧急靶血管血运重建、脑卒中等)和出血事件的发生情况。结果:服药后16h,氯吡格雷600mg组较之300mg组对ADP(5μmol/L和20μmol/L)诱导的MPAR产生更大的抑制作用[ADP5μmol/L,(21·83±18·04)%∶(14·79±9·18)%,P<0·05];[ADP20μmol/L,(22·12±14·81)%∶(15·67±10·15)%,P<0·05)]。而服药后36h,2组ADP(5μmol/L和20μmol/L)诱导的MPAR率分别降低[ADP5μmol/L,(16·70±15·42)%∶(12·94±10·34)%,P>0·05]和[20μmol/L∶(14·14±13·16)%:(10·19±9·49)%,P>0·05]。氯吡格雷600mg组30d和6个月主要临床心血管事件发生率较300mg组显著减少(P<0·05,P<0·01)。2组30d和6个月出血事件差异均无统计学意义。结论:冠脉介入术患者术前服用高负荷剂量氯吡格雷600mg较之常规负荷剂量300mg预治疗能更大程度抑制血小板凝集,同时可显著改善临床预后。

Objective：To compare the short-term efficiency and safety of high loading dose（600mg） clopidogreal pretreatment with those of routine loading dose（300mg）before the procedure in patients undergoing percutaneous coronary intervention. Method：A total of 100 patients scheduled to undergo percutaneous coronary intervention were randomly devided to a 600mg （n=50） or 300 mg （n=50） loading regimen of clopidogrel before the procedure. The adenosine diphosphate （ADP）-induced max platelet aggregation rate （MPAR） were measured at baseline and at 16 and 36 hours after administration of clopidogrel. The incidence of major clinical cardiovascular event （including death, myocardial infarction, target vessel revascularization, stroke ） and hemorrhagic events were followed up to 30 day and 6 month. Result：The baseline clinical and angiographic characteristics and the result of stenting were similar in both groups. At 16 hours after administration of clopidogrel, 600 mg group produced greater inhibition of ADP （5 μmol/L and 20 μmol/L） induced max platelet aggregation than 300 mg group （ADP 5 μmol/L： [21.83 ± 18. 04] % ： [14.79 ± 9. 18] %, P〈 0.05, ADP 20 μmol/L： [22.12 ± 14. 81] % ： [15.67 ± 10. 15]%, P〈0. 05）. At 36 hours after administration of clopidogrel, the reduction of ADP（5 μmol/L and 20 μmol/L） induced-aggregation of the two groups was （ADP 5 μmol/L ： [16.70±15.42]% ： [12. 94± 10.34]%, P〉0.05] and （20 μmol/L：[14.14±13.16] ： [10.19±9. 49]%, P〉0.05）. The incidenc of 30 day and 6 month major clinical cardiovascular event in 600mg group were significantly less than that in 300 mg group（P〈0.05 ; P〈 0.01）. The occurrence of 30 day and 6 month hemorrhagic events between the two groups had no significant difference （P〉 0.05 ; P〉 0.05）. Conclusion： Pretreatment with a 600mg loading dose of clopidogrel before the procedure is more efficient in inhibiting platelet aggregation and, compared with the conventional 300mg dose, significantly improve Clinical outomes in patients undergoing percutaneous coronary intervention.