负荷剂量的氯吡格雷在急性心肌梗死直接支架术中的应用

The effects of loading dose clopidogrel in preventing direct coronary stenting complication with acute myocardial infarction patients

目的 分析负荷剂量的氯吡格雷对急性心肌梗死、直接支架术的治疗效果。方法 采用回顾性分析临床资料的方法 ,将 74例直接支架植入的病例分为氯吡格雷组 (38例 )及噻氯匹定组 (36例 ) ,观察发病 4周内出血、粒细胞及血小板减少等并发症的发生情况 ,随访发病后 6个月内临床事件的发生情况。结果 临床事件总发生数分别为氯吡格雷组 8(2 1.1% )及噻氯匹定组 16例 (4 4 .4 % ) ,P =0 .0 31。轻度出血数分别为 6例 (15 .8% )及 14例 (38.9% ) ,白细胞计数分别为 (5 .8± 1.7)及 (4 .2± 3.6 )(× 10 9 L) ,血小板计数分别为 (130 .3± 4 2 .1)× 10 9及 (89.2± 5 3.3)× 10 9 L(P <0 .0 5 )。结论 负荷剂量的氯吡格雷对直接支架术的急性心肌梗死有良好的治疗效果 。

Objective To compare the effects of clopidogrel and ticlopidine in combination with aspirin in preventing direct coronary stenting complication in patients with acute myocardial infarction.Methods The clinical data of 74 cases with ST-segment elevation myocardial infarction were retrospectively analysed. The patients were divided into two groups. Before direct coronary stenting, clopidogrel,300mg loading dose then 75mg once daily or ticlopidine 250mg twice daily in addition to aspirin 100mg once daily were given to two groups respectively. Hemorrhage, neutropenia, thrombocytopenia were observed during 4 weeks. The frequency of clinical cardiovascular events (including cardiac mortality, myocardial re-infarction, need for revascularization) were followed up at 6 months. Results The incidence of major cardiac events in clopidogrel group was less than ticlopidine group ( 21.1% with Clopidogrel and 44.4% with Ticlopidine,P= 0.031). The incidence of light hemorrhage patents individually were 6(15.8%) vs 14(38.9%). The mean number of neutrophile white celll individually were 5.8 ±1.7 vs 4.2 ±3.6 (×10 9/L). The platelet count were 130.3 ±42.1 vs 89.2 ±53.3(×10 9/L), P< 0.05.Conclusions Loading dose clopidogrel had a better effect on the acute myocardial infarction patients with direct coronary stenting than ticlopidine. The incidence of side-effects events was lower in clopidogrel group.