阿司匹林抵抗的急性冠脉综合征患者加用替罗非班治疗的疗效及安全性探讨

Effect and safety of additional tirofiban for aspirin resistance patients with acute coronary syndrome

目的评价血小板糖蛋白Ⅱb／Ⅲa（GPⅡb／Ⅲa）受体拈抗剂替罗非班应用于阿司匹林抵抗（AR）的急性冠脉综合征（ACS）患者的疗效及安全性。方法128例AR的ACS（包括不稳定性心绞痛和非Q波心肌梗塞）随机分为替罗非班组和对照组，对照组常规联合应用阿司匹林和氯吡格雷治疗，替罗非班组加用替罗非班治疗。观察用药后36小时和30天的不良心血管事件及副反应的发生情况。结果用药后36小时两组患者均未出现死亡及靶血管再次重建。用药后36小时实验组未出现心绞痛及心梗，对照组2例出现心绞痛，无心梗发生。用药后30天实验组无心绞痛发作，无心梗发作，对照组5例出现心绞痛，2例出现心梗。用药后36小时，替罗非班组出现2例牙龈出血，对照组无出血事件发生。用药后30天两组均无出血事件发生。两组均无颅内出血及消化道大出血，无血小板减少发生。两组的出血事件及血小板减少的副反应发生率无统计学意义（P〉0．05）。结论阿司匹林抵抗的急性冠脉综合征患者加用替罗非班治疗可明显降低心绞痛及心梗的发生率，并不增加急性冠脉综合征患者出血及血小板减少的发生率．值得临床推广应用。

Objective To evaluate the safety and efficacy of use of Tirofiban in non-interventional treatment for aspirin resistance（AR） patients with acute coronary syndrome （ACS）. Methods 128 patients with ACS（unstable angina and non-Q-wave myocardial infarction） were divided into two groups ： 63patients in the control- group（aspirin plus clopidogrel） and 65 patients in the Tirofiban group （10 microg/kg within 3 minutes followed by Tirofiban 0.15 microg/kg.min intravenous maintenance infusion with micro pump for 36 hours plus aspirin plus clopidogrel）. The clinical data were recorded and analyzed , including clinical characteristics , main adverse cardiac events （MACE） such as recurrent angina , myocardial infarction and target vessel revascularization , and the adverse effects such as sudden death , hemorrhage and thromhocytopenia. Results No MACE occurred in two groups within 36 hours after administration. In the Tirofiban group, no recurrent angina and myocardial infarction occurred, in control-group 2 patients occurred recurrent angina but no myocardial infarction .In another case within 30 days after administration, while in the controlgroup, recurrent angina occurred in 5patients and 2 patients occurrence of myocardial infarction. No death and target vessel revascularization occurred in the both groups. There were 2cases of minor bleeding in Tirofiban group within 36 hours after administration, and no major bleeding and thrombocytopenia till 30 days after administration. No significant difference was found in MACE occurrence and adverse effects between the two groups （ P〉 0.05）. Conclusions When administered with heparin and aspirin, tirofban was associated with a lower incidence of recurrent angina and myocardial infarction but no higher incidence of hemorrhage and thromhocytopenia in patients with acute coronary syndromes than inpatients who received only aspirin plus clopidogrel.