观察药物洗脱支架植入后应用高维持量氯吡格雷的早期疗效

Early effect of high maintenance dose of clopidogrel in patients with acute coronary syndrome un-derwent drug-eluting stent implantation

目的探讨药物洗脱支架（DES）植入后给予150mg维持量氯吡格雷的早期疗效及安全性。方法96例接受DES植入患者术前6-12h服氯吡格雷300mg，术后在服用阿司匹林基础上随机接受每天75mg（75mg组）或150mg（150mg组）维持量的氯吡格雷治疗7d，以后所有患者接受每天75mg的氯吡格雷治疗。分别检测两组服药前、服药后7d二磷酸腺苷（ADP）诱导的血小板最大聚集率（MPAR），随访术后30d主要临床心血管事件（包括死亡、心肌梗死、靶血管血运重建、再发心绞痛等）和出血事件的发生情况。结果氯吡格雷150mg组与75mg组术前MPAR比较差异无统计学意义（P〉0．05），而术后7d比较差异有统计学意义（P〈0．05）；氯吡格雷150mg组术后30d主要临床心血管事件发生率较75mg组显著减少（P〈0．05）。两组30d出血事件比较差异无统计学意义（P〉0．05）。结论植入DES患者术后服用高维持剂量氯吡格雷150mg较之常规维持剂量75mg治疗能更大程度抑制血小板聚集，同时降低DES植入术后近期发生不良事件的风险，且不增加出血事件发生。

Objective To investigate the short-term efficacy and safety of high maintenance dose （150 rag）of clopidogre in patients with acute coronary syndrome（ACS） undergoing drug-eluting stent （DES） implantation. Methods Ninety-six ACS patients underwent DES implantation were enrolled in the study. Loading dose （300 rag） of clopidiogrel was administered before percutaneous coronary inter- vention（PCI）. Patients were then randomized to receive clopidiogrel 75 rag（75 mg group） or 150 mg （150 mg group）per day for 7 days in addition to 300 mg aspirin daily. From 8 -30 d after surgery, all patients received 75 mg/d clopidogrel. Adenosine diphosphate （ADP）-induced maximal platelet aggrega- tion rate（ MPAR）was measured before PCI and 7 days after PCI. The incidence of major clinical cardio- vascular events （MACE） and hemorrhagic events were studied at 30 days after operation. Results MPAR was decreased obviously in the 150 mg group （P 〈 0. 05 ）at 7 days after PCI. The incidence of MACE in 150 mg group was significantly lower than that in the 75 mg group （P 〈 0. 05）. Conclusions High maintenance dose of 150 mg clopidogrel daily in the first week after PCI procedure can reduce the risk of adverse events in patients with ACS underwent DES implantation and is safe.