氯吡格雷反应变异性与出血事件的关联分析

Association of bleeding events with clopidogrel response variability in patients undergoing percutaneous coronary intervention

目的探讨经皮冠状动脉介入术(PCI)患者氯吡格雷反应变异性与出血事件的关系。方法 107例成功行PCI术患者,术前12h常规服用氯吡格雷300 mg,在服用氯吡格雷前及服药后12h以二磷酸腺苷5μmol·L^(-1)为诱导剂,检测血小板聚集率。根据血小板聚集抑制率将患者分为氯吡格雷反应组(n=45)和反应欠佳组(n=62)。在术后1、3、6、12 mo对患者出血事件进行随访,并采用BleedScore方法对出血事件进行评分。结果累积12 mo,共发生危险性出血事件3例(2.8%)、内部出血事件4例(3.7%),浅表性出血事件9例(8.4%)。氯吡格雷反应组3、6、12 mo出血事件的BleedScore总分显著高于氯吡格雷反应欠佳组(P<0.01)。亚组分析显示氯吡格雷反应组3、6、12 mo浅表性出血BleedScore评分显著高于反应欠佳组(P=0.003)。结论氯吡格雷反应组的出血风险,尤其是浅表性出血风险高于反应欠佳组,需要加强对氯吡格雷反应患者浅表性出血的药学监护。

AIM To explore the association of bleeding events with clopidogrel response variability in Chinese patients undergoing percutaneous coronary intervention （PCI）. METHODS A total of 107 consecutive patients undergoing PCI were enrolled. Platelet aggregation （5 μmol.L-1 ADP） were measured at baseline, 12 hours after the clopidogrel loading dose. Classification of clopidogrel effectiveness （responders, n = 45; poor responders, n = 62） was based on inhibition of platelet aggregation （IPA）. Follow-up was in 1, 3, 6 and 12 months after PCI. Bleeding events are expressed by the new classification called BleedScore. RESULTS Duringthe 12 - month follow - up, 16 bleeding events occurred： 3 （ 2.8% ） alarming bleeding events, 4 （ 3.7% ） internal bleeding events, 9 （8.4%） superficial bleeding events. Responders incurred a higher BleedScore of superficial bleeding events （P = 0.003） and total BleedScore （P 〈 0.01） than poor responders did at 3, 6, 12 months after PCI. CONCLUSION Clopidogrel responders incurred a higher risk of bleeding events, especially of superficial bleeding events, than poor responders did, and pharmaceutical care of superficial bleeding events should be strengthen in elopidogrel responders.