血栓弹力图评价急性冠脉综合征患者氯吡格雷抗血小板效果

Effect of different dose of clopidogrel evaluated by thrombelastography in aged patients with acute coronary syndrome

目的:利用血栓弹力图评价老年急性冠脉综合征(ACS)非血运重建患者不同剂量氯吡格雷的抗血小板效果。方法:60例老年ACS未进行血运重建的患者被随机分为:甲组(30例,冠状动脉造影术后予氯吡格雷75mg/d维持),乙组(30例,冠脉造影术后予氯吡格雷50mg/d维持),两组冠脉造影术前均予氯吡格雷300mg口服。冠脉造影术前24h内及造影术后一周后分别测定两组患者肝肾功能及以血栓弹力图法测定血小板抑制率。并观察3个月内两组的主要心脏不良事件及不良反应。结果:与治疗前比较,治疗一周后两组患者ADP诱导的血小板抑制率[甲组:(25.8±11.4)%比(75.2±12.3)%,乙组:(24.2±13.3)%比(64.8±17.5)%]和花生四烯酸(AA)诱导的血小板抑制率[甲组:(16.7±21.6)%比(82.7±25.4)%,乙组:(23.8±22.2)%比(80.2±22.7)%,P<0.05]均明显升高,两组比较无显著差异(P>0.05)。3个月内两组的心脏不良事件及不良反应无显著差异(P>0.05)。结论:对非血运重建的急性冠脉综合征老年患者,低剂量氯吡格雷同样有效。

Objective： To evaluate antiplatelet effect of different doses of clopidogrel using thrombelastography （TEG） in aged patients with acute coronary syndrome （ACS） not undergoing revascularization. Methods： A total of 60 aged ACS patients not undergoing revaseularization were randomly divided into group A En = 30, received clopidogrel 75 mg/d for maintenance after coronary angiography （CAG）; and group B （n = 30, received clopidogrel 50 mg/d for maintenance after CAG）. Both groups received clopidogrel 300 mg before CAG. Liver and renal function and platelet inhibition rate measured by TEG were measured in two groups within 24h before CAG and one week after CAG. Major adverse cardiovascular events and adverse reactions were observed in two groups within three months after CAG. Results： Compared with before treatment, there were significant increase in ADP induced platelet inhibition rate [group A： （25.8±11.4）% vs. （75.2±12.3）%, groupB： （24.2±13.3）% vs. （64.8± 17. 5）%] and arachidonic acid （AA） induced platelet inhibition rate [group A： （16. 7 ± 21.6）% vs. （82.7 ± 25.4） %, group B： （23.8 ± 22.2） % vs. （80.2 ± 22. 7） %, P〈0. 05] in two groups one week after treatment, and there were no significant difference between two groups （P〉0.05）. There were no significant difference in incidence rate of MACE and adverse reaction within three months between two groups （P〉0.05）. Conclusion： Low dose clopidogrel is also effective in aged patients with acute coronary syndrome not undergoing revascularization.