沙格雷酯联合氯吡格雷在颈动脉内膜剥脱术后的应用

Sarpogrelate combined with Clopidogrel in patients after carotid endarterectomy

目的观察沙格雷酯在颈动脉内膜剥脱术（carotid endarterectomy，CEA）后抗血小板治疗效果和安全性。方法回顾性分析宣武医院血管外科2008年10月至2011年2月收治的接受CEA治疗的64例患者的临床资料。根据术后抗血小板用药情况，将患者分为阿司匹林联合氯吡格雷组（A组，阿司匹林100mg／d联合氯吡格雷50mg／d）和沙格雷酯联合氯吡格雷组（B组，沙格雷酯100mg，3次／d联合氯吡格雷50ms／d），比较术后新发脑卒中、再狭窄、出血事件的发生率和死亡率。结果A组34例，B组30例，其中新发脑卒中1例（B组），患侧颈动脉再狭窄3例（中度再狭窄A组I例，B组2例，重度再狭窄A组1例），出血事件3例（一般出血事件A组3例，其中皮下淤血2例，肉眼血尿1例）。2组均无死亡病例。新发脑卒中和再狭窄发生率及出血事件发生率2组均较低，组问差异无统计学意义。结论在术后新发脑卒中、再狭窄发生率、死亡率和出血事件发生率方面，阿司匹林和沙格雷酯并无明显差异。沙格雷酯联合氯吡格雷用于CEA术后抗血小板治疗是安全有效的。

Objective To observe the effectiveness and safety of Sarpogrelate as antiplatelet therapy in carotid endarterectomy （CEA） cases. Methods We retrospectively analyzed the clinical data of 64 CEA eases collected from October 2008 to February 2011 at Xuanwu Hospital. According to postoperative antiplatelet medication patients were divided into aspirin combined Clopidogrel group （group A, aspirin 100 mg/d; Clopidogrel 50 mg/d） and Sarpogrelate combined Clopidogrel group （group B, Sarpogrelate 100 mg,tid; Clopidogrel 50 mg/d）. Postoperative new stroke, restenosis, bleeding and mortality were compared between groups. Results There were 34 cases in group A and 30 cases in group B. New stroke （one case） （in group B）, ipsilateral carotid restenosis （moderate： 1 case in group A, 2 cases in group B; severe：l case in group A ）, bleeding episode （general bleeding event： 3 cases in group A including hypodermic gore in 2 cases, gross hematuria in 1 case）. There was no death. There was no significant differences between two groups in new stroke, bleeding and restenosis. Conclusions Sarpogrelate combined with CloDidozrel for antiDlatelet therapy after CEA was safe and effective.