停用氯吡格雷对冠状动脉支架术患者血小板功能的影响

Influence of clopidogrel discontinuation to platelet reactivity in patients with coronary stenting

目的:观察经皮冠状动脉介入术(PCI)患者停用氯吡格雷是否导致血小板功能反跳、不同氯吡格雷停用方案对血小板聚集率及血小板CD62P的影响。方法:103例已服用氯吡格雷近1年,且即将停用的PCI术后患者,随机接受两种不同氯吡格雷停用方案:A组(52例)直接停药;B组(51例)在3个月内逐渐停用氯吡格雷。在服药前、停药前1周、停用后1周及停用后1个月时评价血小板聚集率及血小板CD62P的变化。结果:无论直接停用还是逐渐停用氯吡格雷,血小板聚集率在停药1周后较服药前增加,差异具有显著性(P<0.05),但逐渐停用患者在停药1周时血小板聚集率即恢复至服药前水平,而直接停用患者在停药1个月时才恢复至停药前水平,两组患者均未观察到血小板CD62P的反跳。结论:停用氯吡格雷1周后,患者血小板聚集率一过性增加,但血小板功能CD62P无显著性变化。

Objective：To assess whether a platelet rebound exists in patients with percutaneous coronary interventions（PCI）after clopidogrel discontinuation and the influences of different clopidogrel discontinue schedule on platelet aggregation and CD62P.Method：The 103 patients who underwent PCI and coming to the end of their 12 months course of clopidogrel therapy were divided into two discontinuation strategies,group A：abrupt drug cessation;or group B：clopidogrel was withdrawn in 3 months.Platelet aggregation and CD62 Pwere measured at four time-points（before clopidogrel treatment,1 week before clopidogrel stopped,1 week after clopidogrel stopped and 1 month after clopidogrel stopped）.Result：Platelet aggregation increased in both groups 1week after clopidogrel discontinuation.There were significant differences compared with those of baseline（P0.05）.Platelet aggregation returned to the baseline 1week after clopidogrel discontinuation in group B,but in group A,platelet aggregation returned to the baseline 1 month after clopidogrel discontinuation.There was no CD62Prebound in either groups.Conclusion：There is transient period of increased platelet reactivity 1week after clopidogrel discontinuation,but no changes of CD62 Pare observed.