血栓弹力图评价替格瑞洛对氯吡格雷低反应患者血小板抑制的影响

Evaluation of the anti-platelet responsiveness to ticagrelor in patients of clopidogrel low-response by thromboelastograph

目的探讨经皮冠状动脉介入(PCI)术后,经血栓弹力图(TEG)检测的氯吡格雷药物低反应患者,换用替格瑞洛治疗后的血小板抑制情况。方法因冠心病不稳定型心绞痛行PCI术的患者常规氯吡格雷联合阿司匹林抗栓,经TEG筛选出53例氯吡格雷抑制不敏感、阿司匹林抑制正常的患者,换用替格瑞洛联合阿司匹林治疗。使用TEG比较换药前后花生四烯酸(AA)诱导的血小板抑制率及二磷酸腺苷(ADP)诱导的血小板抑制率。结果经TEG检测的氯吡格雷药物低反应患者,在换用替格瑞洛后,由ADP诱导的血小板抑制率明显升高[(41±8)%与(70±11)%],差异有统计学意义(P<0.01)。换用替格瑞洛前后由AA诱导的血小板抑制率变化差异无统计学意义(P>0.05)。结论对于血小板高反应性的患者,每天75mg氯吡格雷不能满足血小板抑制效果,换用替格瑞洛能够有效减低药物低反应的发生率,明显改善血小板抑制效果。

Objective To observe the anti-platelet responsiveness in patients whose anti-platelet agents switched from clopidogrel to ticagrelor because of clopidogrel low-response monitored by thromboelastograph （TEG） after percutaneous coronary intervention （PCI） .Methods The patients with coronary artery disease （CAD）were given regular antiplatelet agents of clopidogrel and aspirin for PCI .In this study ,53 patients were en-rolled as clopidogrel low-response and aspirin normal response monitored by TEG and the antiplatelet agents were switched to ticagrelor and aspirin .Before and after drug switching ,the results of platelet inhibition ratio induced by arachidonic acid （AA） and adenosine diphosphate （ADP） with TEG were compared .Result After switching the antiplatelet agents from clopidogrel to ticagrelor for clopidogrel low-response by TEG ,the results of ADP-in-duced platelet inhibition ratio increased significantly [（41 ± 8）% vs （70 ± 11）% ,P 〈0.01] ,and there were no significant differences in AA-induced platelet inhibition ratio （ P 〉0 .05） .Conclusion According to the results of TEG determinations ,daily 75 mg clopidogrel cannot reach a satisfactory platelet inhibition effect in patients who are not sensitive to clopidogrel .Switching from clopidogrel to ticagrelor can improve anti-platelet responsiveness significantly and decrease the rate of low-response effectively.