血栓弹力图指导冠状动脉介入治疗患者使用抗血小板药物的临床研究

Application of Thromboelastogram to Guide Antiplatelet Drugs Use in Patients Undergoing Percutaneous Coronary Intervention

目的探讨经皮冠状动脉介入治疗(PCI)患者,术后利用血栓弹力图指导抗血小板药物的使用。方法分析我院近期4个月349例经皮冠状动脉介入治疗患者,根据是否做血栓弹力图(TEG)将其分为试验组和对照组。2组患者均使用阿司匹林+氯吡格雷的联合用药方案,再根据抗血小板药物剂量不同,2组又分别分为2个亚组,其中A组抗血小板药物为阿司匹林100 mg+氯吡格雷75 mg;B组抗血小板药物为阿司匹林300 mg+氯吡格雷75 mg。2组患者均予6个月随访,以确定不良缺血事件和出血事件的发生情况。结果试验组比对照组的不良缺血事件和出血事件的发生明显降低,试验组中B组比A组的花生四烯酸抑制率和二磷酸腺苷抑制率明显提高。结论根据血栓弹力图测定的血小板抑制率,调整经皮冠状动脉介入治疗患者的抗血小板药物使用,可减少不良事件的发生。

OBJECTIVE To investigate the feasibility of using thromboelastogram（ TEG） to guide the use of antiplatelet drugs in patients undergoing percutaneous coronary intervention（ PCI）. METHODS A retrospective study was performed with 349 patients undergoing PCI from January 2011 to April 2011. According to whether measured platelet reactivity by TEG or not,patients were divided into experimental group and control group. Patients of the two groups were all given aspirin plus clopidogrel. Each group was divided into two subgroups according to the doses of antiplatelet drugs： group A used aspirin 100 mg plus clopidogrel 75 mg,and group B used aspirin 300 mg plus clopidogrel 75 mg. A 6-month follow-up was carried out to examine the incidences of bleeding and ischemic events. RESULTS The incidences of bleeding and ischemic events in the experimental group were significantly decreased compared with those in the control group. The inhibition rates of AA and ADP were significant higher in group B than those in group A of the experimental group. CONCLUSION Adverse events can be reduced by measuring platelet reactivity by TEG and adjusting antiplatelet drugs.