新型抗血小板药物替格瑞洛临床应用分析

Analysis of clinical application of ticagrelor,a new oral antiplatelet drug

目的：分析住院患者替格瑞洛使用情况,了解该药物的临床应用现状,为提高替格瑞洛的临床合理用药水平提供参考。方法：收集北京大学第一医院2014年1～6月住院期间使用替格瑞洛病历资料,回顾性分析使用替格瑞洛患者的适应症、用法用量、相互作用及不良反应等。结果：纳入分析的患者共36例,男性24例,女性12例;平均年龄（63.77±14.69）岁;体重（70.76±11.17）kg。原发病均为急性冠脉综合征、PCI手术。36例患者中,4例为阿司匹林联用替格瑞洛,30例为阿司匹林联用氯吡格雷后将氯吡格雷更换为替格瑞洛,1例为阿司匹林联用西洛他唑后将西洛他唑更换为替格瑞洛,1例为阿司匹林加用替格瑞洛。31例患者按说明书中所示的用法用量使用,5种患者使用其他不同的用法用量。涉及的可能与替格瑞洛存在相互作用的合并用药共8种。共6例次出现相关不良反应,其中2例（5.56%）发生出血,4例（11.11%）出现呼吸困难。结论：我院替格瑞洛多应用于对氯吡格雷低反应或其他抗血小板药物出现不良反应的急性冠脉综合征患者。临床药师应严格把握该药用法用量,密切监测患者不良反应,促进替格瑞洛的合理应用。

Objective： To investigate the clinical application of ticagrelor for knowing its present situation in order to provide references for improving rational use of ticagrelor in the clinic. Methods： The data of inpatients using ticagrelor in the Peking University First Hospital from January to June in 2014 were collected,and the indication,usage,drug interactions and ADRs of ticagrelor were analyzed retrospectively. Results： A total of 36 patients were enrolled including 24 men and 12 women with an average age of（ 63. 77 ± 14. 69） years and an average weight of（ 70. 76 ± 11. 17） kg. The protopathy was acute coronary syndromes in all the patients. Of the 36 patients,in 4 patients,the initial treatment was ticagrelor and aspirin; in 30 patients; clopidogrel was replaced to ticagrelor; and in 1 patient,cilostazol was replaced to ticagrelor. Thirty-one patients used the drug according to the specification usage shown in instruction; 5 patients with a variety of other usages. Eight concomitant medications might have drug interactions with ticagrelor. Of the 36 patients,ADRs occurred in 6 patients in which 2 were possibly ticagrelor-related bleeding（ 5. 56%） and 4 were dyspnea（ 11. 11%）. Conclusion： In our hospital,the majority of indication of ticagrelor is acute coronary syndromes with low response to clopidogrel. Clinicians and clinical pharmacists should consider both disease and drug use comprehensively,and pay more attention to drug usage and ADRs,so that to promote the rational application of ticagrelor.