摘要
目的探讨冠脉支架植入术后血小板高反应性(HTPR)患者,换用替格瑞洛后的血小板抑制情况。方法我院行冠脉支架植入术的患者,运用Verify Now-P2Y12系统检测P2Y12反应单位(PRU),将PRU≥235定义为HTPR。HTPR患者停用氯吡格雷,给予替格瑞洛治疗。在替格瑞洛负荷剂量后2小时和24小时分别检测PRU,评价换药前后血小板活性的变化。所有患者随访一个月进行安全性评估。结果研究期间共有243例患者成功行冠脉支架植入术。经筛选最终15例HTPR患者入选。在给予替格瑞洛负荷剂量后2小时,PRU即可明显降低(103.2±45.7vs 254.8±36.6,P<0.001),在负荷剂量后24小时,替格瑞洛仍可显著地降低PRU(111.9±47.8 vs 254.8±36.6,P<0.001)。随访一个月后,6例患者(40%)发生轻微出血。结论 PCI术后HTPR患者换用替格瑞洛能够快速强效地抑制血小板活性,疗效确切,安全性和耐受性良好。
Objective To observe the anti-platelet responsiveness of ticagrelor in patients with high on-treatment platelet reactivity （HTPR） following percutaneous coronary intervention （PCI）. Methods Patients with angiographically documented coronary artery disease undergoing PCI were considered for enrollment in the present study. VerifyNow P2Y12 assay was used to screen for high on-treatment platelet reactivity （HTPR）. HTPR was defined as P2Y12 reaction units （PRU） 〉235 at 24 h following PCI. When enrolled as HTPR, the anti-platelet agents were switched to ticagrelor. To compare the change in residual platelet reactivity after drug switching, the PRU was assessed by VerifyNow at 2 and 24 h after 180 mg ticagrelor loading dose. In addition, all patients were observed and followed up for 1 month. Results A total of 243 patients undergoing PCI were screen for HTPR. Finally, 15 patients with HTPR were enrolled. The PRU 2 h after 180mg ticagrelor loading dose was markedly decreased [103.2±45.7 vs. baseline （254.8±36.6）, P 〈0.001]. In addition, 24h after the loading dose, the platelet reactivity was still effectively inhibited （PRU, 111.9±47.8 vs. baseline, P 〈0.001）. After 1 month follow-up, 6 （40%） patients had minor bleeding but no major or fatal bleeding event was observed. Conelusions In patients with HTPR after PCI, switching from clopidogrel to ticagrelor can achieve rapid and effective platelet inhibition. All patients were well tolerated with no serious bleeding event.
出处
《中国分子心脏病学杂志》
CAS
2015年第2期1264-1266,共3页
Molecular Cardiology of China
基金
北京市科委专项基金(Z 131100006813039)
