经皮冠状动脉介入术前应用不同剂量氯吡格雷的疗效与安全性

Efficacy and Safety of Different dose of Clopidogrel Before the Application of Percutaneous Coronary Intervention

目的在经皮冠状动脉介入术(PCI)前应用高剂量(450 mg)氯吡格雷和常规剂量(300 mg)氯吡格雷预治疗的临床疗效及安全性研究。方法将我院206例拟行PCI患抽签随机分为高剂量组与常规剂量组,每组103例,术前分别给予450 mg、300 mg氯吡格雷预治疗,比较两组血小板活化指标、血小板聚集率,并随访30 d、6个月对心血管事件及出血事件进行记录。结果高剂量组CD63、CD62 P、TSP各为(4.13±1.34)%、(8.22±3.46)%、(2.54±0.34)%与常规剂量组(5.32±2.31)%、(10.52±4.11)%、(2.90±0.54)%比较为低(P<0.05);两组MAADP及血小板聚集率治疗后显著下降(P<0.05),血小板抑制率显著上升(P<0.05),组间比较用药后MAADP、血小板抑制率、血小板聚集率差异显著(P<0.05);高剂量组30 d、6月联合终点事件发生率分别为0.0%、1.9%低于常规剂量组3.9%、8.7%,但无显著差异(P>0.05),总发生率高剂量组30 d、6月后分别为13.6%、22.3%,均显著低于常规剂量组32.0%、58.3%,对比差异显著(P<0.05);两组不同时间点出血时间比较差异无统计学意义(P>0.05)。结论 PCI术前应用450 mg高负荷的血小板抑制效果优于常规300 mg剂量,可降低不良事件发生率。

Objective To study the clinical efficacy and safety Before percutaneous coronary intervention（PCI） application of high doses （450 rag）and conventional dose （300 rag）of clopidogrel pretreatment. Methods 206 patients scheduled for PCI patients were randomly divided into high dose group and routine dose group, 103 cases of each,were given 450 rag,300 mg clopidogrel pretreatment during preoperative, compared two groups of platelet maximum aggregation rate （MPAR） , follow-up 30 d, 6 months, recorded on cardiovascular events and bleeding events. Results High dose group of CD63, CD62 P,TSP（4.13 ＋ 1.34） % , （8. 22 ＋3.46） %, （2.54 ＋ 0.34）%, compared to conventional dose group （5.32 ＋ 2.31 ） %, （ 10.52 ＋ 4. 11 ） %, （2.90 ＋ 0.54 ） %, was significantly lower, difference was significant （ P 〈 0.05 ） ; In high dose group, 30 d,6 month combined end point events rate were respectively 0.0% , 1.9% , was lower than that of the conventional dose group 3.9% ,8.7% ,difference had no significant（P 〉 0.05） ,the total incidence rate of 30 d of high dose group,after 6 month were respectively 13.6% ,22.3% ,were significantly lower than that of routine dose group 32% ,58.3% , difference was significant（P 〈 0.05） ;the two group at different time points of bleeding time difference had not significant（ P 〉 0.05 ）. Conclusion 450 mg high load by platelet inhibition effect is better than that of conventional 300 mg dose according to PCI before the operation,can reduce the in- cidence of adverse events, has a high value in clinical application.