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替格瑞洛与氯吡格雷在行冠状动脉介入治疗的不稳定型心绞痛患者中血小板功能抑制及临床疗效和安全性的研究 被引量：22

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摘要 目的探讨对于不稳定型心绞痛(UAP)行PCI治疗的患者,术前服用氯吡格雷负荷剂量300 mg,短时间内(PCI术后1 d)血小板聚集功能抑制相对低下的患者更换替格瑞洛后能否取得更好的血小板聚集功能的抑制、较好的临床疗效及安全性如何。方法入选40例UAP常规行PCI术治疗患者[此40例患者均为术前服用氯吡格雷负荷量300 mg,术后予以常规氯吡格雷75 mg qd,于PCI术后1 d采用血栓弹力图(TEG)检测ADP途径诱导血小板聚集功能的抑制率(IPA)<50%,即对氯吡格雷反应相对低下的患者],将40例氯吡格雷反应相对低下的患者随机分为2组,A组继续用氯吡格雷75 mg qd,B组替换为替格瑞洛90 mg Bid,分别于服药后1周,1个月时采用TEG的方法复测IPA,并观察术后1个月的主要缺血事件(死亡、心肌梗死、靶血管血运重建、反复心绞痛发作)及出血事件。结果两组服用负荷剂量氯吡格雷300 mg PCI术后第1天ADP诱导的IPA(基线PDA)差异无统计学意义,1周后复测ADP诱导的IPA,B组明显高于A组[(81.84±11.10)%vs.(69.74±11.84)%,P=0.030];1个月后复测ADP诱导的IPA,B组仍明显高于A组[(85.91±5.98)%vs.(76.19±9.51)%,P=0.014],差异均有统计学意义。1个月临床随访结果两组均无死亡、心肌梗死、靶血管血运重建、反复心绞痛发作及脑卒中患者,在安全性上两组均无严重的出血及颅内出血。结论本研究提示替格瑞洛较氯吡格雷能快速地产生更强效的血小板抑制作用,在安全性上较氯吡格雷并没有增加主要出血事件的发生率,提示了其在介入治疗中应用的安全性。
作者 任晓楠 王明生 赵霞 李明昌 王河 肖毅 王磊
机构地区 首都医科大学石景山教学医院北京市石景山医院心内科
出处 《中华临床医师杂志（电子版）》 CAS 2015年第17期125-128,共4页 Chinese Journal of Clinicians(Electronic Edition)
关键词 心绞痛 不稳定型 血管成形术 经腔 经皮冠状动脉 血小板功能抑制 血栓弹力图
分类号 R541.4 [医药卫生—心血管疾病]
  • 相关文献

参考文献12

  • 1Muller I, Besta F, Schulz C, et al. Prevalence of clopidogrel nonresponders among patientswith stable angina pectoris scheduled for elective coronary stent placement[J]. Thromb Haemost, 2003, 89(5): 783-787.
  • 2Cairns JA, Eikelboom J. Clopidogrel Resistance[J]. J Am Coil Cardiol, 2008, 51(20): 1935-1937.
  • 3Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus lopidogrel ili Pafiertts with Acute Coronary Syndromes[J]. N Engl J Med, 2009, 361(11): 1045-1057.
  • 4Tolleson TR, Newby LK, Harrington RA, et al. Frequency of stem thrombosis after acute coronary syndromes(from the SYMPHONY and SYMPHONY trials)[J]. Am J Cardiol, 2003, 92(3): 3302-3303.
  • 5Shuldiner AR, OCormell JR, Bliden KP, et al. Association of cytochrome P450 2C19 genotype with the anfiplatelet effect andclinical efficacy of clopidogrel therapy[J]. JAMA, 2009, 302(8): 849-857.
  • 6Miho K, Yumi N, Tomoko I, et al. Identification of the Human Cytochrome P450 Enzymes Involved in the TWo Oxidative Steps in the Bioactivation of Clopidogrel to ItsPharmacologicaUy Active Metabolite[J] Drug Metab Dispos, 2010, 38(1): 92-99.
  • 7Gurbel PA, Kevin P, Kathleen 13, et al. Randomized Double-131ind Assessment of the ONSET and OFFSET of the Antiplatelet Effects of Tieagrelor Versus Clopidogrel in Patients With Stable Coronary Artery Disease: The ONSET/OFFSET Study[J]. Circulation, 2009, 120(25): 2577-2585.
  • 8Gurbel PA, Kevin P, Kathleen B, et al. Response to Ticagrelor in Clopidogrel Nonresponders and Responders and Effect of Switching Therapies: The RESPOND Study[J]. Circulation, 2010, 121(10): 1188-1199.
  • 9Bliden KP, Tantry US, Storey RF, et al. The effect of tieagrelor versus clopidogrel on high on-treatment pIatelet reactivity: Combined analysis of the ONSET/OFFSET and RESPOND studies[J]. American heart journal, 2011, 162(1): 160. ".
  • 10Husted SE, Emanuelsson H, Heptinstall H, et al. Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atheroselerosis: a double-blind comparison to clopidogrel with aspirin[J]. Eur Heart J, 2006, 27(9): 1038-1047.

二级参考文献12

  • 1Muller I, Besta F, Schulz C, et al. Prevalence of clopidogrel nonresponders among patientswith stable angina pectoris scheduled for elective coronary stent placement[J]. Thromb Haemost, 2003, 89(5): 783-787.
  • 2Cairns JA, Eikelboom J. Clopidogrel Resistance[J]. J Am Coil Cardiol, 2008, 51(20): 1935-1937.
  • 3Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus lopidogrel ili Pafiertts with Acute Coronary Syndromes[J]. N Engl J Med, 2009, 361(11): 1045-1057.
  • 4Tolleson TR, Newby LK, Harrington RA, et al. Frequency of stem thrombosis after acute coronary syndromes(from the SYMPHONY and SYMPHONY trials)[J]. Am J Cardiol, 2003, 92(3): 3302-3303.
  • 5Shuldiner AR, OCormell JR, Bliden KP, et al. Association of cytochrome P450 2C19 genotype with the anfiplatelet effect andclinical efficacy of clopidogrel therapy[J]. JAMA, 2009, 302(8): 849-857.
  • 6Miho K, Yumi N, Tomoko I, et al. Identification of the Human Cytochrome P450 Enzymes Involved in the TWo Oxidative Steps in the Bioactivation of Clopidogrel to ItsPharmacologicaUy Active Metabolite[J] Drug Metab Dispos, 2010, 38(1): 92-99.
  • 7Gurbel PA, Kevin P, Kathleen 13, et al. Randomized Double-131ind Assessment of the ONSET and OFFSET of the Antiplatelet Effects of Tieagrelor Versus Clopidogrel in Patients With Stable Coronary Artery Disease: The ONSET/OFFSET Study[J]. Circulation, 2009, 120(25): 2577-2585.
  • 8Gurbel PA, Kevin P, Kathleen B, et al. Response to Ticagrelor in Clopidogrel Nonresponders and Responders and Effect of Switching Therapies: The RESPOND Study[J]. Circulation, 2010, 121(10): 1188-1199.
  • 9Bliden KP, Tantry US, Storey RF, et al. The effect of tieagrelor versus clopidogrel on high on-treatment pIatelet reactivity: Combined analysis of the ONSET/OFFSET and RESPOND studies[J]. American heart journal, 2011, 162(1): 160. ".
  • 10Husted SE, Emanuelsson H, Heptinstall H, et al. Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atheroselerosis: a double-blind comparison to clopidogrel with aspirin[J]. Eur Heart J, 2006, 27(9): 1038-1047.

共引文献21

同被引文献182

  • 1刘大一,王智昊.替格瑞洛在老年ST段抬高型心肌梗死患者急诊冠状动脉介入治疗中的应用[J].中国老年学杂志,2014,34(10):2638-2641. 被引量：21
  • 2张军芳,王磊,魏聪,王宏涛,常丽萍.慢性心力衰竭能量代谢重构与治疗进展[J].中国老年学杂志,2014,34(4):1115-1117. 被引量：19
  • 3柯元南,陈纪林.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-304. 被引量：2143
  • 4Muller I, Besta F, Schulz C, et al. Prevalence of clopidogrel nonresponders among patientswith stable angina pectoris scheduled for elective coronary stent placement[J]. Thromb Haemost, 2003, 89(5): 783-787.
  • 5Cairns JA, Eikelboom J. Clopidogrel Resistance[J]. J Am Coil Cardiol, 2008, 51(20): 1935-1937.
  • 6Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus lopidogrel ili Pafiertts with Acute Coronary Syndromes[J]. N Engl J Med, 2009, 361(11): 1045-1057.
  • 7Tolleson TR, Newby LK, Harrington RA, et al. Frequency of stem thrombosis after acute coronary syndromes(from the SYMPHONY and SYMPHONY trials)[J]. Am J Cardiol, 2003, 92(3): 3302-3303.
  • 8Shuldiner AR, OCormell JR, Bliden KP, et al. Association of cytochrome P450 2C19 genotype with the anfiplatelet effect andclinical efficacy of clopidogrel therapy[J]. JAMA, 2009, 302(8): 849-857.
  • 9Miho K, Yumi N, Tomoko I, et al. Identification of the Human Cytochrome P450 Enzymes Involved in the TWo Oxidative Steps in the Bioactivation of Clopidogrel to ItsPharmacologicaUy Active Metabolite[J] Drug Metab Dispos, 2010, 38(1): 92-99.
  • 10Gurbel PA, Kevin P, Kathleen 13, et al. Randomized Double-131ind Assessment of the ONSET and OFFSET of the Antiplatelet Effects of Tieagrelor Versus Clopidogrel in Patients With Stable Coronary Artery Disease: The ONSET/OFFSET Study[J]. Circulation, 2009, 120(25): 2577-2585.

引证文献22

二级引证文献162

中华临床医师杂志（电子版）
2015年 第17期

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