长期负荷量硫酸氢氯吡格雷显著降低血小板高反应性患者PCI术后心血管缺血事件发生率

Long-term loading dose of clopidogrel decreases recurrent cardiovascular ischemic events in patients undergoing percutaneous coronary intervention

目的观察长期负荷量使用硫酸氢氯吡格雷对血小板高反应性患者PCI术后心血管缺血事件发生率的影响。方法采用血栓弹力仪检测硫酸氢氯吡格雷的药物效果,筛选PCI术后对硫酸氢氯吡格雷药物不敏感患者(血小板高反应性患者)作为研究对象,随机分为对照组及试药组,每组患者各60例,对照组每天服用100 mg阿司匹林及75 mg硫酸氢氯吡格雷,试药组服用100 mg阿司匹林以及150 mg硫酸氢氯吡格雷,检测6个月后硫酸氢氯吡格雷的药物效果,同时观察两组6个月内心血管事件的发生率。结果 6个月内试药组心血管病病死率、支架内血栓再形成率、再发心肌梗死和再发不稳定心绞痛发生率分别为0%、10%、23%以及6%,对照组为3%、20%、36%以及17%,试药组显著低于对照组,试药组硫酸氢氯吡格雷所致血小板抑制率明显高于对照组,两组患者出血风险无显著性差异。结论对于血小板高反应性患者,长期加倍剂量服用硫酸氢氯吡格雷可降低心血管缺血事件发生率。

AIM To investigate the effect of long-term loading dose of clopidogrel on the incidence of cardiovascular ischemic events in patients with high platelet reactivity who underwent percutaneous coronary intervention, METHODS Thrombelastograph was used to detect the effect of clopidogrel in 120 high platelet reactivity patients undergoing PCI and who were insensitive to clopidogrel. Patients were divided randomly into control group （n = 60） and drug-test group （n = 60）. Patients in control group were given 100 mg of aspirin and 75 mg clopidogrel daily, and patients in drug-test group were given 100 mg of aspirin and 150 mg clopidogrel daily. A 6-month follow-up was conducted to examine the incidence of cardiovascular ischemic events. RESULTS After the 6-month antiplatelet therapy, the inhibition ratio of clopidogrel in drug-test group was significantly higher than in control group [ （ 68 ± 5 ） % vs. （42 ± 7） %, P 〈 0. 05 ]. The rate of occurrence of cardiovascular ischemic events including cardiovascular death, stent thrombosis, recurrent unstable angina and myocardial infarction in drug-test group was 0, 10, 23 and 6%, respectively, and decreased significantly compared with those in the control group （3, 20, 36 and 17%, respectively, P 〈 0. 05 ）. CONCLUSION The maintenance loading dose of anti- platelet therapy with 150 mg clopidogrel daily can effectively decrease the rate of recurrent cardiovascularischemic events.