急性冠状动脉综合征患者初始应用氯吡格雷后换用替格瑞洛的疗效与安全性评价

Clinical Efficacy and Safety Evaluation for the Shifting from Clopidogrel to Ticagrelor in Acute Coronary Syndrome Patients

目的:探讨急性冠状动脉综合征(ACS)患者初始应用氯吡格雷后换用替格瑞洛的疗效与安全性。方法:采用回顾性分析方法,收集我院2013年1月-2014年6月初始应用氯吡格雷后换用替格瑞洛的ACS住院患者资料,根据腺苷二磷酸(ADP)诱导的药物抑制率分为低反应组和反应组。比较两组患者门诊随访1、3、6、9个月后因再发心血管事件的再住院率以及替格瑞洛相关的呼吸困难、出血等不良反应。结果:入选患者124例,其中低反应组患者34例,反应组患者90例。反应组中吸烟患者的比例明显高于低反应组,低反应组中合并高血压患者的比例明显高于反应组,差异具有统计学意义(P<0.05)。患者在采用替格瑞洛替换氯吡格雷治疗后1、3、6、9个月因再发心血管事件的总体再住院率分别为6.5%、7.2%、8.1%、10.5%,但两组患者再发心血管事件的再住院率比较,差异无统计学意义(P>0.05)。随访中有12例患者出现呼吸困难,有3例患者发生牙龈出血。结论:替格瑞洛能改善氯吡格雷抵抗现象,降低其因再发心血管事件导致的再住院率;但应警惕其造成的呼吸困难和再出血风险。

OBJECTIVE：To discuss clinical efficacy and safety for the shifting from clopidogrel to ticagrelor in acute coronary syndrome（ACS）patients. METHODS：In retrospective study,clinical data of ACS inpatients receiving clopidogrel initially and ticagrelor instead were collected from our hospital during Jan. 2013 to Jun. 2014. They were divided into low response group and response group by inhibition rate of ADP activator. The rehospitalization rate of recurrent cardiovascular events,ticagrelor-related ADR as respiratory depression and bleeding were compared between 2 groups after followed up 1,3,6 and 9 months. RESULTS：124 patients were included,among which there 34 patients in low response group and 90 patients in response group. The proportion of smokers in response group was higher than in low-response group,and the proportion of patients with hypertension in low response group was higher in response group,with statistical significance（P〈0.05）. After using ticagrelor instead for 1,3,6 and 9months,the rehospitalization rates resulting from recurrent cardiovascular events were 6.5%,7.2%,8.1% and 10.5%,respectively. There was no statistical significance in rehospitalization rates resulting from recurrent cardiovascular events between 2 groups（P〉0.05）. In follow-up,12 patients suffered from dyspnea and 3 suffered from gingival bleeding. CONCLUSIONS：Ticagrelor can improve the low platelet response of clopidogrel that could reduce the rehospitalization rates resulting from recurrent cardiovascular events. But should be carefull of the risk of dyspnea and rehaemorrhagia induced by ticagrelor.