替格瑞洛和双倍剂量氢氯吡格雷治疗氢氯吡格雷抵抗患者的有效性及安全性

Efficacy and safety of ticagrelor and double dosage of clopidogrel in patients with clopidogrel resistance

目的探讨替格瑞洛和双倍剂量氢氯吡格雷在氯吡格雷抵抗的急性冠脉综合征(ACS)患者中的有效性和安全性。方法选取ACS出现氢氯吡格雷抵抗(血小板抑制率<30%)患者124例,随机分为替格瑞洛组(试药组,63例),双倍剂量氢氯吡格雷组(对照组,61例),分别予入院第7天检测血小板抑制率、入院第2天及第7天检测超敏C反应蛋白(hs-CRP),观察1个月及6个月时主要心脏不良事件(MACE)及轻度出血发生率。结果入院第7天时检测血小板抑制率,两组患者均较前显著升高(P<0.05);且试药组血小板抑制率高于对照组〔(60±12)%vs.(46±10)%,P<0.05〕。入院第2天检测hs-CRP,两组患者结果无统计学差异〔(19±4)g/L vs.(20±3)g/L〕;第7天时两组患者的hs-CRP均显著降低(P<0.05),且试药组hs-CRP降低更显著〔(6.4±2.1)g/L vs.(10.8±2.8)g/L,P<0.05〕,和对照组相比有统计学差异。随访1个月两组患者之间MACE及轻度出血发生率无显著差异(3%vs.3%,5%vs.3%);随访至6个月时试药组MACE发生率低于对照组(3%vs.13%,P<0.05),两组之间轻度出血发生率仍旧无明显差异(8%vs.5%)。结论 ACS出现氢氯吡格雷抵抗患者,选用替格瑞洛具有更好的有效性及安全性。

AIM To investigate the clinical efficacy and safety of ticagrelor and double dosage of clopi- dogrel in clopidogrel-resistant acute coronary syndrome （ACS） patients. METHODS One hundred and twenty-four ACS patients with clopidogrel resistance （platelet inhibition rate 〈 30% ） were randomly divided into tieagrelor group （ group A, n = 63 ） and double dosage of clopidogrel group （ group B, n = 61 ）. Platelet inhibition rate was tested at the seventh day after admission and high sensitivity C-reactive protein （hs-CRP） was measured at the second day and the seventh day after admission. The incidence rates of major adverse cardiovascular events （MACE） and slight bleeding were compared between groups at the first- and sixth-month follow-up. RESULTS At the seventh day, platelet inhibition rates in the two groups were significantly elevated （P 〈 0. 05 ） and platelet inhibition in group A was higher than in group B （P 〈 0.05 ）. At the second day, no significant difference in hs-CRP was observed between groups. However, at the seventh day, the hs-CRP in the two groups was significantly reduced （P 〈 0. 05 ） and the hs-CRP in group A was lower than in group B （P 〈 0. 05 ）. At the first-month follow-up, there was no significant difference in the incidence rates of MACE and slight bleeding between groups and at the 6-month follow-up, the incidence rate of MACE in group A was significantly lower than in group B （P 〈 0. 05）, but there was still no significant difference in the incidence rate of slight bleeding between groups. CONCLUSION Ticagrelor is more effective and safer in the treatment of clopidogrel-resistant ACS patients.