高剂量氯吡格雷对急性冠脉综合征患者行介入术后临床疗效和安全性的评价

The effects of high-dose clopidogrel on the treatment of acute coronary syndrome after percutaneous transluminal coronary intervention

目的对比高剂量与标准剂量氯吡格雷在急性冠脉综合征患者介入术后治疗中的临床效果和安全性。方法纳入2013年2月—2015年12月期间收治的急性冠脉综合征的患者270例,按治疗时氯吡格雷用量情况分为2组,其中双倍剂量组120例,标准剂量组150例。双倍剂量组给予氯吡格雷150 mg每日口服,标准剂量组给予75 mg每日口服。比较2组支架内血栓事件、全因死亡以及出血事件的发生情况。结果 2组比较总事件发生率差异无统计学意义(P>0.05),其中支架内血栓事件发生率与死亡率差异均无统计学意义(P>0.05);而双倍剂量组总出血事件显著高于标准剂量组(P<0.001),且其中的小出血事件(P=0.008)及轻微出血事件均分别高于标准剂量组(P<0.001)。Cox回归分析,调整年龄、性别、血糖、血脂、血压、心率、疾病史等因素后,双倍剂量组较标准剂量组并未降低总事件风险(HR=1.32,95%CI:0.83~1.89,P=0.654);但增加了出血事件风险(HR=2.52,95%CI:1.13~3.03)。结论在急性冠脉综合征患者介入术后治疗中,高剂量氯吡格雷较标准剂量氯吡格雷并未降低支架内血栓事件及全因死亡率,但却显著增加了出血事件风险。

Objective To compare the effects of high-and normal-dose Clopidogrel on the treatment of acute coronary syndrome after percutaneous transluminal coronary intervention. Methods All 270 participants diagnosed to be acute coronary syndrome from February,2013 to December,2015 in our hospital were included and divided into two groups：the high-dose group and the normal-dose group. The high-dose group received Clopidogrel 150 mg/day and the normaldose group received Clopidogrel 75 mg/day. Comparisons of incidences of stent thrombosis,all-cause mortality and bleeding were made between two groups. Results The incidences had no difference in both groups（ P〈 0. 05）,and the stent thrombosis incidence and mortality rate had no statistical significance（ P〈 0. 05）. However,the bleeding events were significantly higher in the high-dose group（ P〈 0. 001）,which had higher incidence of minor bleeding（ P =0. 008） and moderate bleeding（ P〈 0. 001）. Compared with the normal-dose group,the high-dose group treatment did not decrease the risk of stent thrombosis and death（ HR = 1. 32,95% CI： 0. 83-1. 89,P = 0. 654） but increased the risk of bleeding events（ HR = 2. 52,95% CI： 1. 13-3. 03）. Conclusion In the treatment of acute coronary syndrome after percutaneous transluminal coronary intervention,patients with high-dose Clopidogrel did not decrease the risk of stent thrombosis and death but had increased risk of bleeding events.