替格瑞洛和氯吡格雷对颈动脉支架术后患者的血小板抑制的临床疗效与安全性

Clinical efficacy and safety of ticagrelor and clopidogrel on the platelet inhibitory of patients after carotid artery stenting operation by thrombelastogram

目的用血栓弹力图评价比较替格瑞洛和氯吡格雷对颈动脉支架术(CAS)后患者血小板抑制的临床疗效与安全性。方法将纳入的颈动脉狭窄患者随机分为试验组和对照组,每组各75例。于CAS术前1天,试验组患者口服阿司匹林300 mg和替格瑞洛180 mg;术后予阿司林100 mg qd,替格瑞洛90 mg bid,口服。于CAS术前1天,对照组患者口服阿司匹林300 mg和氯吡格雷300mg;术后给予阿司匹林100 mg qd,氯吡格雷75 mg qd,口服。2组患者术后均服用双联抗血小板药物3个月以上,所有患者均随访至术后3个月。于CAS术后1,30 d,留取患者静脉血液样本,用血栓弹力图仪检测患者的ADP途径血小板抑制率,记录2组缺血性事件及出血性事件发生情况。结果 CAS术后1,30 d的ADP途径血小板抑制率:对照组分别为(65.41±20.75)%,(42.66±26.34)%;试验组分别为(87.37±17.12)%,(81.91±21.18)%,试验组均高于对照组,组间比较差异均有统计学意义(均P<0.05)。术后1 d,试验组和对照组患者CAS的血小板抑制有效率分别为98.7%,92.0%;术后30 d,这2组的血小板抑制有效率分别为94.7%,74.7%,术后1,30 d的组间差异均有统计学意义(均P<0.05)。对照组和试验组患者的缺血性事件发生率分别为37.3%,13.3%,组间比较差异有统计学意义(P<0.05)。对照组和试验组患者的出血性事件发生率分别为6.7%,4.0%,组间比较差异无统计学意义(P>0.05)。结论替格瑞洛对CAS术后患者的血小板抑制效果及临床疗效优于氯吡格雷,且不增加出血风险。

Objective To investigate the clinical effect and safety of ticagrelor and clopidogrel on platelet inhibitory of patients after carotid artery stenting（ CAS） operation by thrombelastogram. Methods A total of 150 patients with CAS were selected as the research object,randomly divided into two group： 75 patients in treatment group and 75 patients in control group. Patients in treatment group received treatment of 180 mg ticagrelor in combination with 300 mg aspirin 1 d before CAS operation,and received treatment of 90 mg ticagrelor,bid in combination with 100 mg aspirin,qd after CAS operation. Patients in control group received treatment of 300 mg clopidogrel in combination with 300 mg aspirin 1 d before CAS operation,and received treatment of 75 mg clopidogrel,qd in combination with 100 mg aspirin,qd after CAS operation. All patientstook antiplatelet drugs for at least 3 months after CAS operation and were followed for 3 months. All patients＇ venous blood samples were collected at 1 d and 30 d after operation. The rate of platelet inhibition was tested. The ischemic events and bleeding events in two groups were recorded and analyzed. Results The platelet inhibition rates at 1 d and30 d after operation： were（ 65. 41 ± 20. 75） % and（ 42. 66 ± 26. 34） % respectively in the control group; were（ 87. 37 ± 17. 12） % and（ 81. 91 ± 21. 18） % respectively in the treatment group,the difference between two groups was statistically significant（ all P〈0. 05）. The effective rates of platelet inhibition at 1 d after operation： were 98. 7% and 92. 0% respectively in the treatment group and control group. The effective rates of platelet inhibition at 30 d after operation： were 94. 7% and 74. 7% respectively in treatment group and control group,the difference between two groups was statistically significant（ all P〈0. 05）. The rate of ischemic events of control group and treatment group were 37. 3% and 13. 3% respectively,the difference between two groups was statistically significant（ P〈0. 05）. The rate of bleeding events of control group and treatment group were 6. 7% and 4. 0% respectively,and the difference between two groups was not statistically significant（ P〈0. 05）. Conclusion Compared with clopidogrel,ticagrelor shows a better effect of platelet inhibition,and had good security.