替格瑞洛与西洛他唑对氯吡格雷抵抗的急性缺血性脑卒中患者的疗效及安全性比较

The comparison of eEfficacy and safety between ticagrelor and cilostazol on clopidogrel resistance in acute cerebral ischemic stroke patients

目的探讨替格瑞洛与西洛他唑对氯吡格雷抵抗的急性缺血性脑卒中(AIS)患者的疗效及安全性的影响。方法将80例对氯吡格雷抵抗(血小板聚集率>50%)AIS患者按照数字表法随机分为替格瑞洛组(入组40例,完成37例)和西洛他唑组(入组40例,完成39例);在AIS常规治疗的基础上替格瑞洛组将氯吡格雷换用替格瑞洛治疗(90 mg/次,2次/d);西洛他唑组将氯吡格雷换用西洛他唑治疗(100 mg/次,2次/d)。于改变治疗方案前及改变治疗方案后1、3、6、12个月分别检测血小板聚集率(PIR),观察2组治疗12个月内的缺血事件、出血事件及药物的不良反应。结果改变治疗方案后12个月替格瑞洛组总有效率显著高于西洛他唑组(z=-2.086,P=0.037)。替格瑞洛组缺血事件发生率低于西洛他唑组(χ~2=4.057,P=0.034);替格瑞洛组的出血事件发生率高于西洛他唑组(χ~2=4.501,P=0.034);替格瑞洛组的呼吸困难发生率高于西洛他唑组(χ~2=4.505,P=0.034);替格瑞洛组的其他不良反应发生率高于西洛他唑组(χ~2=4.021,P=0.045)。改变治疗方案后1、3、6、12个月替格瑞洛组患者的PAR低于西洛他唑组(F=15.320,P=0.000)。结论对氯吡格雷抵抗的AIS患者,替格瑞洛比西洛他唑的血小板抑制作用更强,缺血事件发生率更低,但出血事件、呼吸困难及其他不良反应的发生率更高,因此对于血栓风险较高、出血风险较低的患者,建议换用替格瑞洛;对于血栓风险较低、出血风险较高的患者,建议换用西洛他唑。

Objective To compare the clinical efficacy and safety between ticagrelor and cilostazol on clopidogrel resistance in acute cerebral ischemic stroke（ AIS） patients. Methods 76 patients with clopidogrel resistance（ Platelet aggregation rate 〉50%） were treated with AIS,randomly divided into ticagrelor group（ selecting 40 cases,completed 37 cases） and cilostazol group（ selecting 40 cases,completed 39 cases） according to number table method. On the basis of routine treatment of acute ischemic stroke,The ticagrelor group was received ticagrelor treatment instead of clopidogre（ 90 mg each time,2 times a day）. The cilostazol group was received cilostazol treatment instead of clopidogre（ 100 mg each time,2 times a day）. Before and after changing the treatment regimen1,3,6,12 months,platelet aggregation rate（ PIR） was detected respectively,the ischemic events,the bleeding events and the drug adverse reactions of two groups within 12 months were observed. Results 12 months after the change of treatment,the total efficiency in the ticagrelor group was significantly higher than that in the cilostazol group（ z =-2. 086,P =0. 037）. The incidence of ischemic events in the ticagrelor group was lower than that in the cilostazol group（ χ~2=4. 057,P = 0. 034）,The occurrence rate of bleeding in the ticagrelor group was higher than that in the cilostazol group（ χ~2= 4. 501,P = 0. 034）,The incidence of dyspnea in the ticagrelor group was higher than that in the cilostazol group（ χ~2= 4. 505,P = 0. 034）,The occurrence of other adverse reaction rate in the ticagrelor group was higher than that in the cilostazol group（ χ~2= 4. 021,P = 0. 045）,the differences were statistically significant. After changing the treatment regimen1,3,6,12 months,PAR in the ticagrelor group was lower than that in the cilostazol group（ F = 15. 320,P =0. 000）. Conclusion On clopidogrel resistance in patients with acute ischemic stroke, the platelet inhibition of ticagrelor was stronger than cilostazol,the ischemic event rate of ticagrelor was lower than cilostazol,but the incidence of bleeding events,dyspnea,and other adverse events of ticagrelor was higher than cilostazol. Therefore,clopidogrel resistance patients with high thrombus risk and low bleeding risk could use ticagrelor,clopidogrel resistance patients with low thrombus risk and high bleeding risk could use cilostazol.