冠状动脉支架植入术后氯吡格雷低反应患者短期替格瑞洛强化治疗研究

Short-term intensive treatment of ticagrelor for patients with low response to clopidogrel after percutaneous coronary intervention

目的:探讨经皮冠状动脉支架植入术(percutaneous coronary intervention,PCI)后氯吡格雷低反应(clopidogrel low re-sponse,CLR)患者短期替格瑞洛强化抗血小板治疗的临床疗效。方法:连续入选PCI术后经光学血小板聚集(light transmit-tance aggregation,LTA)法检出的CLR患者100例,随机分为氯吡格雷组(50例)和替格瑞洛组(50例)。氯吡格雷组予氯吡格雷75 mg/d;后者予替格瑞洛90 mg,2次/d,bid,强化1个月后改为氯吡格雷75 mg/d;两组患者均联合服用阿司匹林100 mg/d。治疗1个月后检测所有患者的血小板聚集率;随访6个月,比较两组心血管不良事件的发生情况。结果:两组患者随机治疗前二磷酸腺苷诱导的血小板聚集率(adenosine diphosphate-induced platelet aggregation,PLADP)及花生四烯酸诱导的血小板聚集率(arachidonic acid-induced platelet aggregation,PLAA)均无统计学差异(P>0.05);治疗1个月时,替格瑞洛组PLADP显著低于氯吡格雷组[(21.27±12.81)%vs.(48.72±10.92)%,P<0.01],两组患者PLAA无统计学差异(P>0.05);6个月时随访,替格瑞洛组心源性再入院患者显著低于氯吡格雷组(6%vs.20%,P<0.05),但轻微出血增加(24%vs.8%,P<0.05)。结论:替格瑞洛的抗血小板聚集作用显著优于氯吡格雷,对CLR患者PCI术后替格瑞洛强化抗血小板治疗1个月可能减少心源性住院事件。

Objective：To investigate the clinical efficacy of short-term intensive antiplatelet treatment of ticagrelor for patients withlow response to clopidogrel after percutaneous coronary intervention（PCI）. Methods：A total of 100 cases who underwent PCI and wereconfirmed with low response to clopidogrel by light transmittance aggregation（LTA）were consecutively recruited and equallyrandomized into Clopidogrel（n=50）and Ticagrelor（n=50）groups. In Clopidogrel group,patients maintained clopidogrel 75 mg,gd incombination with aspirin 100 mg,gd;while in Ticagrelor group,patients were treated with ticagrelor 90 mg twice daily for 1 month,then switching to clopidogrel 75 mg,gd in combination with aspirin 100 mg,gd. The light transmission aggregations were determinedfor all patients 1 month after randomization;all participants were followed up and the adverse cardiovascular events were recorded for 6months. Results：There were no significant differences between the two groups regarding both the adenosine diphosphate-inducedplatelet aggregation（PLADP）and the arachidonic acid-induced platelet aggregation（PLAA）prior to randomization（P 0.05）. At 1 monthafter randomization,PLADPin the Ticagrelor group was significantly lower than that in the Clopidogrel group[（21.27 ± 12.81）% vs.（48.72 ± 10.92）%]（P 0.01）,while PLAAshowed no significant difference between the two groups. The incidence of cardiogenicrehospitalization was significantly lower（6% vs. 20%,P〉0.05）,although minimal bleeding was significantly higher（24% vs. 8%,P〈0.05）in the Ticagrelor group compared with that in the Clopidogrel group. Conclusion：The antiplatelet effect of ticagrelor issignificantly more potent than that of clopidogrel,and 1-month intensive treatment of ticagrelor may reduce the cardiogenicrehospitalization in patients with CLR after PCI.