心肌梗死PCI治疗1年后继续阿司匹林单用或与氯吡格雷联合治疗的对照研究

Efficacy and safety of antiplatelet therapy following PCI in patients with myocardial infarction: aspirin combined with clopidogrel versus aspirin alone

目的探讨心肌梗死患者经皮冠状动脉介入(PCI)治疗1年后继续阿司匹林单用或与氯吡格雷联用在疗效及安全性方面是否存在差异。方法 80例急性心肌梗死行PCI患者,阿司匹林和硫酸氢氯吡格雷片(商品名:波立维,法国赛诺菲公司)双抗满1年后,单双号随机分为联用组(阿司匹林100mg 1次/d、波立维75mg 1次/d)、单用组(阿司匹林100mg 1次/d),随访1年,观察两组主要不良心血管事件(MACE)及药物不良反应情况。结果联用组累计MACE较单用组明显下降,差异有统计学意义(χ~2=5.541,P=0.019);两组出血事件、血小板下降率比较均无统计学意义(均P>0.05),且两组均未出现致死性出血。结论心肌梗死患者PCI 1年后继续双重抗血小板与阿司匹林单用相比可降低MACE发生,而出血事件等药物不良反应无明显增加,因此心肌梗死PCI 1年后继续双重抗血小板仍然获益。

Objective To evaluate the efficacy and safety of aspirin combined with clopigogrel or aspirin alone for antiplatelet therapy in patients with myocardial infarction after percutaneous coronary intervention（PCI）. Methods Eighty patients with acute myocardial infarction underwent PCI, aspirin and clopidogrel（Plavix） were given for one years after surgery, then the patients were randomly divided into combination group（aspirin 100 mg, q. d plus Plavix 75 mg, q. d）, monotherapy group（aspirin 100 mg, q.d）. After one years of follow-up, the major adverse cardiovascular events（MACE） and adverse drug reactions were observed and compared between two groups.Results The cumulative MACE in combination group was significantly lower than that in monotherapy group（χ^2=5.541, P=0.019）. There were no significant differences in incidence of bleeding and thrombocytopenia between two groups（P〉0.05）, and no fatal bleeding occurred in both groups. Conclusion Compared to aspirin use alone, aspirin combined with clopidogrel can reduce the adverse cardiovascular events,so for myocardial infarction patients after PCI and one years of combined antiplatelet therapy, the continuous dual antipletelet therapy is recommended.