双倍剂量氯吡格雷强化抗栓对CHD经皮冠状动脉支架植入术后CLR患者血小板聚集功能的影响

目的分析双倍剂量氯吡格雷强化抗栓3个月对冠心病(CHD)经皮冠状动脉支架植入术后氯咄格雷低反应性(CLR)患者血小板聚集功能及安全性的影响。方法连续入选2015年7月至2017年1月就诊的已接受过支架植入术治疗的CHD患者82例患者,并通过光学血小板聚集仪筛选全部为CLR患者,随机将所选患者分为氯吡格雷双倍剂量组(41例)和氯吡格雷常规剂量组(41例)。氯吡格雷双倍剂量组抗血小板治疗方案为100mg阿司匹林+150mg氯吡格雷,连续治疗3个月,后调整为100mg阿司匹林+75mg氯吡格雷,治疗9个月;氯吡格雷常规剂量组为100mg阿司匹林+75mg氯吡格雷连续治疗12个月。观察随访3个月时两组患者血小板聚集功能的变化,另随访1年记录临床预后及安全性。结果住院期间两组所测二磷酸腺昔诱导的血小板聚集率(PLADP)比较差异无统计学意义(P>0.05),3个月时随访显示两组PLADP均较住院时显著降低(P<0.05),且氯吡格雷双倍剂量组PLADP明显低于同期氯吡格雷常规剂量组(P<0.05),两组住院期间及3个月随访花生四烯酸诱导的血小板聚集率(PLAA)差异均无统计学意义(P>0.05);受试者均完成1年随访,无失访者,氯吡格雷双倍剂量组与氯吡格雷常规剂量组主、次要不良事件及安全性事件比较差异均无统计学意义(P>0.05),次要不良事件中心源性再入院比校差异有统计学意义(P<0.05).结论CLR患者给予双倍剂量氯吡格雷强化治疗3个月可显著改善患者的血小板反应性并减少其心源性再入院率,且未明显增加出血事件的发生。

Objective To analyze the effect of double-dose clopidogrel reinforced antithrombotic for three months on platelet aggregation and safety in patients with CHD with clopidogrel low reactivity after percutaneous coronary artery stent implantation. Methods 82 patients with coronary heart disease were continuously selected, who were admitted to our hospital from July 2015 to January 2017 and had been treated with stent implantation. All CLR patients were screened by optical platelet aggregation instrument and the selected patients were randomly divided into double dose clopidogrel group ( 41 cases) and the conventional dose clopidogrel group ( 41 cases).The antiplatelet therapy of the double dose clopidogrel group was 100 mg aspirin+ 150mg clopidogrel for 3 consecutive months, then it was 100 mg aspirin+ 75 mg clopidogrel for 9 months. While that of the conventional dose clopidogrel group was 100 mg aspirin+75mg clopidogrel for 12 consecudve months. The changes of platelet aggregation function in the two groups were observed at the third month and the clinical prognosis and safety were recorded for 1 year. Results There was no statistically significant difierence in PLADP between the two groups during hospitalization ( P>0.05 ). The follow-up after 3 months showed that PLADP of both groups were significantly lower than those in the hospital ( P<0.05 ). The PLADP of the double dose clopidogrel group was significantly lower than that of the conventional dose clopidogrel group. There was no statistically significant difference in PLAA or between two groups during hospitalization and follow-up after 3 months (P>0.05). Subjects were all done 1 year follow-up and there was no statistically significant differences in main, secondary adverse events and security events between the double dose clopidogrel group and the conventional dose clopidogrel group ( P>0.05 ), however, there existed difierence in cardiac rehospitalization rate in the secondary adverse events ( P<0.05 ). Conclusion It can significantly improve the platelet reactivity, reduce their cardiac rehospitalization rate and there is no significant increase in bleeding events to treat CLR patients with double dose of clopidogrel for 3 months.