急性冠脉综合征患者替格瑞洛与氯吡格雷相互转换治疗的现状调查分析

Current Application Status of Switching between Ticagrelor and Clopidogrel in Hospitalized Patients with Acute Coronary Syndrome

目的:调查分析急性冠脉综合征(ACS)急性期或早期的患者在住院期间替格瑞洛与氯吡格雷相互转换的应用现状。方法:分析2019年6月~12月本院急性期或早期ACS患者院内替格瑞洛与氯吡格雷相互转换的发生率、一般临床特征、转换给药时间和给药剂量。结果:ACS患者替格瑞洛与氯吡格雷转换治疗的比率为12.9%(208/1607),最终纳入的182例患者中,63.2%(115例)由氯吡格雷换为替格瑞洛(升阶治疗组),36.8%(67例)由替格瑞洛换为氯吡格雷(降阶治疗组)。升阶组和降阶组的一般临床特征存在一定的差异;两组患者均在造影术后当天至术后第一天的时间段发生转换的人数最多,且组间存在差异(58.4%vs 40.0%,P=0.018);降阶组仅有35.5%的患者在最后一剂替格瑞洛给药24 h后给予首剂氯吡格雷;仅有37.4%的患者在转换时给予所换用P2Y12受体拮抗剂的负荷剂量。结论:"指南"推荐的P2Y12受体拮抗剂转换策略尚未得到广泛认可,临床实践中转换策略的制定须结合患者情况作个体化选择。

Objective: To investigate and analyze the clinical application of switching between ticagrelor and clopidogrel in hospitalized patients with acute coronary syndrome(ACS) in the acute/early phase.Methods: A retrospective analysis was done on incidence, general clinical characteristics, switching time and dosage of in-hospital switching between ticagrelor and clopidogrel in acute/early phase ACS patients from June to December 2019. Results: The occurrence of in-hospital switching between ticagrelor and clopidogrel was 12.9%(208/1607). Among the 182 patients who were finally included, 115(63.2%) patients switched from clopidogrel to ticagrelor(Escalation) and 67(36.8%) patients switched from ticagrelor to clopidogrel(De-escalation). The general clinical characteristics of the two treatment groups were somewhat different;the two different ways of transitions occurred more frequently in the period from the day after the angiography to the first day after the operation, and there were differences between the groups(58.4% vs.40.0%, P =0.018);only 35.5% of the patients in De-escalation were treated with the first dose of clopidogrel 24 h after the last dose of ticagrelor;only 37.4% of patients were given a loading dose of the switched P2Y12 receptor antagonist at the time of transition. Conclusions: The P2Y12 receptor antagonist transition strategy recommended by the guidelines has not been widely recognized, and the formulation of the transition strategy in clinical practice often depends on the situation of individual patient.