血栓弹力图评估替格瑞洛与氯吡格雷对STEMI患者支架术后抗血小板作用的效果

Assessment effect of TEG on antiplatelet effect of ticagrelor and clopidogrel on STEMI patients after stenting

目的:研究使用血栓弹力图评估替格瑞洛与氯吡格雷对急性ST段抬高型心肌梗死(STEMI)患者支架术后抗血小板作用的效果。方法:选择在我院行急诊冠脉介入治疗的STEMI患者315例,根据服用的抗血小板药物和是否服用奥美拉唑分为替格瑞洛Ⅰ组(A1组,有奥美拉唑,82例)和替格瑞洛Ⅱ组(A2组,无奥美拉唑,76例)及氯吡格雷I组(B1组,有奥美拉唑,79例)和氯吡格雷Ⅱ组(B2组,无奥美拉唑,78例),观察对比各组患者支架术后3个月内主要心血管不良事件(MACE)发生率及服药后7d、1个月和3个月应用血栓弹力图测定二磷酸腺苷(ADP)受体途径及花生四烯酸途径诱导的血小板抑制率。结果:各组患者支架术后MACE发生率差异无统计学意义(P均>0.05)。A1、A2组在3个时间点ADP受体途径诱导的血小板抑制率均分别显著高于B1、B2组(P均=0.001)。在服药后3个月,B2组ADP受体途径诱导的血小板抑制率显著高于B1组[(67.95±8.37)%比(63.95±9.20)%,P=0.005]。随着用药时间延长,A1、A2和B2组ADP受体途径和花生四烯酸途径诱导的血小板抑制率及B1组花生四烯酸途径诱导的血小板抑制率均逐渐显著升高(P<0.05或<0.01)。结论:STEMI患者支架术后不管是否服用奥美拉唑,替格瑞洛抑制血小板聚集作用均优于氯吡格雷,奥美拉唑能降低氯吡格雷对血小板聚集的抑制药效。血栓弹力图监测对抗血小板治疗有指导意义。

Objective:To study assessment effect of thromboelastography(TEG)on antiplatelet effect of ticagrelor and clopidogrel on patients with ST elevation myocardial infarction(STEMI)after stenting.Methods:According to taken antiplatelet drugs and omeprazole used or not,a total of 315 STEMI patients undergoing emergency PCI in our hospital were divided into ticagrelorⅠgroup(group A1,received omeprazole,n=82)and ticagrelorⅡgroup(group A2,no omeprazole,n=76),clopidogrelⅠgroup(group B1,received omeprazole,n=79)and clopidogrelⅡgroup(group B2,no omeprazole,n=78).Incidence rate of major adverse cardiovascular events(MACE)within three months after PCI,adenosine diphosphate(ADP)receptor pathway and arachidonic acid pathway induced platelet inhibition rate(PIR)measured by TEG on 7d,one month and three months after administration were observed and compared among all groups.Results:There were no significant difference in incidence rate of MACE after PCI among all groups,P>0.05 all.ADP receptor pathway induced PIRs at three time points in group A1 and A2 were significantly higher than those of group B1 and B2 respectively,P=0.001 all.On three months after administration,ADP receptor pathway induced PIR in group B2 was significantly higher than that of group B1[(67.95±8.37)%vs.(63.95±9.20)%,P=0.005].As medication time extended,above two pathway induced PIR in group A1,A2 and B2,and arachidonic acid pathway induced PIR in group B1 gradually and significantly rose,P<0.05 or<0.01.Conclusion:Whether taken omeprazole after PCI or not,anti-platelet aggregation effect of ticagrelor is always better than that of clopidogrel in STEMI patients,but omeprazole can reduce antiplatelet aggregation effect of clopidogrel.TEG monitoring possesses guidance significance for antiplatelet treatment.