标准剂量替格瑞洛不耐受的PCI术后患者减半剂量治疗的有效性及安全性

Efficacy and safety of half-dose ticagrelor in patients with standard-dose ticagrelor intolerance after PCI

目的针对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后标准剂量替格瑞洛治疗不耐受(表现为非严重出血或呼吸困难),探讨减半剂量治疗的有效性及安全性。方法纳入使用标准剂量替格瑞洛(90 mg,2/d)不耐受的PCI后ACS患者70例,予以半量替格瑞洛(45 mg,2/d)治疗至PCI后12个月。检测应用半量替格瑞洛治疗前后的血小板聚集功能,记录呼吸困难、出血事件的发生情况及12个月主要不良心血管事件(MACE)的发生情况。结果减半剂量治疗后,二磷酸腺苷(ADP)诱导的血小板聚集率有所升高[(10.0±9.5)%vs.(16.6±10.0)%,P<0.05];呼吸困难明显缓解(共23例,其中显效10例,好转10例,无效2例),总缓解率达87.0%;出血事件明显减少(82.9%vs.24.3%,P<0.05);未记录到MACE。结论PCI后ACS患者予标准剂量替格瑞洛治疗不耐受时,减半剂量治疗可有效缓解呼吸困难和减少出血事件的发生,而未增加MACE的发生率。

Objective To discuss the efficacy and safety of half-dose ticagrelor in patients with standarddose ticagrelor intolerance after PCI(manifested as non-serious bleeding or dyspnea).Methods ACS patients(n=70)with intolerance due to standard-dose ticagrelor(90 mg,2/d)after PCI were chosen and given half-dose ticagrelor treatment(45 mg,2/d)for 12 months after PCI.The platelet aggregation rate(PAG)was detected before and after half-dose ticagrelor treatment,and incidence of dyspnea,bleeding events and MACE in 12 months were recorded.Results After half-dose ticagrelor treatment,ADP-induced PAG increased[(10.0±9.5)%vs.(16.6±10.0)%,P<0.05],dyspnea was relieved significantly(of total 23 cases,10 with significant effects,10 with effects and 2 without effects),and the total relieve rate was 87.0%.The bleeding events decreased significantly(82.9%vs.24.3%,P<0.05),and there were no MACE recorded.Conclusion The half-dose ticagrelor treatment can effectively relive dyspnea,reduce bleeding events and MACE are not increased in ACS patients when they have standard-dose ticagrelor intolerance after PCI.