氯吡格雷和替格瑞洛对急性冠脉综合征支架术后患者血小板抑制效果、疗效及安全性比较

Comparison of platelet inhibitory effect,clinical efficacy and safety of clopidogrel and ticagrelor in patients with acute coronary syndrome undergoing stent implantation

目的 比较抗血小板药物氯吡格雷和替格瑞洛在急性冠脉综合征(acute coronary syndrome,ACS)支架术后患者中抑制血小板的有效性,评估两种药物的临床获益与风险。方法 取2016年6月至2019年12月在上海交通大学医学院附属瑞金医院诊断为ACS且接受支架治疗的患者200例随机分为氯吡格雷组和替格瑞洛组,每组100例。采用血栓弹力图(thromboelastogram,TEG)比较两组支架术后3 d内血小板二磷酸腺苷(adenosine diphosphate,ADP)抑制率、二磷酸腺苷诱导的血小板-纤维蛋白凝块强度(maximum amplitude adenosine diphosphate,MAADP)和花生四烯酸(arachidonic acid,AA)抑制率,记录并比较术后1年内心血管不良事件和出血事件发生情况。结果 替格瑞洛组较氯吡格雷组ADP抑制率更高(P <0.05),MAADP值更低(P <0.05),AA抑制率差异无统计学意义(P> 0.05)。两组心血管不良事件及出血事件发生差异无统计学意义(P> 0.05)。结论 替格瑞洛血小板抑制作用较氯吡格雷更显著,两者临床获益及安全性相似。

Objective In order to compare the effectiveness of clopidogrel and ticagrelor in platelet ihibition in patients with acute coronary syndrome (ACS) undergoing stent implantation,and to evaluate the clinical benefits and risks.Methods Two hundred patients with ACS undergoing stent implantation from June 2016 to December 2019 were enrolled and randomly divided into clopidogrel group and ticagrelor group in Ruijin Hospital,and 100 cases in each group.Adenosine diphosphate (ADP) inhibition ratio,maximum amplitude adenosine diphosphate (MAADP) and arachidonic acid (AA) inhibition ratio were tested with thromboelastogram (TEG) within three days after stent implantation,as well as adverse cardiovascular events and bleeding complications were followed up and observed within one year after stent implantation.Results ADP inhibition ratio in ticagrelor group was higher than that in clopidogrel group (P<0.05),MAADP in ticagrelor group was lower than that in clopidogrel group(P<0.05).There was no significant difference of AA inhibition ratio,adverse cardiovascular events and bleeding events between two groups(P>0.05).Conclusion Ticagrelor was more effective than clopidogrel on platelet inhibition,but their clinical efficacy and safty were similar.