冠脉支架术后氯吡格雷和噻氯匹定应用的临床观察

Clinical study of clopidgrel and ticlopidine treatment after coronary stent implantation

目的探讨冠脉支架术后应用氯吡格雷和噻氯匹定加阿司匹林的抗血小板聚集作用及其安全性。方法对 15 8例冠脉内支架随机分别应用氯吡格雷 75mg/d和阿司匹林 30 0mg/d加低分子肝素 0 .5mL/d(CA组n =32 )、噻氯匹定 5 0 0mg/d和阿司匹林 30 0mg/d加低分子肝素 0 .5mL/d(TA组n =12 6 ) ,测定血栓与止血功能及观察心脏事件、药物的副作用。结果两组患者抗血小板聚集作用的效果和心脏事件发生率相似。药物副作用 :噻氯匹定中性粒细胞减少 (1.5 %比 0 )、腹泻 (5 .6 %比 3.1%)、皮疹 (8.6 %比 3.1%)均高于氯吡格雷 (P <0 .0 5 )。结论氯吡格雷在支架置入后是一种有效的抗血小板聚集药物 ,其副作用少 ,且优于噻氯匹定。

Objective To retrospectively analyze the safety and antiplatelet aggregation efficiency of clopidgrel and ticlopidine plus aspirin in patients after coronary stent implantation. Methods 158 patients undergoing coronary stent implantation were treated with clopidgrel 75mg/d and aspirin 300mg/d plus low molecular weight heparin 0.5mL/d(CA group,n=32)and with ticlopidine 500 mg/d and aspirin 300 mg/d plus low molercular heparin 0.5 mL/d(TA graup,n=126).Resuts The measurement of coagulum and thrombus efficacy was made. Cardiac event and side effects of medicine were observed. There was no difference in antiplatelet efficacy and major adverse cardiac events between the two groups. The probability of drug side effect(neutropenia,diarrhea,rash) was significantly higher in the TA group(1.5% versus 0%,5.6% versus 3.1%,8.6% versus 3.1%,P<0.05) than in the CA group. Conclusion Clopidgrel may be an effective antiplatelet aggregation drug after coronary stent implantation. The absence of clopidgrel side effect makes it a potential safe alternative to ticlopidine.