摘要
目的:评估高维持剂量氯吡格雷在氯吡格雷低反应的冠状动脉介入患者中,对血小板聚集反应及临床预后的影响。方法:连续入选我院心内科2010-01-2010-12接受冠状动脉介入患者中氯吡格雷低反应者60例,随机分为维持量150mg组(30例)和75mg组(30例),共服用6个月,测定2组患者1个月和6个月时的血小板聚集性能,并随访临床预后和出血的发生率。结果:在氯吡格雷低反应患者中,应用双倍维持量氯吡格雷能够显著增强对血小板聚集的抑制反应。在150mg组患者中,1个月时有13例(43.3%)最大血小板聚集性回复至50%以下,6个月时有18例(60.0%)最大血小板聚集性回复至50%以下。而在75mg组患者中,1个月及6个月时均无患者血小板聚集性回复至50%以下。在6个月的临床随访中,150mg组患者的复合终点事件发生率明显降低,而出血的发生率无明显增加。结论:对于氯吡格雷低反应患者,增加氯吡格雷维持剂量可能是一个安全有效的解决途径,值得进一步研究。
Objective：To determine the influence of high maintenance dose of clopidogrel on clinical outcomes and platelet aggregation in patients with clopidogrel low responsiveness underwent percutaneous coronary intervention.Method：Sixty paitents with clopidogrel low responsiveness were randomly divided into treatment with a standard（75 mg,n=30） or high（150 mg,n=30） daily maintenance dose of clopidogrel for 6-month.Platelet aggregation function was assessed at 3 time points： baseline,30 days and 6 months after randomization,and clinical outcomes and the incidence of bleeding were also recorded for 6-month.Result：After randomization,maximal adenosine diphosphate-induced（20 μmol/L） platelet aggregation was significantly reduced in the 150 mg group compared with the 75 mg group.All other platelet function parameters showed enhanced clopidogrel-induced anti-platelet effects with 150 mg,which persisted during 6 months of follow up.The high maintenance dose strategy significantly decreased adverse composite endpoint events at 6 month,without increasing the incidence of TIMI bleeding.Conclusion：High maintenance dose of 150 mg clopidogrel may be an effective and safe strategy for paitents with low responsiveness,which deserves further investigation.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2012年第5期331-334,共4页
Journal of Clinical Cardiology
