摘要
目的:评价不同维持剂量氯吡格雷对直接冠状动脉介入(PPCI)术后发生氯吡格雷抵抗患者的疗效和安全性。方法:回顾性分析2008-01-2011-01因急性心肌梗死(AMI)于我院抢救中心住院行PPCI,术后5d化验检查发现氯吡格雷抵抗的患者277例。所有患者均于术前常规给予口服氯吡格雷负荷剂量300mg、阿司匹林300mg;术后常规给予阿司匹林100mg/d,术后1～4d服用氯吡格雷75mg/d。根据术后第5天起服用氯吡格雷剂量分为75mg/d组(156例)和150mg/d组(121例)。观察2组二磷酸腺苷(ADP)及临床事件发生情况。结果:术后第5天2组ADP值差异无统计学意义(P=0.201);而150mg/d组术后14d(P=0.039)、30d(P=0.038)、90d(P=0.010)和180d(P=0.012)ADP值均显著低于75mg/d组,均差异有统计学意义。术后30d时2组AMI发生率(P=0.634)、病死率(P=0.391)和轻度出血发生率P=0.476)均差异无统计学意义。而在随访180d时150mg/d组AMI发生率(P=0.041)和病死率(P=0.034)均显著低于75mg/d组,均差异有统计学意义;而2组轻度出血发生率(P=0.371)差异无统计学意义。随访过程中2组均无中、重度出血发生。Logis-tic回归分析结果显示,应用氯吡格雷150mg/d是180d时发生AMI(OR=1.236,95%CI:0.567～2.071,P=0.023)的独立影响因素,但不是180d时病死率(OR=0.522,95%CI:0.218～1.369,P=0.224)的独立影响因素。结论:对PPCI术后发生氯吡格雷抵抗的患者,增加氯吡格雷维持量能进一步抑制血小板功能,进而减少临床不良事件的发生率,而且安全性良好。
Objective：To evaluate the efficacy and safety of double doses of clopidogrel on patients with clopidogrel resistance after primary percutaneous coronary intervention（PPCI）.Method：The data of 277 patients with clopidogrel resistance undergoing PPCI from January 2008 to January 2011 were retrospectively analyzed.All patients were giving clopidogrel 300 mg and aspirin 300 mg loading dose,and clopidogrel 75 mg/d and aspirin 100 mg/d maintenance dose after PPCI 1-4 days.They were divided into 2 groups according to the dose of clopidogre from the 5th day after PPCI： group with clopidogre 75 mg/d maintenance dose（n=156） and group with 150 mg/d（n=121）.ADP was measured after PPCI 5,14,30,90,180 days and adverse events were evaluated during 30 and 180 days after PPCI.Result：Compared with group 75 mg/d,ADP after PPCI 14,30,90,180 days,the rate of AMI and mortality after PPCI 180 days were decreased significantly in group 150 mg/d.Although the slight bleeding incidences in the group 75 mg/d during 30 and 180 days after PPCI were less than those in the group 150 mg/d,but no significant differences were observed between the 2 groups,and no severe bleeding was observed between the 2 groups.Multivariate analysis showed that clopidogre 150 mg/d maintenance dose was an independent factor for the accidence of AMI（OR=1.236,95%CI： 0.567-2.071,P=0.023）,but not for mortality（OR=0.522,95%CI： 0.218-1.369,P=0.224） after PPCI 180 days.Conclusion：The maintenance dose of clopidogre 150 mg/d may effectively and safely reduce platelet aggregation rate and adverse events in patients with clopidogrel resistance undergoing PPCI.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2012年第5期342-345,共4页
Journal of Clinical Cardiology
