摘要
目的探讨氯吡格雷抵抗的患者更换为替格瑞洛后其抗血小板聚集效果。方法本研究入选了63例经血栓弹力图结果证实存在氯吡格雷抵抗患者。所有患者均接受经皮冠状动脉介入治疗,并被分为替格瑞洛组和氯吡格雷组。所有患者接受替格瑞洛(90mg,2次/d)或氯吡格雷(75mg,1次/d)治疗。治疗3天后复查血栓弹力图。评价两组患者血小板抑制率及主要不良心脏事件情况。结果对于氯吡格雷抵抗患者,更换为替格瑞洛后腺苷二磷酸(adenosine diphosphate,ADP)抑制率(36.9%)较继续应用氯吡格雷(16.7%)明显升高(P<0.01)。替格瑞洛应用是安全的,并且替格瑞洛组未出现任何严重出血事件。但是有1例服用替格瑞洛患者因严重呼吸困难而停药。经过平均8.2个月随访后未出现急性心肌梗死、心血管死亡或支架内血栓事件。结论氯吡格雷抵抗患者接受替格瑞洛后能获得理想的抗血小板效果。对于接受经皮冠状动脉介入治疗,尤其存在氯吡格雷抵抗患者而言,替格瑞洛是安全、有效并且可以信赖的药物。
ABSTRACT：Objective To observe the clinical efficacy of ticagrelor against platelet aggregation in the treatment for patients with clopidogrel resistance.Methods A total of 63 patients with clopidogrel resistance identified by thrombelastography were enrolled in this study.Each patient had received percutaneous coronary intervention（PCI）. The subjects were divided into ticagrelor group and clopidogrel group,according to their response to clopidogrel. Patients with clopidogrel resistance received ticagrelor treatment （90 mg twice daily）and patients responding to clopidogrel were still treated with clopidogrel （75 mg daily）.After treatment for three days,thrombelastography was carried out on them again.The platelet inhibition ratio and the major adverse cardiac event in both groups were analyzed.Results The inhibition ratio against adenosine diphosphate（ADP）in patients with clopidogrel resistance （36.9%）was significantly higher than that in patients responding to clopidogrel （16.7%,P 〈0.01）.No severe bleeding was found in the ticagrelor group,suggesting that ticagrelor was safe to the patients.However,there was one patient in the ticagrelor group withdrawing drug because of the serious dyspnea.With a follow-up period of 8.2 months,no acute myocardial infarction,cardiovascular-caused death or in-stent thrombosis were observed.Conclusion Ticagrelor therapy can also achieve favorite outcomes for patients with clopidogrel resistence.For the patients with clopidogrel resistance but having to receive PCI,ticagrelor can be a safe,effective and reliable choice for antiplatelet therapy.
出处
《临床荟萃》
CAS
2015年第1期1-5,共5页
Clinical Focus
