摘要
目的前瞻性分析根据血栓弹力图(TEG)指导双联抗血小板治疗方案的有效性及安全性。方法选择浙江省人民医院神经内科自2020年8月至2021年4月采用双联抗血小板治疗的缺血性脑血管疾病患者109例,治疗3~5d后完善TEG检测,住院期间完成氯吡格雷基因学检测,根据TEG检测的二磷酸腺苷(ADP)抑制率将患者分为高效组(n=45)、中效组(n=37)和低效组(n=27)。高效组患者不建议改变用药,中效组、低效组患者均建议改变用药,观察3组患者药物调整后3个月美国国立卫生研究院卒中量表(NIHSS)评分以及疗效和安全性的差异。结果中效组患者的冠心病者所占比例高于高效组和低效组,差异有统计学意义(P<0.05)。高效组中6例患者改用阿斯匹林+西洛他唑。中效组、低效组中分别有28、14例患者不愿换药而继续使用阿斯匹林+氯吡格雷。高效组中,不换药患者新发脑卒中、支架内再狭窄的总发生率(1/39)低于换药患者(1/6)。中效组中,不换药患者新发脑卒中、支架内再狭窄的总发生率(6/28)高于换药患者(1/9)。低效组中,不换药患者新发脑卒中、支架内再狭窄的总发生率(3/14)高于换药患者(0/13)。高效组慢代谢型患者中,不换药患者新发脑卒中、支架内再狭窄的总发生率(2/3)高于换药患者(1/2)。结论根据TEG指导双联抗血小板治疗方案可提高疗效而不增加出血风险,其中对于ADP抑制率>70%、氯吡格雷基因型为慢代谢型的患者,更换氯吡格雷可进一步提高疗效。
Objective To analyze the efficacy and safety of dual antiplatelet therapy guided by thromboelastography(TEG).Methods One hundred and nine patients with ischemic cerebrovascular diseases,admitted to and accepted dual antiplatelet therapy in our hospital from August 2020 to April 2021,were enrolled in this study.TEG test was completed 3-5 d after treatment,and clopidogrel gene test was completed during hospitalization.According to the results of adenosine diphosphate(ADP)inhibition rate in TEG,they were divided into high-efficiency group,moderate efficiency group and low efficiency group.No medication change was recommended for patients in the high-efficiency group,but medication changes were recommended for patients in the moderate efficiency group and low efficiency group;differences of National Institutes of Health Stroke Scale(NIHSS)scores,efficacies and safety were recorded in these 3 groups after drug adjustment.Results The proportion of patients with coronary heart disease in moderate efficiency group was statistically higher than that in high-efficiency group and low efficiency group(P<0.05).Six patients in the high-efficiency group switched to use aspirin and cilostazol;28 in the moderate efficiency group and 14 patients in the low efficiency group were disinclined to change their medications and continued to use aspirin+clopidogrel.In patients from the high-efficiency group,the overall incidence of new stroke and in-stent restenosis in patients without changing medications(1/39)was lower than that in patients with changing medications(1/6);in patients from the moderate efficiency group,that in patients without changing medications(6/28)was higher than that in patients with changing medications(1/9);in patients from the low efficiency group,that in patients without changing medications(3/14)was higher than that in patients with changing medications(0/13).In patients with slow metabolism from high-efficiency group,the overall incidence of new stroke and in-stent restenosis in patients without changing medic
作者
陈桂花
史宗杰
耿昱
潘婕
Chen Guihua;Shi Zongjie;Geng Yu;Pan Jie(Department of Neurology,Zhejiang Provincial People's Hospital,People's Hospital of Hangzhou Medical College,Hangzhou 310014,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2021年第12期1243-1247,共5页
Chinese Journal of Neuromedicine
基金
浙江省医药卫生科技项目(2019RC099、2021KY509)
浙江省科技计划重点研发项目(2018C03008)。
