冠状动脉植入药物支架术后高维持剂量氯吡格雷治疗的近期疗效
《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]
- 期数:
- 2010年第3期
- 页码:
- 396-400
- 栏目:
- 临床研究
- 出版日期:
- 2010-04-06
文章信息/Info
- Title:
- Clinical outcome of a high maintenance dose of clopidogrel in patients undergoing drug-eluting stent implantation
- 作者:
- 蔡国才1; 周鹏1; 张磊1; 王秋林1; 雷长城2; 曾高峰2; 匡希斌2
- 1.成都医学院第一附属医院心血管内科，四川 成都 610500；2.南华大学附属二医院心内科，湖南 衡阳 421001
- Author(s):
- CAI Guo-cai1; ZHOU Peng1; ZHANG Lei1; WANG Qiu-lin1; LEI Chang-cheng2; ZENG Gao-feng2; KUANG Xi-bin2
- 1.Department of Cardiology, First Affiliated Hospital of Medical College of Chengdu, Chengdu 610500, Sichuan, China; 2.Department of Cardiology, Second Affiliated Hospital, University of South China, Hengyang 421001, Hunan, China
- 关键词:
- 氯吡格雷; 经皮冠状动脉介入治疗; 血小板聚集率
- 分类号:
- R541.4
- DOI:
- -
- 文献标识码:
- A
- 摘要:
- 目的: 对比观察植入药物洗脱支架（durg eluting stent,DES）患者术后服用高维持剂量氯吡格雷150 mg/d的有效性及安全性。方法: 前瞻性入选我院2007年1月~12月120例成功行DES植入术的患者。所有患者于术前顿服600 mg负荷量氯吡格雷，术后在服用阿司匹林基础上随机接受每日75 mg(n=60)或150 mg(n=60)维持量的氯吡格雷治疗30 d，30 d后所有患者接受每日75 mg的氯吡格雷治疗直至术后1年。分别检测2组服药前、服药后15和30 d二磷酸腺苷(ADP)诱导的血小板最大凝集率，随访术后30 d和9月主要临床心血管事件(包括死亡、心肌梗死、紧急靶血管血运重建、脑卒中等)和出血事件的发生情况。结果: 氯吡格雷150 mg组与75 mg组患者术前ADP诱导的血小板聚集率和最大聚集时间比较无显著性差异，而术后15和30 d比较差异有显著性(P<0.05)。氯吡格雷150 mg组30 d和9月主要临床心血管事件发生率较75 mg组显著减少(P<0.05,P<0.01)。2组30 d和9月出血事件差异均无统计学意义。结论: 植入DES患者术后服用高维持剂量氯吡格雷150 mg较之常规维持剂量75 mg预治疗能更大程度抑制血小板凝集，同时降低DES植入术的患者术后近期发生不良事件的风险，可显著改善临床预后。
- Abstract:
- AIM: To study the short-term efficacy and safety of a high maintenance dose (150 mg) of clopidogrel in treating patients undergoing drug-eluting stent (DES) implantation. METHODS: One hundred twenty consecutive patients undergoing DES implantation in our hospital from January 2007 to December 2007 were enrolled in the study. A 600-mg loading dose was administered before percutaneous coronary intervention (PCI). Patients were then randomized to receive clopidiogrel 75 mg (n=60) or 150 mg (n=60) per day for 30 days. From 31 days to 12 months after surgery, all patients received 75 mg/day clopidogrel. Adenosine diphosphate (ADP)-induced maximal platelet aggregation rate (MPAR) was measured before PCI and 15 and 30 days after PCI. The incidence of major clinical cardiovascular events (including death, myocardial infarction, target vessel revascularization, stroke) and hemorrhagic events were followed up to 30 days and 9 months. RESULTS: Although no significant difference was observed in ADP-induced MPAR between the 75-mg group and 150-mg group before PCI, significantly decreased platelet aggregation rate was seen in the 150-mg group (P<0.05) at 15 days and 30 days after PCI. The incidence of major clinical cardiovascular events after 30 days and after 9 months in 150-mg group was significantly lower than in the 75-mg group (P<0.05; P<0.01). The occurrence of 30-day and 9-month hemorrhagic events between groups had no significant difference. CONCLUSION: Treatment with a high maintenance dose (150 mg) of clopidogrel after PCI is more efficient in inhibiting platelet aggregation than treatment with 75 mg dose. A high clopidogrel maintenance dose of 150 mg daily for the first month after PCI procedure following a 600-mg loading dose reduces the risk of adverse events in patients undergoing DES implantation and significantly improves clinical outcomes.
参考文献/References
［1］ Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreament with clopidogrel and aspirin followed by long-tem thernpy in patients under-going percutaneous coronary intervention the PC1-CURE, study［J］. Lancet, 2001, 358(9281):527-533.
［2］ Steinhubl SR, Berger PB, Mann JT 3rd, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention a randonized controlled trial［J］. JAMA, 2002, 288(19):2411-2420.
［3］曾昆,顾晔,胡立群,等. 不同维持剂量氯吡格雷对择期经皮冠脉介入治疗患者术后血小板聚集率的影响［J］. 临床内科杂志, 2008, 25(4):248-250.
［4］韩雅玲,徐凯,李毅,等. 150 mg高维持量氯吡格雷提高急性冠脉综合征患者药物洗脱支架植入术后的长期疗效［J］. 第三军医大学学报, 2008, 30(5):435-438.
［5］Cuisset T, Frere C, Quilici J, et al. High post-treament platelet reactivity identified low-responders to dual antiplatelet therapy at increased risk of recurrent cardiovascular events after stenting for acute syndrome［J］. J Thromb Haemost, 2006, 4(3):542-549.
［6］ Frere C, Cuisset T, Quilici J, et al. ADP-induced platelet aggregation and platelet reactivity index VASP are good predictive markers for clinical outcomes in non-ST elevation acute coronary syndrome［J］. Thromb Haemost, 2007, 98(4):838-843.
[7]Sibbing D, von Beckerath O, Schmig A, et al. Platelet function in clopidogrel-treated patients with acute coronary syndrome［J］. Blood Coagul Fibrinolysis, 2007, 18(4):335-339.
[8]Matekt A, Spiewak M, Filipiak KJ, et al. Persistent platelet activation is related to very early Cardiovascular events in patients with acute coronary syndromes［J］. Kardiol Pol, 2007, 65(1):40-45.
[9] Cuisset T, Frere C, Quilici J, et al. High post-treament platelet reactivity is associated with a high incidence of myoneciosis after stenting for non-ST elevation acute coronary syndromes［J］. Thromb Haemost, 2007, 97(2):282-287.
[10]von-Beckerath N, Kastrati A, Wieczorek A, et al. A double-blind randanized study on platelet aggregation in patients treated w ith a daily dose of 150 or 75 mg of clopidogrel for 30 days［J］. Eur Heart J, 2007, 28(15):1814-1819.
[11]Mitsios JV, Papathanasiou AI, Elisaf M, et al. The inhibitory potency of clopidogrel on ADP-induced platelet activation is not attenuated when it is co-administered with atorvastatin(20 mg/day)for 5 weeks in patients with acute coronary syndromes［J］. Platelets, 2005, 16(5):287-292.
[12]Tetik S, Uras F, Eksiog lu-Demiralp E, et al. Low-Denssity lipoprotein specifically binds glycoprotein Ⅱb/Ⅲa: a flow cytometric method for lignld-receptor interaction［J］. Clin Appl Thromb Hemost, 2007, 26(23):143-154.
[13]Angiolillo DJ, Shoemaker SB, Desai B, et al. Randomized comparison of a high clopidogrel maintenance dose in patients with diabetes mellitus and coronary artery disease results of the Optinizing Antiplatelet Therapy in Diabetes Mellitus(OPTMUS) study［J］. Circulation, 2007, 115(6):708-716.
［14］ Bennett MR, OSulliVan M. Mechanism of angiop1asty and Stent restenosis inplications for designs of rational therapy［J］. Phamacol Ther, 2001, 91(2):149-166..
备注/Memo
- 备注/Memo:
- 收稿日期：2008-09-25.通讯作者：张磊，副主任医师，主要从事高血压、冠心病和心衰的研究Email:zhl.037@163.com 作者简介：蔡国才,主治医师，硕士Email:cgc23@163.com
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