替格瑞洛在氯吡格雷抵抗的急性冠脉综合征中疗效的初步观察

Clinical application of TiGraylo in acute coronary syndrome with clopidogrel resistance

关键词:  ACS  PCI术  血栓弹力图  血小板抑制率  氯吡格雷抵抗  替格瑞洛

Key words:  [Key words] ACS  PCI  thrombelastography  platelet inhibition rate  clopidogrel resistance  TiGrayLo

摘要:

[摘要] 目的　观察第三代抗血小板新药血小板二磷酸腺苷（ADP）受体P2Y12拮抗剂——替格瑞洛在氯吡格雷抵抗的急性冠脉综合征（ACS）患者中的临床疗效。方法　随机选取拟行冠脉内支架植入（PCI）术的ACS患者66例，PCI术前均服用氯吡格雷（300~600 mg负荷量），服药后24 h内，应用血栓弹力图检测血小板抑制率分为两组：(1)血小板抑制率<31%，明显减低，为氯吡格雷抵抗组6例；(2)血小板抑制率>50%,正常，为正常组60例。两组血小板抑制率有明显差异（P<0.001)。氯吡格雷抵抗组予替格瑞洛口服，首服180 mg，继90 mg 2次/d持续1年，替换氯吡格雷；正常组予氯吡格雷口服75 mg 1次/d持续1年。 结果　氯吡格雷抵抗组用替格瑞洛治疗，血小板抑制率恢复正常，且略高于正常组,两组血小板抑制率无明显差异(P>0.05)。PCI术后无急性及亚急性冠脉及支架内血栓形成，无出血率增加。结论　替格瑞洛对氯吡格雷抵抗者抑制急性及亚急性血栓形成有效，可显著降低ACS患者心血管事件发生率，不增加大出血。

Abstract:

[Abstract] Objective To investigate the clinical efficacy of the new third generation of antiplatelet drug: platelet adenosine monophosphate (ADP) receptor antagonist P2Y12-TiGrayLo in the treatment of acute coronary syndrome (ACS) with clopidogrel resistance. Methods Randomly selected 66 ACS patients were planned for coronary stent implantation (PCI). All patients took clopidogrel (300~600mg load) before the surgery. The patients were divided into two groups based on the thromboelastography-determined platelet inhibition rate within 24 hours after taking clopidogrel. The clopidogrel-resistant group, defined by platelet inhibition rate <31%, included 6 patients; the normal group, defined by platelet inhibition rate>50%, included 60 patients. The two groups had significant difference in platelet inhibition rate (P<0.001). The patients in clopidogrel-resistant group were treated with oral TiGraylo, first dose 180mg, followed by 90mg twice a day for one year. The patients in normal group were treated with oral clopidogrel 75mg once a day for one year. Results After treatment with TiGraylo, the clopidogrel-resistant group had platelet inhibition rate returned to normal, and slightly higher than those in the normal group. The two groups had no significant difference in platelet inhibition rate (P>0.05). No acute or subacute coronary artery and stent thrombosis were observed after PCI. There was no obviously increased bleeding rate. Conclusion Compared to Clopidogrel, TiGrayLo can significantly reduce the incidence of cardiovascular events in ACS patients without increasing bleeding and can also prevent the acute and subacute thrombosis in patients with clopidogrel resistance.