| 替格瑞洛对急性冠脉综合征氯吡格雷用药低反应性患者的临床疗效观察 |
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| 引用本文： | 林伟,周瑞,林建锋,王毅,贾珠银.替格瑞洛对急性冠脉综合征氯吡格雷用药低反应性患者的临床疗效观察[J].中华全科医学,2017,15(6):934-936. |
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| 作者姓名： | 林伟 周瑞 林建锋 王毅 贾珠银 |
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| 作者单位： | 1. 温州市人民医院心血管内科, 浙江 温州 325000; |
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| 基金项目： | 浙江省医药卫生计划项目(2016KYA169) |
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| 摘 要： | 目的 探讨替格瑞洛对治疗急性冠脉综合征氯吡格雷用药低反应性患者的疗效、预后的临床疗效。 方法 选取2013年9月-2016年4月在温州市人民医院应用氯吡格雷75 mg/d治疗的急性冠脉综合征经皮冠状动脉介入治疗的患者328例,采用血栓弹力图测定血小板聚集率,根据患者的血小板聚集率筛选出氯吡格雷低反应患者110例。采用随机数表法分为替格瑞洛组54例,氯吡格雷组56例,氯吡格雷组继续服用氯吡格雷75 mg/d,替格瑞洛组将氯吡格雷替换为替格瑞洛90 mg,2次/d。比较2组患者治疗后不良心脑血管事件的发生率,不良反应情况以及尿酸水平和血小板聚集率变化情况。 结果 治疗后,替格瑞洛组患者用药3 d、7 d以及30 d血小板聚集率都明显低于氯吡格雷组,2组比较差异有统计学意义(P<0.05);替格瑞洛组患者出现不稳定性心绞痛(unstable angina pectoris,UAP)、急性心肌梗死(acute myocardial infarction,AMI)、一过性脑缺血发作(Transient ischemic attack,TIA)心力衰竭以及脑血管意外的发生率明显的低于氯吡格雷组,2组比较差异有统计学意义(P<0.05);替格瑞洛组患者心原性死亡、出血以及卒中等不良反应的发生率明显的低于氯吡格雷组,2组比较差异有统计学意义(P<0.05);入院后3 d、30 d替格瑞洛组患者的尿酸水平高于氯吡格雷组,氯吡格雷组痛风发生率(3.51%)低于氯吡格雷组(18.51%),2组比较差异有统计学意义。 结论 对于经皮冠状动脉介入治疗的经氯吡格雷治疗后出现低反应性的患者采用替格瑞洛治疗,能够取得比较理想的抗血小板聚集效果,降低不良事件的发生,效果显著。
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| 关 键 词： | 氯吡格雷 替格瑞洛 急性冠脉综合征 |
| 收稿时间： | 2016-09-19 |
Efficacy and loading dose analysis of ticagrelor in acute coronary syndrome patients with low on-clopidogrel platelet reactivity and its influence on prognosis |
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| Affiliation: | Department of Cardiology, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, China |
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| Abstract: | Objective To evaluate the therapeutic efficacy and influence on the prognosis of ticagrelor in acute coronary syndrome (ACS) patients with low on-clopidogrel platelet reactivity,and analyze its loading dose. Methods A total of 328 cases of ACS patients undergoing percutaneous coronary intervention (PCI) and receiving clopidogrel 75 mg/d treatment in our hospital between September,2013 and April,2016 were enrolled into this study.The platelet aggregation was detected by thrombelastography and 110 patients with low on-clopidogrel platelet reactivity were selected.They were randomly assigned into ticagrelor group (n=54) and clopidogrel group (n=56).The clopidogrel group was continually administrated with clopidogrel 75 mg/d,while the ticagrelor group with ticagrelor 90 mg,2 times/d.The incidence of major adverse cardiac and cerebrovascular events,adverse reactions,uric acid levels and platelet aggregation after the treatment were compared between the two groups. Results After the treatment,the platelet aggregation rate on d3,d7 and d30 in ticagrelor group were significantly lower than those in the clopidogrel group,the difference was significant (P<0.05);The incidence of UAP,AMI,TIA,heart failure and cerebrovascular accidents in the ticagrelor group was significantly lower than those in the clopidogrel group,the difference was significant (P<0.05);The incidence of cardiogenic mortality,bleeding and stroke in the ticagrelor group were significantly lower than those in the clopidogrel group,the difference was significant (P<0.05);Three days and 30 days after the discharge,uric acid levels in the clopidogrel group was significantly higher than that in the ticagrelor group,the incidence of gout in the ticagrelor group (3.51%) was lower than that in the clopidogrel group (18.51%),the difference was significant. Conclusion Ticagrelor therapy for ACS patients with low on-clopidogrel platelet reactivity after PCI can improve the platelet aggregation,reduce the incidence of adverse events,the curative effect is significant. |
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