替格瑞洛对比氯吡格雷治疗东亚ACS患者有效性和安全性的Meta分析

目的:系统性评价替格瑞洛对比氯吡格雷治疗东亚急性冠状动脉综合征(ACS)患者的有效性和安全性,旨在为临床用药提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、Embase、中国知网、万方数据库等,收集替格瑞洛(试验组)对比氯吡格雷(对照组)治疗东亚ACS患者的随机对照试验(RCT)。筛选文献、提取数据后采用Cochrane系统评价员手册5.1.0推荐的偏倚风险评估工具对纳入文献进行质量评价,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入5项RCT,共计4511例患者。Meta分析结果显示,两组患者主要心血管不良事件发生率[OR=0.85,95%CI(0.68,1.04),P=0.12]、心血管原因死亡率[OR=0.76,95%CI(0.57,1.03),P=0.08]、脑卒中发生率[OR=0.77,95%CI(0.48,1.24),P=0.28]比较,差异均无统计学意义;试验组患者主要出血事件发生率[OR=1.54,95%CI(1.19,1.99),P=0.001]、次要出血事件发生率[OR=1.80,95%CI(1.40,2.32),P<0.00001]均显著高于对照组。结论:替格瑞洛在降低东亚ACS患者的主要心血管不良事件、心血管原因死亡以及脑卒中的发生风险等方面的作用与氯吡格雷相当,但该药会增加患者主要出血、次要出血事件的发生风险。     

Comparison of two preventive dual antiplatelet regimens for unruptured intracranial aneurysm embolization with flow diverter/disrupter: A matched-cohort study comparing clopidogrel with ticagrelor

PurposeStandard dual antiplatelet therapy (DAPT) for complex aneurysms treated with flow diversion and flow disruption is acetylsalicylic acid (ASA) plus clopidogrel. However, clopidogrel resistance frequently occurs and can lead to thromboembolic events. Ticagrelor is an alternative not requiring platelet inhibition testing. We compared two DAPT regimens (ASA with clopidogrel or ticagrelor) on morbi-mortality, safety and efficacy of unruptured aneurysm embolization with flow diverter/disrupter.Materials and methodsThis retrospective analysis of a 1:1 matched cohort compares patients treated with ASA + clopidogrel (March 2013–December 2015) vs. ASA + ticagrelor (January 2016–March 2017). No platelet inhibition testing was conducted. Patients matched for age (±10 years), type of treatment and aneurysm sac size ( ± 2 mm). Primary outcome measures were morbidity and mortality at 1-month; secondary outcomes were thromboembolic and hemorrhagic complications [on angiography and magnetic resonance imaging (MRI)] and groin complications. Outcomes were compared using bivariate analyses.ResultsNinety patients fulfilled inclusion criteria, of which 80 remained after matching (40 per group). There was no statistical difference in 1-month morbidity between the ticagrelor and clopidogrel groups (2.5% vs. 10%, P = 0.36) and no deaths reported. We observed no significant differences between ticagrelor and clopidogrel groups in terms of angiographic thromboembolic complications (5% vs. 12.5%, P = 0.43), territorial infarction on DWI (2.5% vs. 7.5%, P = 0.61), angiographic (0% vs. 0%, P = 1) and MRI (5% vs 5%, P = 1) hemorrhagic complications, new microbleeds (57.5% vs. 40%, P = 0.12) and groin puncture complications (2.5% vs. 0%, P = 1). At three months, there was no delayed territorial infarction or hemorrhage in either group.ConclusionsTicagrelor is safe and effective in replacing clopidogrel as DAPT for unruptured aneurysms.     

Therapeutic experience of ticagrelor in Indian patients with acute coronary syndrome: A non-interventional,prospective, and observational study

ObjectiveThis observational study was designed to understand the usage pattern of ticagrelor in real-life clinical practice among a large number of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or medical management (MM). The study also recorded clinical events, i.e., bleeding, dyspnea, and cardiovascular (CV) events, reported by the investigator during the follow-up period.MethodsThe ACS patients aged ≥18 years hospitalized for ACS and were prescribed ticagrelor upon discharge or ≤1 month and patients who underwent PCI, CABG, or MM for ACS were enrolled. The subjects were followed up for a period of up to 12 months. The data were collected on a case report form.ResultThe study recruited 2997 subjects from 49 sites in India. Approximately half of the ACS subjects had ST segment elevation myocardial infarction (48.9%), and PCI was used as management in 92.4% subjects. The mean (±SD) duration of use of ticagrelor was 314 (±110.2) days over a period of 12 months. Of 136 subjects (4.5%) who experienced any clinical events, CV deaths were reported in 20 (0.7%), myocardial infraction in 19 (0.6) subjects and ischemic stroke in 23 (0.8%) subjects, and severe dyspnea was reported in 68 (2.2%) subjects. Out of 33 bleeding cases, 25 (0.8%) subjects had thrombolysis in myocardial infarction (TIMI) minimal, seven (0.2%) had TIMI minor, and one TIMI major. Platelet inhibition and patient outcomes (PLATO) major was reported in two subjects and CABG bleed in one subject. The incidence of PLATO defined major and minimal bleeding were lower in subjects undergoing fibrinolysis than overall population.ConclusionTicagrelor has been used across ACS types and in different management strategies in real world settings in India. The incidence of clinical events was lower as compared with data in literature. ClinicalTrials.gov Identifier: NCT02408224     

血栓弹力图评价替格瑞洛和氯吡格雷在急性ST段抬高型心肌梗死中抗血小板的疗效

目的:通过血栓弹力图评价替格瑞洛和氯吡格雷在急性ST段抬高型心肌梗死(STEMI)中抗血小板的疗效。方法:60例STEMI患者分为两组,阿司匹林+氯吡格雷组(Ⅰ组,n=30)和阿司匹林+替格瑞洛组(Ⅱ组,n=30),于抗血小板药物负荷剂量给药2 h后和维持治疗3个月后,使用血栓弹力图检测花生四烯酸(AA)途径和二磷酸腺苷(ADP)受体途径诱导的血小板抑制率。结果:抗血小板药物负荷剂量给药2 h后和维持治疗3个月后,Ⅱ组ADP受体途径诱导的血小板抑制率均明显高于Ⅰ组[(54.67±5.83)%对(45.75±16.72)%,P0.05;(59.53±12.18)%对(45.10±16.26)%,P0.05],AA途径诱导的血小板抑制率两组间无明显差异,患者的出血和缺血事件发生率两组间无明显差异。结论:替格瑞洛较氯吡格雷在STEMI治疗中能更快速充分地抑制血小板,血栓弹力图可用于指导STEMI患者抗血小板治疗。     

替格瑞洛对急性冠状动脉综合征患者血小板聚集的影响

目的比较替格瑞洛和氯吡格雷对急性冠状动脉综合征(ACS)患者血小板聚集的影响。方法 81例ACS患者被随机分为替格瑞洛组(A组,41例)和氯吡格雷组(B组,40例),比较两组服药前和服药后1、2、4、8、24h及治疗第7天的血小板最大聚集率(PMAR)、血小板聚集抑制率(IPA)及出血事件。结果两组服药前PMAR水平相近(P>0.05)。A组患者服药期间的PMAR均低于B组(P<0.01),IPA及IPA≥50%的患者比例均高于B组(P<0.01)。B组服药后2h的IPA低于服药后8h(P<0.01),而A组两个时间段IPA差异无统计学意义(P>0.05)。两组均只有轻微出血事件。结论在ACS患者,替格瑞洛较氯吡格雷更能有效地抑制血小板聚集;两药短期的安全性相仿。     

经皮冠脉介入法围术期替格瑞洛联合替罗非班抗血小板出血风险临床观察

目的:观察经皮冠脉介入法(percutaneous coronary intervention,PCI)围术期替格瑞洛联合替罗非班抗血小板出血风险。方法:回顾性分析我院急性冠脉综合征并成功完成PCI手术的患者328例,其中替格瑞洛组172例,氢氯吡格雷组156例,所有患者均在术后给予替罗非班11.5 h,并长期口服阿司匹林100 mg,1次/d。分析患者临床资料观察PCI术后30 d内出血情况。结果:两组患者间一般情况、危险因素、临床资料、临床用药及PCI数据等均无统计学意义。替格瑞洛联合替罗非班组和氢氯吡格雷联合替罗非班组,两组均未见致命性出血患者。替格瑞洛组发生非致命性出血发生率为9.30%;氯吡格雷组为7.05%,两组比较差异无统计学意义(χ2=0.157,P>0.05)。结论:与氢氯吡格雷相比,PCI术后替格瑞洛联合替罗非班不会增加患者的出血风险。     

急性ST段抬高型心肌梗死急救治疗中应用替格瑞洛与阿司匹林的临床价值

目的研究替格瑞洛联合阿司匹林治疗急性ST段抬高型心肌梗死(STEMI)患者的临床价值。方法选择2014年2月至2017年2月期间我院收治的68例急性STEMI患者,随机分为两组各34例。对照组采用氯吡格雷联合阿司匹林治疗,观察组采用替格瑞洛联合阿司匹林治疗。观察两组患者的心功能情况以及血常规指标。结果治疗前,两组的LVEF、 WMSI、 cTnI水平比较无统计学差异(P>0.05);治疗后,观察组的LVEF水平高于对照组, WMSI、 cTnI水平均低于对照组(P均<0.05)。治疗前,两组患者的PLT、 MPV、 HCT、 WBC水平比较无统计学差异(P>0.05);治疗后,观察组的PLT水平高于对照组(P <0.05),但两组的MPV、 HCT、 WBC水平比较无统计学差异(P>0.05)。结论替格瑞洛联合阿司匹林治疗急性STEMI患者的效果较好,能明显改善患者的心功能,抑制血小板,值得临床应用推广。     

替格瑞洛在急性冠脉综合征患者介入治疗中的近期疗效评价

目的 探讨替格瑞洛对急性冠脉综合征(acute coronary syndrome,ACS)患者介入治疗近期临床疗效的影响.方法 将入选的拟行冠状动脉支架植人术(percutaneous coronary intervention,PCI)的ACS 283例患者随机分为对照组(氯吡格雷+常规治疗)和试验组(替格瑞洛+常规治疗).检测两组PCI治疗前后TIMI血流分级、血小板聚集率和血小板计数;随访30 d,记录心血管不良事件(MACE)发生率;观察治疗后出血并发症的发生率.结果 两组患者PCI术前TIMI血流分级比较,差异无统计学意义(P＞0.05),术后试验组TIMI血流3级例数明显高于对照组(P＜0.05);PCI术后试验组血小板聚集率为0.27±0.08,明显低于对照组的0.37±0.09(P＜0.05);术后随访30 d,与对照组比较,试验组MACE发生率明显低于对照组(P＜0.05);而对照组与试验组出血并发症发生率无明显差异(P＞0.05).结论 对于行PCI的ACS患者,替格瑞洛能有效改善患者术后TIMI血流分级,降低血小板聚集率,改善近期临床疗效,且不增加出血风险.     

急性ST段抬高型心肌梗死患者直接PCI术后口服替格瑞洛与氯吡格雷疗效比较

目的评估替格瑞洛对接受直接经皮冠状动脉介入术(PCI)的急性ST段抬高型心肌梗死(STEMI)患者抗血小板治疗的临床疗效及安全性。方法入选诊断STEMI并行直接PCI的164例患者,随机分为替格瑞洛组(40例)和氯吡格雷组(124例)。根据治疗后第5天血小板聚集率结果进而将氯吡格雷组分为非氯吡格雷抵抗(CPGR)组(81例)和CPGR组(43例),CPGR组患者改服替格瑞洛。随访3个月,分析替格瑞洛组和非CPGR组用药后5天、1个月、3个月血小板聚集率、主要不良心血管事件(MACE)(心源性死亡、非致死性心肌梗死、卒中、靶血管再次血运重建、支架内血栓形成、再发心绞痛、心功能不全)和药物不良反应(出血、呼吸困难)发生情况;分析CPGR组换药前后血小板聚集率变化。结果替格瑞洛组治疗后第5天、1个月、3个月的血小板聚集率均明显低于非CPGR组(33.94%±14.90%比53.13%±14.07%,25.26%±8.89%比35.51%±9.45%,24.91%±7.55%比31.57%±9.53%),差异有统计学意义(P0.05);CPGR组换用替格瑞洛1个月后血小板聚集率明显降低(28.33%±8.11%比64.50%±11.38%),差异有统计学意义(t=18.944,P0.05)。随访3个月,替格瑞洛组MACE、轻中度呼吸困难发生率较非CPGR组明显降低,且差异有统计学意义(P0.05)。两组患者在轻微出血方面差异无统计学意义(P0.05)。两组患者均无严重出血及重度呼吸困难者。结论替格瑞洛抗血小板作用明显优于氯吡格雷,且对于CPGR患者安全有效,不良反应较轻微,安全性好。