不同维持量氯吡格雷对ACS患者血小板聚集功能影响的观察

目的评估不同维持剂量氯吡格雷对择期PCI的ACS患者血小板聚集率的影响,探讨高维持剂量氯吡格雷对ACS患者的有效性及安全性。方法选择接受药物治疗、择期PCI的急性冠脉综合征患者150例,随机分为2组(各75例),2组均服用300mg负荷量氯吡格雷,然后分别给予氯吡格雷150mg/d、75mg/d治疗14d,14d后所有患者接受75mg/d氯吡格雷治疗直至PCI术后1年。分别于服药前、服药后第14天采2组患者静脉血,采用光学比浊法测定血小板聚集率(PA),同时计算血小板聚集抑制率(PAI)。观察住院14天内2组终点事件发生情况。结果试验组和对照组服药前血小板聚集率的差别无统计学意义(89.63±4.89vs.90.27±4.84,p>0.05);试验组服药第14天的血小板聚集率较对照组明显下降(41.36±5.13vs.51.69±3.98,p<0.05),血小板聚集抑制率较对照组明显增强(48.27±6.29vs.38.58±5.48,p<0.05),均有统计学差异。住院14天内,两组均无心血管死亡、严重的颅内出血和严重血小板减少,亚急性血栓形成发生率(1.3%vs4.0%,P>0.05)相近,轻微出血发生率(2.7%vs4.0%,P>0.05)无统计学差异。结论对高危急性冠脉综合症患者,150mg/日高氯吡格雷维持量可以明显降低血小板聚集率,从而降低血栓事件,且不增加短期出血风险,具有较好的耐受性和安全性。

Effect of Different Maintenance Dose of Clopidogrel on Platelet Function in Patients with Acute Coronary Symptom

Objective To assess the efficacy and safety of the high clopidogrel maintenance dose in acute coronary syndromes （ACS） patients undergoing selective percutaneous coronary intervention（PCl）. Methods 150 ACS patients were randomly divided into 2 groups （75 cases in each group）. All Patients received a 300-mg loading dose of clopidogrel. Based on taking aspirin, clopidogrel were given 75mg/d or 150mg/d for 14 days. After 14 days, all patients received clopidogrel 75mg/d until 1 year after PCI. Respectively, before administration and at the 14 days, peripheral venous blood was collected to determine the ADP-induced platelet aggregation （PA） with turbidimetric method. At same time platelet aggregation in- hibition rate （PAl） was calculated. Primary endpoints included death, target organ revascularization. Secondary endpoints included serious and minor bleeding events. Results Before administration, PA had the non-significance difference （P〉0.05） between two groups, and at the 14th day, PA and PAl between two groups were significant different （P〈0.05）. Via 14 days follow up, the incidence of primary endpoint in 150 mg/d group was not obvi- ously lower than that in 75mg group （1.3% vs4.0%,P〉0.05）, and not higher in sub-end events （P〉0.05）. Conclusion The high maintenance dose clopi- dogrel （150mg per day） can strongly inhibit platelet aggregation and decrease the hemorrhage events, but not obviously decreases the risk of adverse events in 14 days.