替格瑞洛在氯吡格雷抵抗复杂 PCI患者中的疗效

目的：通过血栓弹力图（ TEG）评价替格瑞洛在氯吡格雷抵抗复杂PCI术后患者中的抗血小板疗效。方法：纳入2013年4月至2013年12月入北京安贞医院行择期经皮冠状动脉介入（PCI）的复杂病变患者34例。所有患者经改良TEG法证实为氯吡格雷抵抗。氯吡格雷抵抗定义为二磷酸腺苷（ADP）诱导的血小板抑制率＜30％。将氯吡格雷更换为替格瑞洛负荷量180mg，随后改为90mg每天2次。出院1周后门诊复查TEG。结果：服用替格瑞洛后TEG显示ADP 抑制率从（21．5±5．0）％增加至（56．6±16．7）％（P＜0．001），有85．3％（29例）的患者 ADP 抑制率＞30％。结论：替格瑞洛能够有效提高氯吡格雷抵抗复杂PCI患者ADP诱导血小板聚合抑制率。

Response to Ticagrelor in Complex PCI Patients with Clopidogrel Resistance

Objective：To investigate the antiplatelet effects of ticagrelor in complex percutaneous coro-nary intervention （PCI） patients with clopidogrel resistance.Method： From April 2013 through December 2013, 34 complex PCI patients with clopidogrel resistance were enrolled .Platelet reactivity was measured by using the modified TEG platelet mapping system （ Haemonetics Corp , Massachusetts , USA） according to the manufacturer’s instructions.The cut-off values of inhibition of platelet aggregation （IPA） 〈30%to define clopidogrel resistance have been used .Patients received 180mg ticagrelor load followed by 90mg twice daily maintenance therapy .Percent platelet inhibition was remeasured one week after discharge .Result： The IPA was increased from （21.5±5.0）%to （56.6±16.7）%（P〈0.001）after switching from clopidogrel to ticagrelor . 29 （85.3%） patients had an adequate response to ticagrelor （IPA ＆gt;30%）.Conclusion：Effective IPA can be achieved by ticagrelor in complex PCI patients with clopidogrel resistance .