替格瑞洛对冠心病患者经皮冠状动脉介入治疗术后冠脉微循环功能的影响

目的研究替格瑞洛对冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)术后冠脉微循环功能的影响。方法选取2013年9月至2014年9月在我院进行PCI手术的冠心病患者76例为研究对象,抽签随机分为观察组(替格瑞洛)与对照组(氯吡格雷),每组38例。两组入院后均进行药物治疗与常规护理,住院期间均给予扩冠、他汀类药物、B他受体阻断剂、低相对分子质量肝素。两组术前均给予阿司匹林肠溶片,对照组加入氯吡格雷联合治疗,观察组加入替格瑞洛联合治疗。比较两组治疗前后凝血酶元时间(PT)、血小板聚集率(PAgT)和纤维蛋白原(Fbg)含量、循环抵抗指数(IMR)、冠脉血流储备(CFR);观察治疗期间出血事件发生情况;电话和门诊随访治疗后6个月、1年、2年心血管事件发生率。结果治疗后观察组PT、PAgT和Fbg值(P0.05);观察组治疗后的IMR值为(26.80±5.97),显著低于对照组(29.87±6.14),CFR值为(2.23±0.51),显著高于对照组(1.84±0.44)(P0.05);观察组治疗期间出血事件发生率为2.63%,明显低于对照组15.79%(P0.05),观察组治疗后6个月、1年、2年内心血管不良事件发生率分别为5.26%、10.53%、13.16%,均显著低于对照组21.05%、28.95%、34.21%(P0.05)。结论对冠心病患者PCI术后给予替格瑞洛抗血小板治疗,可获得优于氯吡格雷对凝血功能与冠脉微循环功能的改善效果,并降低短期、中远期心血管不良事件的发生率。     

雷贝拉唑在急性心肌梗死患者经皮冠状动脉介入术后预防消化道出血的效果分析

目的 观察雷贝拉唑用于减少急性心肌梗死患者术后消化道出血的临床疗效.方法 纳入2014年1月-2015年6月桂林市人民医院收治的急性心肌梗死患者120例,按用药方法将其分为治疗组和对照组,每组60例.所有患者均行经皮冠状动脉介入治疗,对照组给予阿司匹林和替格瑞洛治疗,治疗组在对照组基础上给予雷贝拉唑治疗.对比两组术后4周内消化道出血发生率,分析两组治疗前后不同时点的血小板计数(blood platelet,PLT)、外周血红细胞计数(red blood cell,RBC)和血红蛋白(hemoglobin,Hb)水平变化.结果 治疗组术后4周内消肖化道出血发生率显著低于对照组(P＜0.05).术后2周和4周,治疗组PLT、RBC和Hb水平均高于对照组(P＜0.05).两组不良反应总发生率比较差异无统计学意义(P＞0.05).结论 雷贝拉唑可减少急性心肌梗死患者经皮冠状动脉介入治疗术后消化道出血的风险,效果明显,且不良反应少.     

替格瑞洛用于急性冠脉综合征患者疗效与安全性的回顾性评价

摘 要 目的：评价替格瑞洛用于急性冠脉综合征（ACS）患者抗血小板治疗的疗效与安全性。方法: 采用回顾性研究方法,收集本院2015年7～12月诊断为ACS并应用替格瑞洛治疗的病例,记录患者的基本信息、用药情况、ADP诱导的血小板聚集率、心血管不良事件(心源性死亡、非致死性心肌梗死、靶血管血运重建、支架内血栓形成）、药品不良反应发生情况,计算终点事件发生率并利用SPSS软件对服药前后ADP诱导的血小板聚集率变化进行分析。结果: 共收集有效病例161例,心血管不良事件的发生率为1.2%,不良反应事件发生率为30.4%,其中出血事件发生率为15.5%,但无主要出血事件;呼吸困难发生率10.6%,严重呼吸困难3例。对122例氯吡格雷低反应患者服用替格瑞洛前后血小板聚集率进行统计,分别为（54.96±14.654）%和（24.37±13.183）%（P<0.01）。结论:推荐剂量的替格瑞洛用于ACS患者可以使ADP诱导的血小板聚集率进一步降低;虽然不良反应发生率较高,但程度较轻,药物耐受性较好。     

不稳定型心绞痛患者经皮冠状动脉介入治疗中使用替格瑞洛的疗效与安全性分析

目的探讨不稳定型心绞痛(unstable angina pectoris,UAP)患者经皮冠状动脉介入治疗(percutaneous coro nary intervention,PCI)中使用替格瑞洛的疗效与安全性。方法选取2015年1月~2017年1月在本院择期行PCI的121例不稳定型心绞痛患者,采用简单随机的方法分将其分为观察组(n=60)和对照组(n=61)。两组患者在术前和术后均给予阿司匹林,观察组在此基础上口服替格瑞洛,对照组增加服用氯吡格雷,联合使用6个月。观察指标包括随访6个月的主要不良心血管事件(major adverse cardiovascular events,MACE)和TIMI(thrombolysis in myocardial infarction)出血分级以及患者治疗前后血压、血常规及血脂指标。结果对两组患者进行为期半年的随访,其中两组主要不良心血管事件发生率差异有统计学意义(P0.05)。两组患者的总出血发生率差异无统计学意义(P0.05)。两组患者治疗前血压、血常规及血脂指标对比无显著差异(P0.05);治疗后观察组患者的血压、血常规及血脂指标明显优于对照组,差异均有统计学意义(P0.05)。结论替格瑞洛较氯吡格雷降低了出血风险及优化了生理指标,更加有利于保障择期行PCI不稳定型心绞痛患者的安全性。     

Efficacy and safety of ticagrelor versus clopidogrel with different dosages in acute coronary syndrome patients with high GRACE and CRUSADE scores

ObjectiveTo investigate the efficacy and safety of ticagrelor and different dosages of clopidogrel after acute coronary syndrome.MethodsWe compared different antiplatelet strategies for the prevention of cardiovascular events in 1939 patients admitted to the hospital with an acute coronary syndrome undergoing percutaneous coronary intervention (PCI).ResultsAt 24 months, a survival analysis showed that ticagrelor and double-dose clopidogrel decreased the incidence of MACCE (a composite of all-cause death, myocardial infarction (MI), target vessel revascularization and stroke) (p < 0.001, p = 0.012, respectively). Although double-dose clopidogrel obviously increased the risk of major bleeding (p < 0.001), a similar result was not observed in the ticagrelor group (p = 0.398). These two stronger antiplatelet strategies also decreased the incidence of myocardial infarction (p = 0.004 and 0.045, respectively). The advantages of ticagrelor are also evident in the endpoints of all cause death and target vessel revascularization. The NACCE (a composite of all-cause death, MI, stroke and major bleeding) rate was also reduced in the ticagrelor group (p = 0.004).ConclusionsIn PCI patients with a high ischemic and bleeding risk, the ticagrelor antiplatelet strategy significantly reduced the MACCE rate without increasing the risk of major bleeding. A decreased MACCE rate was also observed in patients administered the double dosage of clopidogrel, but the bleeding risk was increased compared with the control group.     

Annual Incidence of Confirmed Stent Thrombosis and Clinical Predictors in Patients With ACS Treated With Ticagrelor or Prasugrel

Introduction and objectives

There is little evidence on rates of stent thrombosis (ST) in patients receiving dual antiplatelet therapy (DAPT) with ticagrelor or prasugrel. The aim of this study was to analyze the incidence and predictors of ST after an acute coronary syndrome among patients receiving DAPT with ticagrelor vs prasugrel.

替格瑞洛导致呼吸困难的1例分析

替格瑞洛为新型的抗血小板药物,具有起效快速和作用可逆的特点,ACS（AcuteCoronarySyndromes）患者不论接受PCI术后或仅接受替格瑞洛保守治疗,与氯吡格雷相比,均可显著降低心血管事件,且未见出血风险增加。但该药可使部分ACS患者出现呼吸困难与心动过缓,在临床上应引起重视。本文就1例替格瑞洛导致ACS患者呼吸困难的病例进行分析．并提出临床药师的体会和建议。     

Infarto de miocardio con elevación del segmento ST revascularizado. Tendencias temporales de los tratamientos contemporáneos y su impacto en los resultados

Introduction and objectivesTo assess, in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention, the pace of introduction in clinical practice (2010-2017) of drug-eluting stents (DES), ticagrelor, prasugrel, and prolonged dual antiplatelet therapy (DAPT) duration, and their potential impact on the risk of 2-year outcomes.MethodsProspective and exhaustive community-wide cohort of 14 841 STEMI patients undergoing primary percutaneous intervention between 2010 and 2017. Index episodes were obtained from the Catalan Codi IAM Registry, events during follow-up from the Minimum Data Set and DAPT were defined by pharmacy dispensation. Follow-up was 24 months. The temporal trend for exposures and outcomes was assessed using regression models.ResultsAge > 65 years, diabetes, renal failure, previous heart failure, and need for anticoagulation at discharge were more frequent in later periods (P < .001). From 2010 to 2017, the use of DES increased from 31.1% to 69.8%, ticagrelor from 0.1% to 28.6%, prasugrel from 1.5% to 23.8%, and the median consecutive months on DAPT from 2 to 10 (P < .001 for all). Adjusted analysis showed a temporal trend to a lower risk of the main outcome over time: the composite of death, acute myocardial infarction, stroke and repeat revascularization (absolute odds reduction 0.005% each quarter; OR, 0.995; 95%CI, 0.99-0.999; P = .028). The odds of all individual components except stroke were reduced, although significance was only reached for revascularization.ConclusionsDespite a strong increase between 2010 and 2017 in the use and duration of DAPT and the use of ticagrelor, prasugrel and DES, there was no substantial reduction in major cardiovascular outcomes.Full English text available from:www.revespcardiol.org/en