氯吡格雷防治动脉粥样硬化缺血性疾病的研究进展

氯吡格雷防治动脉粥样硬化斑块破裂后血栓形成尤其是冠状动脉疾病及其经皮冠脉介入性治疗有了充足的临床试验证据,对于粥样斑块的形成和发展的相关依据正在进行,现就氯吡格雷全面预防和治疗动脉粥样硬化缺血性疾病的研究进展作一综述。     

氯吡格雷在缺血性心脏病中的应用

缺血性心脏病是威胁人类生命的主要病因,其发病率呈逐年上升趋势,目前认识到血小板在其中发挥关键作用,而新型抗血小板药物氯吡格雷可显著减少心脏不良事件。     

氯吡格雷联合阿司匹林治疗心肌梗塞临床观察

目的:观察氯吡格雷联合阿司匹林治疗心肌梗塞的临床疗效和安全性。方法:78例心肌梗塞患者随机分为观察组和对照组,两组均给予常规内科治疗,在此基础上,观察组加用氯吡格雷首剂300mg,随后75mg,1次/d,口服;阿司匹林0.3g,1次/d,口服,连用3d后,改为0.1g,1次/d,口服。半年为1个疗程。观察2组临床疗效及治疗半年后的心脏事件发生情况。结果:观察组总有效率为90%,对照组总有效率为84.2%,2组比较差异有统计学意义(P0.05)。观察组发生休克病人1例,对照组发生2例。观察组心电图及血液流变学均较对照组有明显改善。结论:氯吡格雷联合阿司匹林治疗心肌梗塞优于单一使用阿司匹林。     

Risk factors for bleeding after dental extractions in patients over 60 years of age who are taking antiplatelet drugs

The aim of this retrospective, single-centre study was to identify the risk factors for bleeding after dental extractions in patients aged over 60 who were being treated with antiplatelet drugs. A total of 338 patients who fulfilled the inclusion criteria were enrolled, and their personal and clinical details, and complications with bleeding after extraction, were retrieved and recorded. There were 182 men and 156 women (mean (SD) age 72 (8) years). A total of 469 teeth were extracted, with a mean (SD) of 1.4 (0.6) teeth/patient. Seventy-seven patients (23%) developed mild, and 55 (16%) severe, bleeding postoperatively. No patient developed a major cardiovascular or cerebrovascular event. We calculated the significance of the association of different variables with the occurrence of postoperative haemorrhage using a multivariate stepwise logistic regression model. The presence of three or more coexisting conditions, a complicated tooth extraction, and the use of two antiplatelet drugs were independent risk factors, while discontinuation of antiplatelet treatment four or more days before the tooth was extracted was a protective factor. This suggests that clinicians should assess the thrombotic risk associated with the interruption of antiplatelet drugs as well as the risk of bleeding for each patient before dental extraction. Strong and effective measures for haemostasis may be preferred over blind discontinuation of antiplatelet drugs. This study is registered in the Chinese Clinical Trial Registry (No. ChiCTR1800014355).     

Clopidogrel in acute coronary syndrome: implications of recent study findings

The platelet ADP receptor antagonist clopidogrel is recommended for the treatment of patients with acute coronary syndrome and/or percutaneous coronary intervention. Patients who received a coronary stent in particular should be protected by sufficient antiplatelet therapy to prevent stent thrombosis. Clopidogrel is a prodrug and has to undergo extensive metabolization before the active metabolite can irreversibly bind to platelets. This makes clopidogrel treatment susceptible to genetic and drug interactions. Recent study findings suggest that initial treatment with a higher dose of clopidogrel may be superior to the currently approved dose. It is not clear whether this approach will be sufficient to entirely overcome clopidogrel hyporesponsiveness, which worsens outcomes in up to one-third of patients. Newer antiplatelet agents are emerging but clopidogrel remains the best established treatment option, with more than 120,000 patients treated in randomized trials and 12 years of clinical postmarketing experience.