应用血栓弹力图评估ACS患者替格瑞洛与氯吡格雷抗血小板的疗效

目的通过血栓弹力图(TEG)检测血小板聚集率,观察接受双联抗血小板药物治疗的急性冠状动脉综合征(ACS)患者应用替格瑞洛或氯吡格雷的抗血小板疗效。方法选取清华大学第一附属医院心脏中心住院的84例急性冠状动脉综合征患者,随机分为两组,氯吡格雷组(n=42)与替格瑞洛组(n=42),通过TEG检测方法比较两组患者服用氯吡格雷和替格瑞洛后的血小板抑制率情况。结果氯吡格雷组中11例出现氯吡格雷抵抗,发生率为26.19%,替格瑞洛组中1例患者出现替格瑞洛抵抗,发生率为2.38%,两组发生率的比较差异有统计学意义(χ2=9.722,P=0.002);氯吡格雷组中有1例(2.38%)发生阿司匹林抵抗;替格瑞洛组中有2例(4.76%)发生阿司匹林抵抗,两者发生率比较差异无显著统计学意义(χ2=0.346,P=0.557)。结论接受标准抗血小板治疗的部分急性冠状动脉综合征患者存在抗血小板抵抗,TEG监测结果显示,替格瑞洛的抗血小板聚集效果明显优于氯吡格雷。

Thrombelastography for reviewing antiplatelet efficacy of ticagrelor and clopidogrel in patients with acute coronary syndrome

Objective To observe the antiplatelet efficacy of ticagrelor or clopidogrel in the patients with acute coronary syndrome （ACS） treated with dual antiplatelet drug by using thrombelastography （TEG） for detecting platelet aggregation rate. Methods The patients with ACS （n=84） were randomly divided into clopidogrel group and ticagrelor group （each n=42）. The platelet aggregation rate was compared by using TEG between 2 groups after treatment with ticagrelor or clopidogrel. Results There were 11 patients （26.19%） had clopidogrel resistance in clopidogrel group, and 1 patient （2.38%） had ticagrelor resistance in ticagrelor group （χ2=9.722, P=0.002）. There was 1 patients （2.38%） had aspirin resistance in clopidogrel group, and 2 patients （4.76%） had aspirin resistance in ticagrelor group （χ2=0.346,P=0.557）. Conclusion Some ACS patients treated with standard antiplatelet therapy have antiplatelet resistance, and TEG outcomes show that the antagonizing effect of ticagrelor on platelet aggregation is better than that of clopidogrel.