超负荷量氯吡格雷对急诊经皮冠脉介入治疗患者围术期的影响

目的:对比研究拟行急诊冠脉介入治疗(PCI)患者术前服用超负荷量氯吡格雷(600 mg)与常规负荷量(300 mg)预处理的近期疗效及安全性。方法:选择2007年1月至2009年12月行急诊PCI治疗的急性心肌梗死患者60例,随机分为常规负荷量组(300 mg,n=30)和超负荷量组(600 mg,n=30),入院后两组立即分别服用氯吡格雷300 mg和600 mg。观察术后28天内主要临床心血管事件(包括亚急性支架内血栓形成、死亡、心肌梗死、紧急靶血管血运重建)和出血事件。结果:氯吡格雷600 mg组28天主要心血管事件发生率较300 mg组显著减少(3.3%vs 20.0%,P<0.05),而两组28天出血事件发生率无显著差异(20.0%vs13.3%,P>0.05)。结论:超负荷量氯吡格雷(600 mg)预治疗与常规负荷量(300 mg)相比,可显著改善急性心肌梗死行急诊PCI患者的近期疗效,且安全性相似。

Short-term outcomes of high loading dose clopidogrel pretreatment before emergent percutaneous coronary intervention in patients with acute myocardial infarction

Objective:To compare the short-term efficiency and safety of high loading dose(600 mg) clopidogrel pretreatment with that of routine loading dose(300 mg) before emergent percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI).Methods:60 patients with AMI were divided into 600 mg group and 300 mg group randomly between January 2007 and December 2009.The two groups received 600 mg or 300 mg clopidogrel respectively before undergoing emergent PCI.The incidence of major cardiovascular events(including subacute in-stent thrombosis,death,myocardial infarction,urgent target vessel revascularization) and hemorrhagic events were followed up to 28 days after the procedure.Results:The incidence of major cardiovascular events in 600 mg group was significantly less than that in 300 mg group(3.3% vs 20.0%,P<0.05).The occurrence of bleeding events between the two groups had no significant difference(20.0% vs 13.3%,P>0.05).Conclusion:Compared with the routine 300 mg loading dose,600 mg high loading dose of clopidogrel as pretreatment before emergent PCI in patients with AMI is safe and more efficient in improving clinical outcomes at 28 days after stenting.