缺血性卒中患者因氯吡格雷低反应性改为高维持量及替格瑞洛后血小板抑制率变化

目的探讨用血栓弹力图评价符合双抗治疗的缺血性脑血管病患者,因氯吡格雷低反应性,改为高维持剂量及改服替格瑞洛后血小板抑制率的变化。方法选择符合双抗治疗的缺血性脑血管病患者联合应用抗血小板制剂(阿司匹林肠溶片100 mg/qd+氯吡格雷75 mg/qd)前及后7 d,用血栓弹力图检测患者的花生四烯酸(AA)和二磷酸腺苷(ADP)途径诱导的血小板抑制率,筛选出氯吡格雷低反应性者96例,随机分为3组,常规剂量组(氯吡格雷75 mg/qd,32例)、高维持量组(氯吡格雷150 mg/qd,32例)和替格瑞洛组(替格瑞洛90 mg/bid,32例),3组阿司匹林继续按原剂量服用。分组后3组按新方案治疗7 d,再次复查血栓弹力图。结果分组后高维持量组及替格瑞洛组ADP诱导的血小板抑制率较常规剂量组有显著性差异(P0.05),3组均未发生出血等严重不良事件,替格瑞洛组发生1例轻度呼吸困难。替格瑞洛组高于同一时间点高维持量组ADP途径诱导的血小板抑制率(P0.05)。结论针对常规剂量氯吡格雷的低反应性,替格瑞洛及双倍剂量的氯吡格雷均能有效降低血小板的高反应性,并且替格瑞洛的作用更为明显,且未增加出血等不良事件的发生。

Evaluation of changes in the rate of platelet inhibition to high maintenance dose clopidogrel and ticagrelor in patients with ischemic stroke for clopidogrel low-response

Objective To explore the change of platelet inhibition rate by thrombelastometry with dual antiplatelet therapy in patients with ischemic cerebrovascular disease ,due to low response to clopidogrel ,instead of high maintenance dose and ticagrelor .Methods Selected the patients with ischemic cerebrovascular disease who were treated with dual antiplatelet therapy (aspirin enteric coated tablets 100 mg/qd+clopidogrel 75 mg/qd),before and after 7 days,detected the platelet inhi-bition rate of arachidonic acid ( AA) and adenosine phosphate ( ADP) pathway induced by thromboelastography ,screened the low response to clopidogrel of 96 cases were randomly divided into 3 groups,the conventional dose group (clopidogrel 75 mg/qd,32 cases),high maintenance dose group (clopidogrel 150 mg/qd,32 cases) and ticagrelor group (ticagrelor 90 mg/bid,32 cases),3 groups of aspirin continued to take the original dose .The three groups according to the new program for 7 days, checked again by thrombelastograph .Results The high maintenance dose group and the ticagrelor group ADP-induced plate-let inhibition rate had significant difference than the conventional dose group (P<0.05),3 groups were not bleeding and oth-er serious adverse events occur ,only 1 patient occurred mild breathing difficulties in the ticagrelor group .ADP-induced plate-let inhibition rate of the ticagrelor group was higher than the high maintenance dose group in the same time (P<0.05). Conclusion For conventional dose clopidogrel low reactivity ,ticagrelor and double dose of clopidogrel can effectively reduce high platelet reactivity ,and ticagrelor is more obvious without increasing bleeding and other adverse events .