阿加曲班对急性脑梗死患者血小板功能的影响

目的探讨阿加曲班抗凝治疗对急性脑梗死患者血小板功能的影响及其可能的作用机制。方法将急性脑梗死患者60例分为阿加曲班组(30例)和对照组(30例)。2组均给予脑梗死基础治疗。在基础治疗上,阿加曲班组第1、2天给予阿加曲班120 mg/d,48 h持续静脉泵入,第3～7天给予阿加曲班20 mg,2次/d,抗凝治疗结束后加用氯吡格雷75 mg/d;对照组入院后即给予氯吡格雷75 mg/d,持续应用。测定2组治疗前后次日晨、48 h、第7、14天的血小板聚集率(PA),并观察治疗前后血小板计数、活化部分凝血酶时间的变化。结果阿加曲班组治疗后48 h、第7天的PA明显高于治疗前,治疗后第14天的PA明显低于治疗前(P<0.01)。对照组氯吡格雷治疗后次日晨、第7、14天PA明显低于治疗前(P<0.01)。阿加曲班组治疗前同治疗后次日晨、第7天PA差值与对照组治疗前同治疗后次日晨、第7天PA差值比较,差异有统计学意义(P<0.01)。结论急性脑梗死患者应用阿加曲班抗凝治疗时二磷酸腺苷诱导的PA增加。

Effect of argatroban on platelet function in acute cerebral infarction patients

Objective To study the effect of argatroban anticoagulation on platelet function and its probable mechanisms in acute cerebral infarction.Methods Sixty acute cerebral infarction patients were assigned to argatroban therapy group(30 cases) and clopidogrel therapy group(30 cases). All patients received the basic treatment for acute cerebral infarction.Patients in argatroban therapy group received continuous intravenous argatroban on first two days(120 mg/d),intravenous injection of argatroban 20 mg twice a day for the next 5 days,then received clopidogrel 75 mg/d after argatroban therapy.Patients in clopidogrel therapy group only received clopidogrel 75 mg everyday after hospitalization.The platelet aggregation(PA) was measured at baseline and the second morning,48~(th) hour,7~(th) day,and 14~(th) day.The platelet count and activated partial thromboplastin time at baseline and on 14~(th) day were observed.Results PA was significantly higher at 48~(th) hour and on 7~(th) day than baseline in patients of argatroban therapy group(P<0.01),while it was significantly lower on the second day morning,the 7~(th) day and the 14~(th) day than baseline in patients of clopidogrel therapy group(P<0.01).The PA difference between the second morning, the 7~(th) day after therapy and before therapy in argtroban therapy group was significantly different from that in clopidogrel therapy group(P<0.01).Conclusions The PA induced by adenosine diphosphate was significantly increased after intravenous argatroban in acute cerebral infarction.