国产氯吡格雷个体化用药在经皮冠状动脉介入术患者中使用的评价

目的通过观察经皮冠状动脉介入治疗（PCI）患者常规使用氯吡格雷后的血小板聚集率情况,并根据血小板聚集率以及是否存在PCI术后支架内血栓形成的高危因素来个体化调整氯吡格雷的使用剂量,以评价氯吡格雷的个体化用药在PCI术患者中使用的疗效及安全性。方法将在我院行PCI术的冠心病患者182例随机分为个体化用药组（88例）和常规用药组（94例）,两组术前3天起常规服用阿司匹林100 mg/d＋氯吡格雷75 mg/d或术前顿服阿司匹林300 mg＋氯吡格雷300 mg,术后两组均予氯吡格雷75 mg/d。常规用药组使用氯吡格雷75 mg/d维持至术后一年。而个体化用药组则可根据患者的血小板聚集率以及是否存在PCI术后支架内血栓形成的高危因素来调整氯吡格雷的用量。结果个体化用药组的出血并发症明显少于常规用药组（2/88比12/94,P〈0.01）。两组间主要心血管不良事件（MACE）的发生率差异无统计学意义（P〉0.05）,支架内再狭窄发生率差异无统计学意义（2/33比3/38,P〉0.05）。结论国产氯吡格雷在PCI患者中使用是有效并且安全的,而个体化调整氯吡格雷剂量能更进一步减少并发症,增加安全性。

Evaluation of the use of domestic clopidogrel in patients undergoing percutaneous intervention with individualized dose

Objective To study the rate of platelet aggregation in PCI patient who received domestic clopidogrel intially at a ronture dose,followed by individualized dose adjusted according to the platelet aggregation rate and the existance of other risk factors of thrombosis after the PCI.Methods A total of 182 patients with coronary artery disease who received PCI in our hospital were randomly divided into the individualized dose group（n=88） and the routine dose group（n=94）.Patients in both groups were given aspirin 100 mg/d＋clopidogrel 75 mg/d for three days prior to the operation or clopidogrel 300 mg＋aspirin 300 mg one-time right before operation.All patients were given clopidogrel 75 mg/d after operation.The routine dose group was given clopidogrel 75 mg/d for one year after operation.The individualized group adjusted the dose of clopidogrel according to the platelet aggregation rate and other risk factors.Results Compared with the routine dose group,incidence of bleeding complications in the individualized dose group was significantly lower（2/88 vs 12/94,P〈0.01）.There was no significant difference in the incidence of MACE between the 2 groups（P〉0.05） as well as in terms of stent restenosis（2/33 vs 3/38,P〉0.05）.Conclusion The use of domestic clopidogrel in PCI patients with individualized dose is safe and effective which can further reduce bleeding complications.