血栓弹力图检测老年冠心病患者经皮冠状动脉介入治疗后血小板反应性

目的探讨经皮冠状动脉介入治疗术后,经血栓弹力图检测的氯吡格雷药物抵抗患者,不同药物剂量治疗下血小板反应性。方法筛选120例阿司匹林抑制良好而氯吡格雷抑制不敏感的患者,随机分为试验组(60例)和对照组(60例),对照组每天服用100 mg阿司匹林及75 mg氯吡格雷,试验组服用100 mg阿司匹林及150 mg氯吡格雷,检测6个月后氯吡格雷的作用效果,观察2组间6个月内心血管事件及出血事件的发生率。结果试验组心血管死亡、支架内血栓形成、不稳定性心绞痛、心肌梗死发生率分别为0,8.3%,21.7%,8.3%;对照组分别为3.3%,18.3%,35.0%,15.0%,试验组患者氯吡格雷药物抑制率较对照组明显升高(65.6±5.1)% vs (40.9±7.3)%,差异有统计学意义(P0.01)。结论对于血小板高反应性老年患者,每天75 mg氯吡格雷不能满足血小板抑制效果,长期加倍剂量服用能够在一定程度上有效减低药物抵抗发生率,改善血小板抑制效果,从而降低心血管缺血事件的发生率。

Evaluation of platelet reactivity by thromboelastogram in elderly patients after percutaneous coronary intervention

Objective To investigate platelet reactivity measured by thromboelastogram in patients with clopidogrel resistance treated with different dosages of the drug after percutaneous coronary intervention(PCI).Methods 120 patients who were sensitive to aspirin and not sensitive to clopidogrel were randomly divided into two groups,and given 100 mg aspirin plus 75 mg clopidogrel daily in control group(CON) and 100 mg aspirin plus 150 mg clopidogrel in test group.A 6-month follow-up was carried out to examine the change of effect of antiplatelet therapy,the incidence of bleeding,and to estimate the relationship between platelet aggregation inhibition rate and the incidence of cardiovascular ischemic events.Results After 6-month antiplatelet therapy,the platelet aggregation inhibition rate of clopidogrel in test group was significantly higher than that in CON group[(65.6 ± 5.1) % is (40.9 ± 7.3) %,P < 0.01].The incidences of cardiovascular ischemic events including cardiovascular death,in-stent thrombosis,recurrent unstable angina and myocardial infarction in test group were 0,8.3%,21.7% and 8.3% respectively,decreased significantly as compared with those in CON group(3.3%,18.3%,35.0% and 15.0%,P < 0.01).Conclusion According to the result of thromboelastograph determinations,daily 75 mg clopidogrel can not reach a satisfactory platelet inhibition effect in patients who were not sensitive to clopidogrel.A maintenance loading dose of antiplatelet therapy with 150 mg clopidogrel daily can decrease the rate of recurrent cardiovascular ischemic events effectively.