Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA.
Am Heart J. 2011 Apr;161(4):689-97. doi: 10.1016/j.ahj.2010.12.025.
A higher loading dose of clopidogrel achieves a more rapid and consistent degree of platelet inhibition than standard dosing, although the clinical benefit of higher doses has not been clearly established. The use of the different doses in clinical practice is not known. We evaluated the patient, procedural, and hospital characteristics associated clopidogrel loading doses given to patients with non-ST-segment elevation myocardial infarction (NSTEMI).
The National Cardiovascular Data Registry ACTION Get With the Guidelines Registry was queried for patients with NSTEMI admitted from 2007 to 2008. Demographic, clinical, and procedural information were collected on standardized data forms. Patients were categorized according to the clopidogrel loading dose received. Temporal trends in the use of different doses were evaluated in quarterly time intervals.
Between January 1, 2007, and December 31, 2008, the use of a 600-mg clopidogrel loading dose increased steadily from 36.4% to 45.5%, whereas the use of 300 mg decreased slightly from 40.1% to 37.1%. Patients loaded with clopidogrel before cardiac catheterization were more likely to receive 300 mg, whereas those receiving a loading dose at the time of catheterization more often received 600 mg. The temporal increase in the use of 600 mg clopidogrel loading doses was not explained by temporal changes in periprocedural loading, use of early invasive management of patients with NSTEMI, or use of antithrombotics or glycoprotein 2b/3a inhibitors.
Higher loading dose clopidogrel increased between 2007 and 2008. Higher-dose clopidogrel was more frequently used in lower-risk patients undergoing an early invasive strategy and receiving periprocedural loading.
与标准剂量相比，氯吡格雷的高负荷剂量可实现更快速和一致的血小板抑制程度，但高剂量的临床益处尚未明确确立。在临床实践中使用不同剂量的情况尚不清楚。我们评估了与接受非 ST 段抬高型心肌梗死（NSTEMI）的患者给予氯吡格雷负荷剂量相关的患者、程序和医院特征。
从 2007 年至 2008 年，国家心血管数据注册中心 ACTION Get With the Guidelines 注册中心对 NSTEMI 入院患者进行了查询。收集了标准化数据表格上的人口统计学、临床和程序信息。根据患者接受的氯吡格雷负荷剂量对其进行分类。每季度评估不同剂量使用的时间趋势。
在 2007 年 1 月 1 日至 2008 年 12 月 31 日期间，600mg 氯吡格雷负荷剂量的使用从 36.4%稳步增加到 45.5%，而 300mg 的使用从 40.1%略微下降到 37.1%。在进行心脏导管插入术之前接受氯吡格雷负荷治疗的患者更有可能接受 300mg，而在导管插入术时接受负荷剂量的患者更常接受 600mg。600mg 氯吡格雷负荷剂量使用的时间增加不能用围手术期负荷、NSTEMI 患者早期侵入性管理的使用、或抗血栓药物或糖蛋白 2b/3a 抑制剂的使用的时间变化来解释。
2007 年至 2008 年期间，更高剂量的氯吡格雷增加。在接受早期侵入性策略和接受围手术期负荷的低风险患者中，更频繁地使用高剂量氯吡格雷。
