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伊朗经皮冠状动脉介入治疗患者氯吡格雷的血小板反应模式。

The pattern of platelet response to clopidogrel in Iranian patients after percutaneous coronary intervention.

机构信息

Department of Pharmacotherapy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

出版信息

J Clin Pharmacol. 2012 Jul;52(7):1098-105. doi: 10.1177/0091270011407499. Epub 2012 Jan 9.

Abstract

Despite certain clinical benefit in using clopidogrel in patients undergoing percutaneous coronary intervention (PCI), some patients do not attain adequate antiplatelet effects. In this study, the authors investigated the response to clopidogrel in Iranian patients after PCI. Patients who were candidates for elective PCI were enrolled in this study. All patients had received aspirin 80 to 325 mg daily for ≥1 week before PCI. Blood samples were taken from patients at baseline, 2 hours after taking a 600-mg loading dose of clopidogrel, and 24 hours and 30 days after stenting. Platelet aggregation was measured by light transmittance aggregometry with adenosine diphosphate (5 and 20 μM) and arachidonic acid (500 and 5000 μg/mL). One hundred twelve patients were included (79 men, 33 women). Maximal and minimal clopidogrel nonresponsiveness occurred at 2 hours (26%) and 48 hours (13%) after taking 600 mg clopidogrel, respectively. Pretreatment platelet reactivity had no effects on posttreatment platelet reactivity. Moreover, clopidogrel responsiveness did not correlate with pretreatment reactivity. Patients' demographic and procedural characteristics had no significant effect on clopidogrel responsiveness. The frequency of clopidogrel nonresponsiveness in this study was similar to other studies. However, clopidogrel required more than 2 hours for induction of its maximal antiplatelet effect in this study.

摘要

尽管在经皮冠状动脉介入治疗(PCI)的患者中使用氯吡格雷具有一定的临床益处,但有些患者并未达到充分的抗血小板作用。在这项研究中,作者研究了伊朗 PCI 后的患者对氯吡格雷的反应。这项研究纳入了符合择期 PCI 适应证的患者。所有患者在 PCI 前均已每日服用阿司匹林 80 至 325 毫克,至少 1 周。在基线、服用 600 毫克负荷剂量氯吡格雷后 2 小时以及支架置入后 24 小时和 30 天采集患者的血样。通过光传输聚集法用二磷酸腺苷(5 和 20 μM)和花生四烯酸(500 和 5000 μg/mL)测量血小板聚集。共纳入 112 例患者(79 例男性,33 例女性)。服用 600 毫克氯吡格雷后 2 小时(26%)和 48 小时(13%)时,最大和最小氯吡格雷无反应性分别出现。治疗前血小板反应性对治疗后血小板反应性无影响。此外,氯吡格雷反应性与治疗前反应性无关。患者的人口统计学和手术特征对氯吡格雷反应性无显著影响。这项研究中的氯吡格雷无反应率与其他研究相似。然而,在这项研究中,氯吡格雷需要超过 2 小时才能发挥其最大的抗血小板作用。

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