早期应用负荷剂量阿司匹林和氯吡格雷可降低行经皮冠状动脉介入治疗患者的复发性心血管缺血事件发生率。

Earlier application of loading doses of aspirin and clopidogrel decreases rate of recurrent cardiovascular ischemic events for patients undergoing percutaneous coronary intervention.

机构信息

Departments of Cardiology, 309th Hospital of Chinese People's Liberation Army, Beijing, China.

出版信息

Chin Med J (Engl). 2012 Feb;125(4):631-8.

Abstract

BACKGROUND

Aspirin and clopidogrel resistance plays a significant role in the development of cardiovascular ischemic events for ninety patients undergoing percutaneous coronary intervention. Recent studies have indicated that increasing the dose of antiplatelet drugs maybe a potent method to improve the inhibition of platelet aggregation.

METHODS

Thrombelastograph (TEG) determinations were used to evaluate the effect of antiplatelet therapy. According to the results, 90 patients were divided into three groups and given different doses of aspirin and clopidogrel. Thirty patients with both an inhibition rate of aspirin > 50% and an inhibition rate of clopidogrel > 50% were defined as the control group. Sixty patients with an inhibition rate for aspirin < 50% and an inhibition rate for clopidogrel < 50% were defined as the resistance group. Patients in resistance group were randomly assigned to be given a routine dose (100 mg aspirin plus 75 mg clopidogrel per day, which we called a resistance plus routine dose group, R + R) and a loading dose (200 mg aspirin and 150 mg clopidogrel per day, which we called resistance plus loading dose group, R + L) of antiplatelet therapy. A 12-month follow-up was observed to examine the change of inhibition rate of antiplatelet therapy and to estimate the relationship between inhibition rate and the occurrence of cardiovascular ischemic events.

RESULTS

After 6 months of antiplatelet therapy, the inhibition rate of aspirin in the R + L group increased from (31.4 ± 3.7)% to (68.6 ± 7.1)%, which was significantly higher than that in R + R group, (51.9 ± 8.2)% (P < 0.01). The inhibition rate of clopidogrel in the R + L group increased from (22.1 ± 3.8)% to (60.2 ± 7.4)%, which was significantly higher than in the R + R group, (45.9 ± 4.3)% (P < 0.01). The occurrence rates of cardiovascular ischemic events, stent thrombosis, recurrent unstable angina and myocardial infarction in the R + R group were 20%, 36% and 17%, respectively. Occurrence was significantly increased compared with that in the control group, 3%, 10% and 1%, respectively (P < 0.01). In contrast, the occurrence rates in the R + L group (10%, 23% and 6%, respectively) were attenuated compared with those in the R + R group (P < 0.01), although still higher than in the control group (P < 0.01).

CONCLUSIONS

Almost all of the cardiovascular ischemic events occurred in the first six months after percutaneous coronary intervention. According to the result of TEG determinations, earlier application of a loading dose of aspirin and clopidogrel can decrease the rate of recurrent cardiovascular ischemic events.

摘要

背景

阿司匹林和氯吡格雷抵抗在 90 例行经皮冠状动脉介入治疗的患者发生心血管缺血事件中起着重要作用。最近的研究表明，增加抗血小板药物的剂量可能是提高血小板聚集抑制作用的有效方法。

方法

使用血栓弹力图（TEG）测定来评估抗血小板治疗的效果。根据结果，将 90 例患者分为三组，并给予不同剂量的阿司匹林和氯吡格雷。将阿司匹林抑制率>50%且氯吡格雷抑制率>50%的 30 例患者定义为对照组。将阿司匹林抑制率<50%且氯吡格雷抑制率<50%的 60 例患者定义为抵抗组。抵抗组患者随机分为常规剂量（每天 100mg 阿司匹林加 75mg 氯吡格雷，我们称之为抵抗加常规剂量组，R+R）和负荷剂量（每天 200mg 阿司匹林和 150mg 氯吡格雷，我们称之为抵抗加负荷剂量组，R+L）抗血小板治疗。进行为期 12 个月的随访，以观察抗血小板治疗抑制率的变化，并评估抑制率与心血管缺血事件发生之间的关系。

结果

抗血小板治疗 6 个月后，R+L 组阿司匹林抑制率从（31.4±3.7）%升高至（68.6±7.1）%，明显高于 R+R 组的（51.9±8.2）%（P<0.01）。R+L 组氯吡格雷抑制率从（22.1±3.8）%升高至（60.2±7.4）%，明显高于 R+R 组的（45.9±4.3）%（P<0.01）。R+R 组心血管缺血事件、支架血栓形成、复发性不稳定型心绞痛和心肌梗死的发生率分别为 20%、36%和 17%，明显高于对照组的 3%、10%和 1%（P<0.01）。相比之下，R+L 组（分别为 10%、23%和 6%）的发生率低于 R+R 组（P<0.01），尽管仍高于对照组（P<0.01）。