Guan Shao-yi, Han Ya-ling, Li Yi, Guo Liang, Yang Bai-song, Wang Shou-li, Jing Quan-min, Wang Xiao-zeng, Ma Ying-yan, Liu Xiao-dong
General Hospital of Shenyang Military Region, Shenyang, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2012 Jan;40(1):25-9.
To explore the effects of intensive antiplatelet therapy for patients with high on-treatment platelet reactivity (HPR) after coronary stent implantation.
Between March 2009 and February 2011, a total of 3316 consecutive acute coronary syndrome patients undergoing drug-eluting stent implanting from 3 hospitals were enrolled. Among them, 840 patients (25.3%) were identified as HPR (defined as 20 µmol/L adenosine diphosphate induced platelet aggregation of ≥ 55% at 24 hours after administration of 300 mg clopidogrel loading dose and 300 mg aspirin). The HPR patients were randomly assigned to receive standard (aspirin 300 mg/d and clopidogrel 75 mg/d, n = 280) or intensified (n = 560) antiplatelet therapy by the ratio of 1:2. Patients in the intensive group were initially treated with a double maintenance dose of clopidogrel (150 mg/d) and aspirin (300 mg/d). After 3 days, patients with unsolved HPR received additional cilostazol treatment (50 - 100 mg, bid). The reversion rate of HPR and clinical events were observed.
In the intensive group, HPR reversed in 304 out of 560 patients (54.3%) at 3 days post therapy and the remaining 256 patients with HPR were treated with additional cilostazol regimen for another 3 days and the total reversion rate of HPR was 81.1% (454/560). The reversion rate of HPR at 30 days in the intensified group was significantly higher than that of the standard group (69.9% vs. 55.7%, P = 0.000). At 30 days after percutaneous coronary intervention, 1 patient suffered from subacute stent thrombosis (0.2%) in intensified group and no stent thrombosis was observed in standard group (P = 1.000). There were no death, major or minor bleeding in both two groups. Minimal bleeding was also similar in the two groups (intensive: 4.28% vs. standard: 2.14%, P = 0.166).
The intensified antiplatelet therapy regimens could significantly increase the reversion rate of HPR in acute coronary syndrome patients undergoing coronary stenting without increasing the risk of bleeding. The clinic impact of this strategy needs to be elucidated by long term follow-up outcome studies.
探讨强化抗血小板治疗对冠状动脉支架植入术后高治疗期血小板反应性（HPR）患者的影响。
2009年3月至2011年2月，共纳入3家医院连续3316例接受药物洗脱支架植入的急性冠状动脉综合征患者。其中，840例患者（25.3%）被确定为HPR（定义为在给予300mg氯吡格雷负荷剂量和300mg阿司匹林后24小时，20μmol/L二磷酸腺苷诱导的血小板聚集≥55%）。将HPR患者按1:2的比例随机分为接受标准抗血小板治疗（阿司匹林300mg/d，氯吡格雷75mg/d，n = 280）或强化抗血小板治疗（n = 560）。强化组患者初始接受双倍维持剂量的氯吡格雷（150mg/d）和阿司匹林（300mg/d）治疗。3天后，HPR未解决的患者接受额外的西洛他唑治疗（50 - 100mg，每日两次）。观察HPR的逆转率和临床事件。
强化组560例患者中，治疗后3天有304例（54.3%）HPR逆转，其余256例HPR患者再接受3天额外的西洛他唑治疗方案，HPR的总逆转率为81.1%（454/560）。强化组30天时HPR的逆转率显著高于标准组（69.9%对55.7%，P = 0.000）。经皮冠状动脉介入治疗后30天，强化组有1例患者发生亚急性支架血栓形成（0.2%），标准组未观察到支架血栓形成（P = 1.000）。两组均无死亡、严重或轻微出血。两组的轻微出血情况也相似（强化组：4.28%对标准组：2.14%，P = 0.166）。
强化抗血小板治疗方案可显著提高接受冠状动脉支架植入的急性冠状动脉综合征患者HPR的逆转率，且不增加出血风险。该策略的临床影响需要通过长期随访结果研究来阐明。
