Liang Jing, Wang Zhijian, Shi Dongmei, Liu Yuyang, Zhao Yingxin, Han Hongya, Li Yueping, Liu Wei, Zhang Linlin, Yang Lixia, Zhou Yujie
Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China
Angiology. 2015 Apr;66(4):319-25. doi: 10.1177/0003319714538804. Epub 2014 Jun 8.
We evaluated the impact of clopidogrel 150 mg/d in patients with chronic kidney disease (CKD) having clopidogrel resistance (CR) after percutaneous coronary intervention (PCI); 1076 consecutive patients with coronary artery disease (CAD) having CKD were enrolled. Maximal platelet aggregation (MPA) was assessed before, 24 hours, and 30 days after a 300-mg loading dose of clopidogrel prior to PCI. After PCI, 370 patients with CR were randomized to receive clopidogrel 75 mg/d (n = 184) or 150 mg/d (n = 186) for 30 days. Stent thrombosis (ST), major adverse cardiac events (MACEs), and bleeding were analyzed after 1 month. Patients in the 150 mg group had significant lower rates of ST and MACE. There was no significant difference in major or minor bleeding. Patients in the 150 mg group had lower MPA and greater inhibition of platelet aggregation. One-month administration of 150 mg/d of clopidogrel decreases the rate of ST and MACE without increasing bleeding in patients with CKD having CR after PCI.
我们评估了每日150毫克氯吡格雷对经皮冠状动脉介入治疗（PCI）后存在氯吡格雷抵抗（CR）的慢性肾脏病（CKD）患者的影响；连续纳入了1076例患有CKD的冠心病（CAD）患者。在PCI前给予300毫克氯吡格雷负荷剂量之前、之后24小时和30天时评估最大血小板聚集率（MPA）。PCI后，370例CR患者被随机分为接受每日75毫克氯吡格雷（n = 184）或150毫克氯吡格雷（n = 186）治疗30天。1个月后分析支架血栓形成（ST）、主要不良心脏事件（MACE）和出血情况。150毫克组患者的ST和MACE发生率显著更低。严重或轻微出血方面无显著差异。150毫克组患者的MPA更低，血小板聚集抑制作用更强。对PCI后存在CR的CKD患者，每日给予150毫克氯吡格雷治疗1个月可降低ST和MACE发生率，且不增加出血风险。
