Ma Wenfang, Liang Yan, Zhu Jun, Wang Yang, Wang Xinjie
Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Am J Cardiol. 2015 Mar 1;115(5):592-601. doi: 10.1016/j.amjcard.2014.12.013. Epub 2014 Dec 18.
The CURRENT-OASIS 7 (Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events-Seventh Organization to Assess Strategies in Ischemic Symptoms) trial showed that a 7-day 150-mg maintenance dose (MD) clopidogrel could reduce cardiovascular events in subgroup patients who underwent percutaneous coronary intervention (PCI) compared with the 75 mg/day regimen, although whether prolonging the high MD clopidogrel (≥150 mg) treatment period to at least 4 weeks can reduce major adverse cardiac events in the patients who underwent PCI with and without high on-clopidogrel platelet reactivity (HPR) is still controversial. We searched Pubmed, Embase, and Cochrane Library from inception until September 2014 for randomized controlled trials that compared high versus standard MD clopidogrel in patients who underwent PCI. Seventeen trials involving 4,822 patients who underwent PCI included 2,879 patients who were allocated to the "HPR patients" subgroup and 1,943 to the "native patients" subgroup without paying attention to the clopidogrel reactivity before randomization. Compared with the standard therapy, the high MD clopidogrel was associated with a significant reduction in the risk of major adverse cardiac events (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.39 to 0.71, p <0.0001) in patients who underwent PCI. The HPR patients subgroup was also benefited from such high MD treatment (OR 0.54, 95% CI 0.38 to 0.77, p = 0.0007). The observed benefits were mainly attributed to treatment-associated reduction in stent thrombosis (OR 0.43, 95% CI 0.23 to 0.78, p = 0.006) and target vessel revascularization (OR 0.38, 95% CI 0.20 to 0.74, p = 0.004). There was no difference in the rate of major/minor bleeding event between the high and standard MD group (OR 0.80, 95% CI 0.56 to 1.13, p = 0.21). In conclusion, the efficacy and safety of at least 4 weeks' high MD clopidogrel is greater than that of standard therapy for patients who underwent PCI with and without HPR.
CURRENT-OASIS 7（氯吡格雷与阿司匹林最佳剂量用于减少复发事件——第七个评估缺血症状策略的组织）试验表明，与75毫克/天的方案相比，为期7天的150毫克氯吡格雷维持剂量（MD）可降低接受经皮冠状动脉介入治疗（PCI）的亚组患者的心血管事件，尽管将高剂量氯吡格雷（≥150毫克）治疗期延长至至少4周是否能降低有或无高氯吡格雷血小板反应性（HPR）的PCI患者的主要不良心脏事件仍存在争议。我们检索了从创刊至2014年9月的PubMed、Embase和Cochrane图书馆，以查找比较高剂量与标准剂量氯吡格雷在PCI患者中的随机对照试验。17项试验涉及4822例接受PCI的患者，其中2879例被分配到“高氯吡格雷血小板反应性患者”亚组，1943例被分配到“普通患者”亚组，随机分组前未关注氯吡格雷反应性。与标准治疗相比，高剂量氯吡格雷使接受PCI的患者发生主要不良心脏事件的风险显著降低（优势比[OR]0.52，95%置信区间[CI]0.39至0.71，p<0.0001）。高氯吡格雷血小板反应性患者亚组也从这种高剂量治疗中获益（OR 0.54，95%CI 0.38至0.77，p = 0.0007）。观察到的益处主要归因于治疗相关的支架血栓形成减少（OR 0.43，95%CI 0.23至0.78，p = 0.006）和靶血管血运重建减少（OR 0.38，95%CI 0.20至0.74，p = 0.004）。高剂量与标准剂量氯吡格雷组之间的主要/轻微出血事件发生率无差异（OR 0.80，95%CI 0.56至1.13，p = 0.21）。总之，对于有或无高氯吡格雷血小板反应性的PCI患者，至少4周的高剂量氯吡格雷治疗的有效性和安全性高于标准治疗。
