Alexopoulos Dimitrios, Perperis Angelos, Koniari Ioanna, Karvounis Haralambos, Patsilinakos Sotirios, Ziakas Antonios, Barampoutis Nikolaos, Panagiotidis Theofilos, Akinosoglou Karolina, Hahalis George, Xanthopoulou Ioanna
Department of Cardiology, Patras University Hospital, Rion, 26500, Patras, Greece,
J Thromb Thrombolysis. 2015 Oct;40(3):261-7. doi: 10.1007/s11239-015-1183-9.
Limited data are available on high platelet reactivity (HPR) rate early post fibrinolysis, while no effective way to overcome it has been proposed. In this context, we aimed to compare ticagrelor versus high dose clopidogrel in patients with ST-segment elevation myocardial infarction (STEMI) who exhibit HPR post fibrinolysis. In a prospective, randomized, parallel design, 3-center study, 56 STEMI patients, out of 83 (67.5 %) screened, who presented with HPR (PRU ≥ 208 by VerifyNow) 3-48 h post fibrinolysis and prior to coronary angiography were allocated to ticagrelor 180 mg loading dose (LD)/90 mg bid maintenance dose (MD) or clopidogrel 600 mg LD/150 mg MD. Platelet reactivity was assessed at randomization (Hour 0), at Hour 2, Hour 24 and pre-discharge. The primary endpoint of platelet reactivity (in PRU) at Hour 2 was significantly lower for ticagrelor compared to clopidogrel with a least square mean difference (95 % confidence interval) of -141.7 (-173.4 to -109.9), p < 0.001. HPR rates at Hour 2 and 24 were significantly lower for ticagrelor versus clopidogrel (14.3 vs. 82.1 %, p < 0.001 and 0 vs. 25.0 %, p = 0.01 respectively), though not significantly different pre-discharge. In-hospital Bleeding Academic Research Consortium type ≥2 bleeding occurred in 1 and 2 clopidogrel and ticagrelor-treated patients, respectively. In STEMI patients, post fibrinolysis HPR is common. Ticagrelor treats HPR more effectively compared to high dose clopidogrel therapy. Although antiplatelet regimens tested in this study were well tolerated, this finding should be considered only exploratory.
关于纤维蛋白溶解术后早期高血小板反应性（HPR）发生率的可用数据有限，同时尚未提出克服该现象的有效方法。在此背景下，我们旨在比较替格瑞洛与高剂量氯吡格雷在纤维蛋白溶解术后出现HPR的ST段抬高型心肌梗死（STEMI）患者中的疗效。在一项前瞻性、随机、平行设计的三中心研究中，83例接受筛查的患者中有56例（67.5%）在纤维蛋白溶解术后3 - 48小时且在冠状动脉造影术前出现HPR（VerifyNow检测PRU≥208），这些患者被随机分配接受替格瑞洛180mg负荷剂量（LD）/90mg每日两次维持剂量（MD）或氯吡格雷600mg LD/150mg MD治疗。在随机分组时（第0小时）、第2小时、第24小时和出院前评估血小板反应性。与氯吡格雷相比，替格瑞洛在第2小时的血小板反应性主要终点（以PRU计）显著更低，最小二乘均值差异（95%置信区间）为 -141.7（-173.4至 -109.9），p < 0.001。替格瑞洛在第2小时和第24小时的HPR发生率显著低于氯吡格雷（分别为14.3%对82.1%，p < 0.001；0对25.0%，p = 0.01），但在出院前差异不显著。氯吡格雷和替格瑞洛治疗的患者中分别有1例和2例发生了≥2型出血学术研究联盟定义的院内出血。在STEMI患者中，纤维蛋白溶解术后HPR很常见。与高剂量氯吡格雷治疗相比，替格瑞洛治疗HPR更有效。尽管本研究中测试的抗血小板治疗方案耐受性良好，但这一发现仅应被视为探索性的。
