Xin Yan-Guo, Zhang Hai-Shan, Li Yu-Ze, Guan Qi-Gang, Guo Liang, Gao Yuan, Yu Hai-Jie, Zhang Xin-Gang, Xu Feng, Zhang Yue-Lan, Jia Da-Lin, Sun Ying-Xian, Qi Guo-Xian, Tian Wen
Department of Geriatric Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China; Department of Cardiology, The General Hospital of Tianjin Medical University, Tianjin, PR China.
Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
Int J Cardiol. 2017 Feb 1;228:275-279. doi: 10.1016/j.ijcard.2016.11.160. Epub 2016 Nov 9.
Dual antiplatelet therapy is recommended as a standard antiplatelet strategy in acute coronary syndrome. For those with reduced pharmacologic response to clopidogrel, strengthening antiplatelet therapy (clopidogrel 150mg daily) may reduce adverse clinical events. Ticagrelor is a direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and offset than clopidogrel.
In this retrospective study, we compared ticagrelor (180mg loading dose 90mg twice daily thereafter), clopidogrel (300mg loading dose, 75mg or 150mg daily thereafter) for the prevention of cardiovascular events in 273 high-risk patients admitted to coronary care unit with acute coronary syndrome.
The rate of IST in hospital was significantly reduced in patients of ticagrelor group comparing with those receiving clopidogrel 75mg (0.69% vs 8.2%, p=0.009). Moreover, the TVR rate was less in the ticagrelor group than clopidogrel 75mg group (2.7% vs 13.1%, p=0.007) 6months follow-up. The incidence of MACCE has no difference between the two clopidogrel groups. Kaplan-Meier analysis of MACCE-free indicated that there was no difference between the three groups. Ticagrelor significantly increased the rate of minor bleeding compared with clopidogrel 75mg daily during hospital (45.5% vs 26.2%,p=0.012) and 6-month follow-up (66.9% vs 45.9%,p=0.004).Bleeding-free prognosis was significantly better in the clopidogrel 75mg daily group.
In patients with acute coronary syndrome undergoing PCI, the rate of in-stent thrombosis and TVR were significantly reduced treated with ticagrelor compared with clopidogrel 75mg daily, without an increase of overall major bleeding, but with an increase of minor bleeding.
双联抗血小板治疗被推荐为急性冠状动脉综合征的标准抗血小板策略。对于那些对氯吡格雷药理反应降低的患者，强化抗血小板治疗（每日氯吡格雷150mg）可能会减少不良临床事件。替格瑞洛是一种二磷酸腺苷受体P2Y12的直接作用抑制剂，其起效和作用消失比氯吡格雷更快。
在这项回顾性研究中，我们比较了替格瑞洛（负荷剂量180mg，此后每日两次，每次90mg）、氯吡格雷（负荷剂量300mg，此后每日75mg或150mg）在273例入住冠心病监护病房的急性冠状动脉综合征高危患者中预防心血管事件的效果。
与接受75mg氯吡格雷治疗的患者相比，替格瑞洛组患者住院期间支架内血栓形成（IST）发生率显著降低（0.69%对8.2%，p = 0.009）。此外，在6个月随访时，替格瑞洛组的靶病变血运重建（TVR）率低于氯吡格雷75mg组（2.7%对13.1%，p = 0.007）。两个氯吡格雷组之间主要不良心血管和脑血管事件（MACCE）发生率无差异。MACCE-free的Kaplan-Meier分析表明三组之间无差异。与每日75mg氯吡格雷相比，替格瑞洛在住院期间（45.5%对26.2%，p = 0.012）和6个月随访时（66.9%对45.9%，p = 0.004）显著增加了轻微出血率。每日75mg氯吡格雷组的无出血预后明显更好。
在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征患者中，与每日75mg氯吡格雷相比，替格瑞洛治疗可显著降低支架内血栓形成率和TVR，且不增加总体大出血，但会增加轻微出血。
