Ovrakh T, Serik S, Kochubiei O
1GI "L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine", Department of atherosclerosis and ischemic heart disease, Kharkiv; 2Kharkiv National Medical University, Department of Fundamentals of Internal Medicine №1, Fundamentals of Bioethics and Biosafety, Ukraine.
Georgian Med News. 2017 Apr(265):7-14.
In patients with ischemic heart disease and type 2 diabetes mellitus in 4-6 weeks after acute coronary syndrome (ACS) on stable dual antiplatelet therapy (DAPT) with aspirin and clopidogrel co-adminstrated with rosuvastatin residual platelet reactivity on adenosine diphosphate was higher than in patients receiving atorvastatin. However, the rate of high residual on-clopidogrel treatment platelet reactivity (RCPR) in rosuvastatin-treated patients exceeded the rate of high RCPR in atorvastatin-treated patients insignificantly. In 6 months after ACS residual platelet reactivity did not differ between the groups. After 12 months of DAPT platelet reactivity increased as compared to baseline values both in patients receiving rosuvastatin and in patients receiving atorvastatin without switching. In patients, randomly switching from one statin type to another at 6 month of treatment, platelet reactivity did not change significantly in comparison to baseline and the prevalence of high RCPR was lower than in patients receiving statins without switching. Thus, in patients with diabetes with ACS on DAPT with acetylsalicylic acid and clopidogrel statin treatment should be started with atorvastatin and in 6 months after ACS atorvastatin should be switched to rosuvastatin. This approach will provide lower RCPR within at least first 4-6 weeks after ACS and prevent RCPR increase during 12 months of DATT use in this patients group.
在急性冠状动脉综合征（ACS）后4 - 6周，接受阿司匹林和氯吡格雷稳定双联抗血小板治疗（DAPT）并联合瑞舒伐他汀的缺血性心脏病和2型糖尿病患者中，二磷酸腺苷诱导的残余血小板反应性高于接受阿托伐他汀的患者。然而，瑞舒伐他汀治疗患者中氯吡格雷治疗时高残余血小板反应性（RCPR）的发生率略高于阿托伐他汀治疗患者。ACS后6个月，两组间残余血小板反应性无差异。在12个月的DAPT治疗后，接受瑞舒伐他汀和未换药接受阿托伐他汀治疗的患者血小板反应性均较基线值升高。在治疗6个月时随机从一种他汀类药物换用另一种他汀类药物的患者中，与基线相比血小板反应性无显著变化，且高RCPR的发生率低于未换药的他汀类药物治疗患者。因此，对于接受乙酰水杨酸和氯吡格雷DAPT治疗的ACS合并糖尿病患者，应起始使用阿托伐他汀，且在ACS后6个月应将阿托伐他汀换为瑞舒伐他汀。这种方法将在ACS后至少前4 - 6周内降低RCPR，并防止该患者组在12个月的DATT使用期间RCPR升高。
