替格瑞洛单药治疗与氯吡格雷单药治疗对血小板反应性的影响：一项随机交叉临床研究（SINGLE研究）。
Effects of ticagrelor monotherapy vs. clopidogrel monotherapy on platelet reactivity: a randomized, crossover clinical study (SINGLE study).
作者信息
He Meijiao, Yan Wei, Zhang Yun, Kong Yihui, Han Xuejie, Ren Jie, Zhao Zhongyang, Liu Guangzhong, Shi Jing, Li Yue
机构信息
Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, P.R. China.
Institute of Metabolic Disease, Heilongjiang Academy of Medical Science, Harbin, P.R. China.
出版信息
Platelets. 2022 Nov 17;33(8):1146-1152. doi: 10.1080/09537104.2022.2052036. Epub 2022 Apr 5.
Increasing clinical trials demonstrated that the discontinuation of aspirin while maintaining a P2Y inhibitor monotherapy could decrease the risk of bleeding without losing the antithrombotic effect. However, no data are available on the platelet reactivity of patients undergoing ticagrelor monotherapy vs. clopidogrel. Therefore, we performed this study to observe the efficacy of ticagrelor monotherapy vs. clopidogrel in Chinese patients with chronic coronary syndrome. This randomized, single-blinded, crossover trial enrolled 50 patients who were administered with ticagrelor (90 mg twice daily for 2 weeks) or clopidogrel (75 mg once daily for 2 weeks). Followed by a 2-week washout period, the two groups of patients underwent a crossover trial. Light transmission aggregometry (LTA) and thromboelastography (TEG) assays were used to test platelet reactivity. The platelet aggregation rate (PAgR) of ADP and AA was significantly lower with ticagrelor than clopidogrel (PAgR of ADP, 27.30% (7.30%-42.635%) vs. 35.55% (12.03%-69.25%), = .0254; PAgR of AA, 77.80% (21.60%-86.43%) vs. 83.10% (67.13%-87.20%), = .0400). There was no significant difference in PAgR of collagen and epinephrine between the two groups. The TEG assay showed that ADP and AA, which induced the inhibition of platelet aggregation, were significantly higher in the ticagrelor group than those in the clopidogrel group [ADP%, 69.00% (59.68%-88.95%) vs. 60.55% (35.98%-78.35%), = .0020; AA%, 53.65% (22.75%-79.28%) vs. 15.15% (5.75%-70.25%), = .0127]. High on-treatment platelet reactivity (HTPR) on ADP was 2.17% with ticagrelor and 19.57% with clopidogrel. HTPR on AA was 50.00% with ticagrelor and 69.57% with clopidogrel. Ticagrelor and clopidogrel caused the inhibition of ADP and AA-induced platelet aggregation. Moreover, ticagrelor monotherapy had a stronger inhibitory effect than clopidogrel monotherapy (except on collagen and epinephrine).
越来越多的临床试验表明，在维持P2Y抑制剂单药治疗的同时停用阿司匹林可以降低出血风险，且不丧失抗血栓作用。然而，关于接受替格瑞洛单药治疗与氯吡格雷治疗的患者的血小板反应性，尚无相关数据。因此，我们开展了本研究，以观察替格瑞洛单药治疗与氯吡格雷在中国慢性冠状动脉综合征患者中的疗效。这项随机、单盲、交叉试验纳入了50例患者，这些患者分别接受替格瑞洛（90mg，每日2次，共2周）或氯吡格雷（75mg，每日1次，共2周）治疗。在为期2周的洗脱期后，两组患者进行交叉试验。采用光透射聚集法（LTA）和血栓弹力图（TEG）检测血小板反应性。替格瑞洛组的二磷酸腺苷（ADP）和花生四烯酸（AA）的血小板聚集率（PAgR）显著低于氯吡格雷组（ADP的PAgR：27.30%（7.30%-42.635%） vs. 35.55%（12.03%-69.25%），P = 0.0254；AA的PAgR：77.80%（21.60%-86.43%） vs. 83.10%（67.13%-87.20%），P = 0.0400）。两组之间胶原和肾上腺素的PAgR无显著差异。TEG检测显示，诱导血小板聚集抑制的ADP和AA，替格瑞洛组显著高于氯吡格雷组[ADP%：69.00%（59.68%-88.95%） vs. 60.55%（35.98%-78.35%），P = 0.0020；AA%：53.65%（22.75%-79.28%） vs. 15.15%（5.75%-70.25%），P = 0.0127]。替格瑞洛治疗时ADP高治疗期血小板反应性（HTPR）为2.17%，氯吡格雷为19.57%。替格瑞洛治疗时AA的HTPR为50.00%，氯吡格雷为69.57%。替格瑞洛和氯吡格雷均能抑制ADP和AA诱导的血小板聚集。此外，替格瑞洛单药治疗的抑制作用强于氯吡格雷单药治疗（除对胶原和肾上腺素外）。
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