Cheng Biao, Kong Xianghai, Chen Jian, He Qin, Zhou Mi, Deng Aiping
Department of Pharmacy, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Medicine (Baltimore). 2025 May 30;104(22):e42551. doi: 10.1097/MD.0000000000042551.
Continuation of single antiplatelet treatment (SAPT) is recommended for patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) after dual antiplatelet treatment (DAPT). However, the optimal long-term SAPT remains unclear for these patients. The retrospective study recruited ACS patients who underwent PCI and chosen clopidogrel to SAPT after DAPT between 01/2014 and 12/2016 at the Central Hospital of Wuhan, Wuhan, China. Patients were divided into 2 groups after standard DAPT: low dose group (clopidogrel, 50 mg/d) and control group (clopidogrel, 75 mg/d). Among 378 enrolled patients with ACS undergoing PCI, 49/378 (14.5%) were taking 50 mg clopidogrel after DAPT. At the mean follow-up of 34 months, the cumulative incidence of the primary outcomes (hazard ratio [HR] 1.345, 95% CI: 0.455-3.974; P = .592), secondary outcome (HR 1.483, 95% CI: 0.506-4.348; P = .473), and safety outcomes (HR 2.268, 95% CI: 0.835-6.160; P = .108) showed no significant differences between the 2 group. Propensity score-matched analysis confirmed these findings. A 50 mg maintenance dose of clopidogrel may be comparable to 75 mg clopidogrel for Chinese patients with ACS undergoing PCI after at least 12 months of DAPT in efficacy and safety.
对于接受双联抗血小板治疗（DAPT）后行经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者，推荐继续进行单药抗血小板治疗（SAPT）。然而，这些患者的最佳长期SAPT方案仍不明确。这项回顾性研究纳入了2014年1月至2016年12月在中国武汉中心医院接受PCI且在DAPT后选择氯吡格雷进行SAPT的ACS患者。在标准DAPT后，患者被分为两组：低剂量组（氯吡格雷，50mg/d）和对照组（氯吡格雷，75mg/d）。在378例接受PCI的入选ACS患者中，49/378（14.5%）在DAPT后服用50mg氯吡格雷。在平均34个月的随访中，主要结局（风险比[HR]1.345，95%可信区间：0.455 - 3.974；P = 0.592）、次要结局（HR 1.483，95%可信区间：0.506 - 4.348；P = 0.473）和安全性结局（HR 2.268，95%可信区间：0.835 - 6.160；P = 0.108）在两组之间均无显著差异。倾向评分匹配分析证实了这些结果。对于接受至少12个月DAPT后行PCI的中国ACS患者，氯吡格雷50mg维持剂量在疗效和安全性方面可能与75mg氯吡格雷相当。
