Neumann F J, Gawaz M, Dickfeld T, Wehinger A, Walter H, Blasini R, Schomig A
Deutsches Herzzentrum und 1. Medizinische Klinik der Technischen Universität München, Munich, Germany.
J Am Coll Cardiol. 1997 Jun;29(7):1515-9. doi: 10.1016/s0735-1097(97)00073-9.
This study sought to investigate the contribution of ticlopidine to the inhibition of platelet activation after coronary stent placement.
After coronary stenting, antiplatelet therapy with aspirin and ticlopidine improves stent patency compared with anticoagulation. However, the specific role of ticlopidine has not been elucidated.
After successful coronary stent placement, we randomized 22 patients to receive ticlopidine and aspirin (ticlopidine group) and 25 to receive aspirin alone (aspirin group). Surface expression on platelets of the activated fibrinogen receptor and of P-selectin was assessed by flow cytometry.
In the aspirin group the percent of platelets with activated fibrinogen receptors increased between days 1 and 5 (p = 0.001), whereas there were no substantial changes in the ticlopidine group. The percent of P-selectin-positive platelets did not change significantly in the aspirin group but decreased in the ticlopidine group (p = 0.019). At day 5 after the intervention, the percent of platelets with activated fibrinogen receptors in the ticlopidine group was significantly lower (median [interquartile range]: 8.5 [3.1 to 17.8] vs. 18.1 [8.5 to 35.5], p = 0.025), and there was a trend to fewer P-selectin-positive platelets than in the aspirin group (5.8 [3.4 to 9.5] vs. 8.8 [4.0 to 15.8], p = 0.073).
Combined antiplatelet therapy with ticlopidine plus aspirin is superior to treatment with aspirin alone in suppressing platelet activation after coronary stenting.
本研究旨在探讨噻氯匹定对冠状动脉支架置入术后血小板活化抑制作用的贡献。
冠状动脉支架置入术后，与抗凝治疗相比，阿司匹林和噻氯匹定联合抗血小板治疗可提高支架通畅率。然而，噻氯匹定的具体作用尚未阐明。
冠状动脉支架置入成功后，我们将22例患者随机分为接受噻氯匹定和阿司匹林治疗组（噻氯匹定组）和25例仅接受阿司匹林治疗组（阿司匹林组）。通过流式细胞术评估血小板表面活化纤维蛋白原受体和P-选择素的表达。
阿司匹林组中，活化纤维蛋白原受体阳性血小板百分比在第1天至第5天之间增加（p = 0.001），而噻氯匹定组无明显变化。阿司匹林组中P-选择素阳性血小板百分比无显著变化，但噻氯匹定组降低（p = 0.019）。干预后第5天，噻氯匹定组中活化纤维蛋白原受体阳性血小板百分比显著更低（中位数[四分位间距]：8.5[3.1至17.8]对18.1[8.5至35.5]，p = 0.025），且P-选择素阳性血小板有比阿司匹林组更少的趋势（5.8[3.4至9.5]对8.8[4.0至15.8]，p = 0.073）。
冠状动脉支架置入术后，噻氯匹定加阿司匹林联合抗血小板治疗在抑制血小板活化方面优于单独使用阿司匹林治疗。
