强化抗血小板治疗对冠状动脉支架术后血小板高反应性的影响  

Effects of intensive ant/plate.let therapy for patients with high on-treatment platelet reactivity after coronary stent implantation

作　　者：关绍义[1] 韩雅玲[1] 李毅[1] 郭亮[2] 杨柏松 王守力[1] 荆全民[1] 王效增[1] 马颖艳[1] 刘晓东[1] 

机构地区：[1]沈阳军区总医院心内科,110016 [2]中国医科大学附属第一医院心内科 [3]解放军第四六三医院心内科

出　　处：《中华心血管病杂志》2012年第1期25-29,共5页Chinese Journal of Cardiology

基　　金：“十二五”国家科技支撑计划（2011BAI11B07）

摘　　要：目的 探讨强化抗血小板治疗对急性冠状动脉综合征患者冠状动脉支架术后血小板高反应性（HPR）的影响.方法 2009年3月至2011年2月在3家医院连续入选3316例置入药物洗脱支架的急性冠状动脉综合征患者,其中840例（25.3％）患者诊断为HPR.HPR定义为氯吡格雷300 mg和阿司匹林300 mg治疗24h后,20 μmol/L二磷酸腺苷诱导的血小板聚集率＞55％.HPR患者按1：2的比例随机接受标准抗血小板治疗（标准组,n=280）及强化抗血小板治疗（强化组,n=560）.标准组患者服用阿司匹林300 mg/d和氯吡格雷75 mg/d.强化组患者服用阿司匹林300 mg/d和双倍剂量氯吡格雷（150 mg/d）,3d后如 HPR 未改善则加用西洛他唑（50～100 mg,每天2次）.观察患者的HPR改善率及发生的临床事件.结果 强化组患者治疗3d后HRP改善率为54.3％（304/560）；256例HRP未改善的患者接受西洛他唑治疗3d后,强化组的HRP改善率为81.1％（454/560）.术后30 d,强化组HPR改善率显著高于标准组（69.9％比55.7％,P=0.000）.两组患者均未发生死亡及卒中事件.强化组发生亚急性支架血栓形成1例（0.2％）,标准组未发生支架血栓形成事件（P =1.000）.两组均未发生死亡和主要及次要出血事件,轻度出血发生率两组之间差异无统计学意义（强化组为4.3％,标准组为2.1％,P=0.166）.结论强化抗血小板治疗可显著改善急性冠状动脉综合征患者冠状动脉支架术后的HPR,且不增加出血风险,但其临床获益还需更长时间随访研究的证实.Objective To explore the effects of intensive antiplatelet therapy for patients with high on-treatment platelet reactivity（HPR）after coronary stent implantation.Methods Between March 2009 and February 2011,a total of 3316 consecutive acute coronary syndrome patients undergoing drug-eluting stent implanting from 3 hospitals were enrolled.Among them,840 patients（25.3%）were identified as HPR （defined as 20 μmol/L adenosine diphosphate induced platelet aggregation of ≥ 55% at 24 hours after administration of 300 mg clopidogrel loading dose and 300 mg aspirin）.The HPR patients were randomly assigned to receive standard（aspirin 300 mg/d and clopidogrel 75 mg/d,n =280）or intensified（n =560）antiplatelet therapy by the ratio of 1： 2.Patients in the intensive group were initially treated with a double maintenance dose of clopidogrel（150 mg/d）and aspirin（300 mg/d）.After 3 days,patients with unsolved HPR received additional cilostazol treatment（50-100 mg,bid）.The reversion rate of HPR and clinical events were observed.Results In the intensive group,HPR reversed in 304 out of 560 patients（54.3%）at 3 days post therapy and the remaining 256 patients with HPR were treated with additional cilostazol regimen for another 3 days and the total reversion rate of HPR was 81.1%（454/560）.The reversion rate of HPR at 30 days in the intensified group was significantly higher than that of the standard grooup（69.9% vs.55.7%,P =0.000）.At 30 days after percutaneous coronary infervention,l patient suffered from subacute stent thrombosis（0.2%）in intensified group and no stent thrombosis was observed in standard group（P =1.000）.There were no death,major or minor bleeding in both two groups.Minimal bleeding was also similar in the two groups（intensive： 4.28% vs.standard： 2.14%,P =0.166）.Conclusions The intensified antiplatelet therapy regimens could significantly increase the reversion rate of HPR in acute coronary syndrome patients undergoing coronary stenting without increasing the

关 键 词：冠状动脉疾病 支架 血小板聚集抑制剂 

分 类 号：R541.4[医药卫生—心血管疾病]