替格瑞洛在治疗氯吡格雷抵抗患者时血小板聚集率分析

被引：39

作者：

李江

刘文娴

赵一楠

任燕龙

机构：

[1] 首都医科大学附属北京安贞医院心内科

来源：

中国全科医学 | 2014年 / 17卷 / 19期

关键词：

氯吡格雷; 氯吡格雷抵抗; 血小板聚集率; 替格瑞洛;

D O I：

暂无

中图分类号：

R541.4 [冠状动脉（粥样）硬化性心脏病（冠心病）];

学科分类号：

1002 ; 100201 ;

摘要：

目的探讨在治疗氯吡格雷抵抗患者时,将氯吡格雷更换为替格瑞洛后血小板聚集率的变化情况。方法选择正在应用氯吡格雷75 mg/d治疗的经皮冠状动脉介入治疗(PCI)术后患者512例,用比浊法测定血小板聚集率,根据血小板聚集率筛选出氯吡格雷抵抗患者88例。然后将这88例患者1∶1随机分为氯吡格雷组及替格瑞洛组,氯吡格雷组继续服用氯吡格雷(75 mg/d),替格瑞洛组将氯吡格雷(75 mg/d)更换为替格瑞洛(90 mg,2次/d)。随访7 d,主要观察7 d前后血小板聚集率的变化,同时观察7 d内出血发生率。结果治疗后替格瑞洛组较氯吡格雷组血小板聚集率低〔(43.3±8.2)%比(56.9±5.3)%〕,差异有统计学意义(P<0.05);替格瑞洛组血小板聚集率下降值较氯吡格雷组大〔(16.4±9.8)%比(1.1±4.1)%〕,差异有统计学意义(P<0.05);替格瑞洛组血小板聚集率达标率较氯吡格雷组高(84.4%比4.7%),差异有统计学意义(P<0.05);替格瑞洛组及氯吡格雷组在试验过程中均无主要出血。结论对于氯吡格雷抵抗患者,将氯吡格雷更换为替格瑞洛后能明显降低血小板聚集率。

引用

页码：2231 / 2234

页数：4

共 11 条

[1] 氯吡格雷抑制血小板功能的两种检测方法比较:血小板聚集实验与血小板膜糖蛋白检测 [J].

谭大伟 ;

朱平 ;

李小鹰 .

中国组织工程研究与临床康复, 2007, (11) :2021-2024

[2]

High Doses of Clopidogrel to Overcome Genetic Resistance.[J].Jean-Philippe Collet;Jean-Sébastien Hulot;Ghalia Anzaha;Ana Pena;Thomas Chastre;Claire Caron;Johanne Silvain;Guillaume Cayla;Anne Bellemain-Appaix;Jean-Baptiste Vignalou;Sophie Galier;Olivier Barthélémy;Farzin Beygui;Vanessa Gallois;Gilles Montalescot.JACC: Cardiovascular Interventions.2011, 4

[3] Consensus and Future Directions on the Definition of High On-Treatment Platelet Reactivity to Adenosine Diphosphate [J].

Bonello, Laurent ;

Tantry, Udaya S. ;

Marcucci, Rossella ;

Blindt, Ruediger ;

Angiolillo, Dominick J. ;

Becker, Richard ;

Bhatt, Deepak L. ;

Cattaneo, Marco ;

Collet, Jean Philippe ;

Cuisset, Thomas ;

Gachet, Christian ;

Montalescot, Gilles ;

Jennings, Lisa K. ;

Kereiakes, Dean ;

Sibbing, Dirk ;

Trenk, Dietmar ;

Van Werkum, Jochem W. ;

Paganelli, Franck ;

Price, Matthew J. ;

Waksman, Ron ;

Gurbel, Paul A. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2010, 56 (12) :919-933

[4] Response to Ticagrelor in Clopidogrel Nonresponders and Responders and Effect of Switching Therapies The RESPOND Study [J].

Gurbel, Paul A. ;

Bliden, Kevin P. ;

Butler, Kathleen ;

Antonino, Mark J. ;

Wei, Cheryl ;

Teng, Renli ;

Rasmussen, Lars ;

Storey, Robert F. ;

Nielsen, Tonny ;

Eikelboom, John W. ;

Sabe-Affaki, Georges ;

Husted, Steen ;

Kereiakes, Dean J. ;

Henderson, David ;

Patel, Dharmendra V. ;

Tantry, Udaya S. .

CIRCULATION, 2010, 121 (10) :1188-1199

[5] Randomized Double-Blind Assessment of the ONSET and OFFSET of the Antiplatelet Effects of Ticagrelor Versus Clopidogrel in Patients With Stable Coronary Artery Disease The ONSET/OFFSET Study [J].

Gurbel, Paul A. ;

Bliden, Kevin P. ;

Butler, Kathleen ;

Tantry, Udaya S. ;

Gesheff, Tania ;

Wei, Cheryl ;

Teng, Renli ;

Antonino, Mark J. ;

Patil, Shankar B. ;

Karunakaran, Arun ;

Kereiakes, Dean J. ;

Parris, Cordel ;

Purdy, Drew ;

Wilson, Vance ;

Ledley, Gary S. ;

Storey, Robert F. .

CIRCULATION, 2009, 120 (25) :2577-U103

[6] Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes [J].

Wallentin, Lars ;

Becker, Richard C. ;

Budaj, Andrzej ;

Cannon, Christopher P. ;

Emanuelsson, Hakan ;

Held, Claes ;

Horrow, Jay ;

Husted, Steen ;

James, Stefan ;

Katus, Hugo ;

Mahaffey, Kenneth W. ;

Scirica, Benjamin M. ;

Skene, Allan ;

Steg, Philippe Gabriel ;

Storey, Robert F. ;

Harrington, Robert A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (11) :1045-1057

[7] Low response to clopidogrel is associated with cardiovascular outcome after coronary stent implantation [J].

Geisler, Tobias ;

Langer, Harald ;

Wydymus, Magdalena ;

Goehring, Katrin ;

Zuern, Christine ;

Bigalke, Boris ;

Stellos, Konstantinos ;

May, Andreas E. ;

Gawaz, Meinrad .

EUROPEAN HEART JOURNAL, 2006, 27 (20) :2420-2425

[8] Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial [J].

Chen, ZM ;

Jiang, LX ;

Chen, YP ;

Xie, JX ;

Pan, HC ;

Peto, R ;

Collins, R ;

Liu, LS ;

Chen, ZM ;

Liu, LS ;

Collins, R ;

Jiang, LX ;

Chen, YP ;

Xie, JX ;

Pan, HC ;

Peto, R ;

Cai, NS ;

Chen, YZ ;

Cui, JJ ;

Dai, GZ ;

Feng, JZ ;

Fu, SY ;

Gent, M ;

Gong, LS ;

Hu, DY ;

Huang, DJ ;

Huang, J ;

Huang, TG ;

Huang, ZW ;

Hui, RT ;

Jiang, BQ ;

Li, DY ;

Li, SM ;

Li, TD ;

Li, YQ ;

Li, ZQ ;

Liu, YH ;

Meng, QY ;

Qian, TJ ;

San, J ;

Tao, SQ ;

Wang, DW ;

Wang, LH ;

Wang, W ;

Wu, HA ;

Xi, WH ;

Xu, CB ;

Yang, DC ;

Yang, XF ;

Yin, JQ .

LANCET, 2005, 366 (9497) :1607-1621

[9] Resistance to clopidogrel: A review of the evidence [J].

Nguyen, TA ;

Diodati, JG ;

Pharand, C .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2005, 45 (08) :1157-1164

[10] Resistance to thienopyridines: Clinical detection of coronary stent thrombosis by monitoring of vasodilator-stimulated phosphoprotein phosphorylation [J].

Barragan, P ;

Bouvier, JL ;

Roquebert, PO ;

Macaluso, G ;

Commeau, P ;

Comet, B ;

Lafont, A ;

Camoin, L ;

Walter, U ;

Eigenthaler, M .

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2003, 59 (03) :295-302

← 1 2 →