经皮冠状动脉介入治疗术6个月后应用低剂量替格瑞洛的有效性及安全性研究

摘要

目的 探讨经皮冠状动脉介入治疗(PCI)术6个月后应用低剂量替格瑞洛的有效性及安全性.方法 选取2015年7月-2016年2月在天津市人民医院行PCI术6个月后复查的患者95例,根据术后服用的二磷酸腺苷受体(P2Y12受体)拮抗剂类型,将其分为替格瑞洛组(n=33)和氯吡格雷组(n=62).其中,替格瑞洛组患者术后服用标准剂量替格瑞洛(90 mg/次,2次/d)、6个月后改为低剂量替格瑞洛(45 mg/次,2次/d),氯吡格雷组患者术后持续服用氯吡格雷(75 mg/次,1次/d),两组均联合服用阿司匹林(100 mg/次,1次/d).比较两组患者PCI术6个月后服药1周、3个月时采用光比浊(LTA)法检测的血小板聚集率,以及随访6个月的主要不良心血管事件(MACE)和不良反应发生率.结果 PCI术6个月后服药1周、3个月,替格瑞洛组患者血小板聚集率均低于氯吡格雷组,差异有统计学意义(P<0.05);服药3个月,两组患者血小板聚集率与服药1周比较,差异无统计学意义(P>0.05).随访期间,替格瑞洛组患者MACE发生率低于氯吡格雷组,差异有统计学意义(P<0.05);但两组患者轻度出血、呼吸困难发生率比较,差异无统计学意义(P>0.05).结论 PCI术后6个月应用低剂量替格瑞洛的抗血小板聚集作用强于氯吡格雷,可有效减少PCI术后患者的缺血事件发生,且不增加出血风险.%Objective To evaluate the efficacy and safety of low-dose ticagrelor in patients at six months after percutaneous coronary intervention(PCI).Methods Nine-five patients underwent postoperative review at 6 months after PCI in Tianjin People′s Hospital between July 2015 and February 2016 were selected as the participants and divided into the ticagrelor group(n=33) and clopidogrel group(n=62) based on the P2Y12 adenosine diphosphate-receptor antagonist type that the postoperatively orally taken drug belongs to.Patients in the ticagrelor group received standard dose of ticagrelor(90 mg,twice daily),and those in the clopidogrel group took clopidogrel(75 mg,once daily) after PCI.At six months after PCI,the ticagrelor group changed to low-dose ticagrelor(45 mg,twice daily),but the clopidogrel group continued to take the same dose of clopidogrel.Both groups were given aspirin(100 mg,once daily).Light transmission aggregometry(LTA) was used to measure the platelet aggregation rate at the time that they completed 1-week,and 3-month administration following the reviewing.Comparisons were made between the two groups′ two measurement results of platelet aggregation rate,major adverse cardiac events(MACE) and adverse reactions occurred during the 6-month follow-up.Results The platelet aggregation rates measured at the time that the patients completed 1-week,and 3-month administration following the reviewing in ticagrelor group were all dramatically lower than those in clopidogrel group(P<0.05).In both groups,little difference was observed between the two measurement results of platelet aggregation rate(P>0.05).The follow-up results showed that,the incidence of MACE was significantly lower in the ticagrelor group than that in the clopidogrel group(P<0.05),but there were no significant difference in the incidence of mild hemorrhage and dyspnea between the two groups(P>0.05).Conclusion Inhibitory effect on platelet aggregation of low-dose ticagrelor administered at 6 months after PCI was significantly stronger than that of clopidogrel.Low-dose ticagrelor can reduce the incidence of ischemic events in the patients after PCI,without increasing the risk of bleeding.