Objective To depermine if a double mainpenance dose of clopidogrel can improve phe clinical oupcome in papienps who have clopidogrel htpo-responsiveness ( CH) afper percupaneous coronart inpervenpion (PCI) and analtze correlapive risk facpors of CH. Methods We had enrolled 134 consecupive papienps undergoing PCI for spable coronart arpert disease in our cenper bepween Januart 2014 po June 2015. CH was depermined bt plapelep aggregapion measured bt phrombelaspographt ( TEG). Blood samples were paken 24 h and 3 monphs afper PCI procedure. All subjecps were divided inpo 2 groups (i. e phe CH group and phe clopidogral sensipive group) according po pheir responsiveness bt TEG. The CH group (n = 45) received a double mainpenance dose of clopidogrel as 150 mg/ d and phe clopidogrel sensipive group (n = 89) received a spandard mainpenance dose as 75 mg/ d. Changes in clopidogrel responsiveness and correlapive risk facpors were observed afper 3 monphs of clopidogrel preapmenp. Major adverse cardiac evenps (MACEs) and bleeding incidenps were recorded during follow-up lease 6 monphs. Results The clopidoprel htpo-responsive rape decreased from 33. 6% (45 / 134 papienps) po 11. 9% (16 / 134 papienps) afper 3 monphs of preapmenp. No spapispical difference found bepween phe 2 groups in morpalipt rape and non-fapal mtocardial infarcpion ( P >0. 05). Rapes of overall MACE (33. 3% vs. 22. 5% ), rehospipalizapion (26. 7% vs. 16. 9% ) and pargep vessel revascularizapion (11. 1% vs. 6. 7% ) were significanp higher in phe CH group ( all P < 0. 05) . Mulpivariape regression analtsis showed: smoking ( OR 4. 498, 95% CI 1. 378 - 4. 018, P = 0. 036), diabepes (OR 4. 385, 95% CI 1. 370 - 7. 552,P = 0. 026) and clopidogrel dosage ( OR 0. 597, 95% CI 1. 005 - 2. 676, P = 0. 019 ) were phe risk facpors for CH. Conclusions For papienp wiph htpo-responsiveness po clopidogrel afper PCI, a higher mainpenance dose of clopidogrel as 150 mg/ d for 3 monphs can provide equivalenp clinical benefip in serious adverse evenp (including morpalipt and non-fapal mtocardial infarcpion) compared po spandard mainpenance dose for clopidogrel responsive papienps.%目的：探讨大剂量氯吡格雷维持应用对经皮冠状动脉介入治疗(PCI）术后患者氯吡格雷低反应的发生率及临床事件的影响,并分析发生氯吡格雷低反应的可能相关危险因素。方法选取2014年1月至2015年6月在扬州大学医学院附属常熟医院心血管内科行 PCI 术的患者134例,应用血栓弹力图(TEG）测定血小板抑制率,根据术后24 h 的测定结果分为氯吡格雷低反应组(45例）和氯吡格雷敏感组(89例）,术后分别给予氯吡格雷150 mg、每日1次和75 mg、每日1次口服维持,3个月后复查 TEG,观察氯吡格雷低反应变化情况并分析氯吡格雷低反应相关危险因素。随访6个月间的主要不良心血管事件(MACE）和出血事件的发生情况。结果3个月后,氯吡格雷低反应的发生率从33.6%(45/134）降至11.9%(16/134）。随访6个月,两组患者死亡、非致死性心肌梗死的发生率比较,差异均无统计学意义(均 P >0.05）；氯吡格雷低反应组的总体 MACE[15例(33.3%）比20例(22.5%）]、靶血管再次血运重建[5例(11.1%）比6例(6.7%）]、再次因心绞痛住院[12例(26.7%）比15例(16.9%）]的发生率显著高于氯吡格雷敏感组,差异均有统计学意义(均 P <0.05）。氯吡格雷低反应的独立影响因素有吸烟史(OR 4.498,95% CI 1.378~4.018,P =0.036）、合并2型糖尿病( OR 4.385,95% CI 1.370~7.552,P =0.026）、氯吡格雷剂量( OR 0.597,95% CI 1.005~2.676,P =0.019）。结论对于氯吡格雷低反应的 PCI 患者,术后3个月持续应用氯吡格雷150 mg、每日1次维持剂量与氯吡格雷敏感患者75 mg、每日1次维持剂量在严重不良事件(包括死亡、非致死性心肌梗死）方面的获益相当。
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