缺血性卒中患者因氯吡格雷低反应性改为高维持量及替格瑞洛后血小板抑制率变化

发布时间：2018-05-08 10:23

本文选题：氯吡格雷 + 替格瑞洛　；参考：《中风与神经疾病杂志》2017年10期

【摘要】：目的探讨用血栓弹力图评价符合双抗治疗的缺血性脑血管病患者,因氯吡格雷低反应性,改为高维持剂量及改服替格瑞洛后血小板抑制率的变化。方法选择符合双抗治疗的缺血性脑血管病患者联合应用抗血小板制剂(阿司匹林肠溶片100 mg/qd+氯吡格雷75 mg/qd)前及后7 d,用血栓弹力图检测患者的花生四烯酸(AA)和二磷酸腺苷(ADP)途径诱导的血小板抑制率,筛选出氯吡格雷低反应性者96例,随机分为3组,常规剂量组(氯吡格雷75 mg/qd,32例)、高维持量组(氯吡格雷150 mg/qd,32例)和替格瑞洛组(替格瑞洛90 mg/bid,32例),3组阿司匹林继续按原剂量服用。分组后3组按新方案治疗7 d,再次复查血栓弹力图。结果分组后高维持量组及替格瑞洛组ADP诱导的血小板抑制率较常规剂量组有显著性差异(P0.05),3组均未发生出血等严重不良事件,替格瑞洛组发生1例轻度呼吸困难。替格瑞洛组高于同一时间点高维持量组ADP途径诱导的血小板抑制率(P0.05)。结论针对常规剂量氯吡格雷的低反应性,替格瑞洛及双倍剂量的氯吡格雷均能有效降低血小板的高反应性,并且替格瑞洛的作用更为明显,且未增加出血等不良事件的发生。
[Abstract]:Objective to investigate the changes of platelet inhibition rate in patients with ischemic cerebrovascular disease treated with thromboelastography due to low reactivity of clopidogrel to high maintenance dose and tigride. Methods Ischemic cerebrovascular disease patients who were in accordance with double antibody therapy were selected to be treated with antiplatelet preparation (aspirin enteric-coated tablet 100 mg/qd clopidogrel 75 mg / qd) before and 7 days after treatment. Thromboelastography was used to detect arachidonic acid (AA) and diethylenoic acid (AA) in patients with ischemic cerebrovascular disease. Platelet inhibition rate induced by adenosine phosphate (ADP) pathway, 96 cases of clopidogrel hyporeactivity were selected and randomly divided into 3 groups. The routine dose group (clopidogrel 75 mg / qdU 32 cases), high maintenance group (clopidogrel 150 mg / qdU 32 cases) and tigrilol group (90 mg / kg tigride 32 cases) continued to take aspirin according to the original dose. After the 3 groups were treated with the new regimen for 7 days, the thromboelastogram was reexamined again. Results the platelet inhibition rate induced by ADP in the high maintenance dose group and tigrilol group was significantly higher than that in the routine dose group. There were no severe adverse events such as hemorrhage in the three groups, while one case in the tigrillo group had mild dyspnea. The platelet inhibition rate induced by ADP pathway in tigrilol group was higher than that in high maintenance group at the same time point (P 0.05). Conclusion both tigrilol and double dose clopidogrel can reduce platelet hyperreactivity effectively in allusion to the low reactivity of clopidogrel at conventional dose, and the effect of tigrilol is more obvious, and the occurrence of adverse events such as hemorrhage is not increased.
【作者单位】：北京航天中心医院神经内科;
【分类号】：R743.3

【相似文献】