刘然,师树田,索旻,王成钢,原琳,祖晓麟,张新勇,阙斌,艾辉,王春梅,聂绍平

• 1:首都医科大学附属北京安贞医院急诊危重症中心

摘要(Abstract)：

目的探索对氯吡格雷低反应的急性冠状动脉综合征(ACS)患者换用替格瑞洛时,起始使用负荷剂量与无负荷剂量两种方案的有效性与安全性的比较。方法前瞻性入选154例对氯吡格雷低反应拟换用替格瑞洛的患者,由主诊医师自行决定替格瑞洛是否使用负荷剂量(负荷剂量组180mg负荷量,随后90 mg每日两次维持;非负荷剂量组直接用90 mg每日两次维持)。主要终点事件为腺苷二磷酸(ADP)诱导的血小板聚集率变化情况。次要终点事件包括心源性死亡、心肌梗死、卒中事件发生率、呼吸困难、出血、尿酸变化等不良事件发生率。结果负荷剂量组由氯吡格雷转换为替格瑞洛3 d后,血小板聚集率明显低于非负荷剂量组(17.6±7.2比25.7±18.3,P=0.008),但30 d后两组血小板聚集率差异无统计学意义。换用替格瑞洛后,两组患者均未发生心源性死亡和脑卒中事件。无负荷剂量组发生心肌梗死事件2例,分别在术后3 d(转换为替格瑞洛后2 d)和90 d;负荷剂量组无心肌梗死事件。无负荷剂量组呼吸困难的发生率明显低于负荷剂量组(12.2%比19.4%,P=0.001);两组的出血事件发生率差异无统计学意义。结论与不使用负荷剂量相比,氯吡格雷低反应的患者转换为替格瑞洛时应用负荷剂量后早期血小板抑制作用更显著,且不增加出血事件,但呼吸困难发生率也更高。

关键词(KeyWords)： 急性冠状动脉综合征;氯吡格雷;替格瑞洛;负荷剂量

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘然,师树田,索旻,王成钢,原琳,祖晓麟,张新勇,阙斌,艾辉,王春梅,聂绍平

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