【摘要】 目的 通过血栓弹力图(TEG)筛检氯吡格雷抵抗的急性冠脉综合征(ACS)患者,探讨替格瑞洛序贯治疗的疗效。方法 纳入ACS患者473例。TEG法证实存在氯吡格雷抵抗患者193例,为替格瑞洛序贯治疗组,接受3个月替格瑞洛±9个月氯吡格雷治疗。280例患者氯吡格雷反应良好,为氯吡格雷标准治疗组,接受12个月氯吡格雷治疗。观察并比较两组术后12个月的支架内血栓(ST)、死亡、心肌梗死的发病率。结果 与氯吡格雷标准治疗相比,序贯治疗明显降低了支架内血栓(3.1%比8.2%,P=0.023)和心肌梗死(3.6%比10.4%,P=-0.007)的发病率,并未显著增加大出血风险(4.1%比3.6%,P=0.749)。结论 替格瑞洛序贯疗法可有效降低氯吡格雷抵抗ACS患者的ST风险,且并未增加大出血发生率。更多还原

【Abstract】 Objective To evaluate the effectiveness and safety of Ticagrelor sequential therapy for optimization of antiplatelet strategy in patients with low or non-Clopidogrel response and acute coronary syndromes(ACS).Methods In this prospective clinical study,473 ACS patients were included into Ticagrelor sequential therapy group(Ticagrelor for 3 months and Clopidogrel for 9 months,n = 193) or Clopidogrel group(Clopidogrel for12 months,n=280) according to the ADP-induced platelet aggregation.The primary efficacy end points were death,myocardial infarction(MI) and stent thrombosis(ST).The safety end points were PLATO major bleeding and dyspnea instances.Results The rates of ST(3.1%vs 8.2%,P=0.023) or MI(3.6%vs 10.4%,P=0.007)were lower in the Ticagrelor sequential therapy group than in the Clopidogrel group.Dyspnea was more often in the Ticagrelor sequential therapy group than in the Clopidogrel group(15.0%vs 4.3%,P<0.01).No significant difference in the rates of major bleeding was found between the two groups(4.1%vs 3.6%,P=0.749).Conclusion In patients with low or non-Clopidogrel response and acute coronary syndromes,compared with Clopidogrel,Ticagrelor sequential therapy significantly decreased the rates of ST or MI,without increase risk of major bleeding.更多还原