氯吡格雷更换为替格瑞洛抗血小板聚集疗效的前后对比

摘要
图/表
参考文献(23)
相关文章 (15)

全文: PDF (0 KB) HTML (43 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨急性冠脉综合征患者氯吡格雷更换为替格瑞洛抗血小板聚集疗效的前后对比。方法选取2018年4～11月北京大学国际医院收治的31 例急性冠脉综合征患者作为研究对象，所有患者采用氯吡格雷治疗后接受血栓弹力图二磷酸腺苷（ADP）抑制率检测（A 阶段数据），然后停用氯吡格雷更换为替格瑞洛治疗后再次检测血栓弹力图ADP 抑制率（B 阶段数据），对比前后两次检测ADP 抑制率的结果。将氯吡格雷更换为替格瑞洛后行血栓弹力图ADP 抑制率检测，按照该检测的采血时间点距离最后1 次服用氯吡格雷的时间间隔分为三组，第一组（24～＜36 h），第二组（36～＜96 h），第三组（≥96 h）。比较三组的一般资料和A、B 阶段血栓弹力图ADP 抑制率，并对其中24 例患者行CYP2C19 基因型检测。结果三组B 阶段的血栓弹力图ADP 抑制率均高于本组A 阶段血栓弹力图ADP 抑制率，差异有统计学意义（P＜0.05）。24 例行CYP2C19 基因型检测的患者中（CYP2C19*1/*1）正常代谢型17 例，17 例中有10 例（58.8%）服用氯吡格雷后ADP 抑制率＜30%，但这10 例患者更换为替格瑞洛后ADP 抑制率9 例均升至50%以上。结论氯吡格雷更换为替格瑞洛具有更好的抗血小板聚集疗效，急性冠脉综合征患者服用替格瑞洛具有更好的抗血小板聚集的疗效，即使是基因正常代谢型的患者也可能存在氯吡格雷抵抗，更换为替格瑞洛后抗血小板聚集疗效好转。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	王光亮
	吴雪梅

关键词 ：氯吡格雷, 替格瑞洛, 血栓弹力图, 血小板, 二磷腺苷抑制率

Abstract：Objective To explore the comparison of anti-platelet aggregation effect of Clopidogrel replaced to Ticagrelor in patients with acute coronary syndrome.Methods Thirty-one patients with acute coronary syndrome treated in Peking University International Hospital from April to November 2018 were selected as the research objects,all patients received thromboelastomeric adenosine diphosphate (ADP) inhibition rate test (stage A data) after clopidogrel treatment,then discontinuing Clopidogrel and replaced it with Ticagrelor to test the ADP inhibition rate (stage B data)of the thromboelastometry chart again,the results of the ADP inhibition rate tests was compared.After the Clopidogrel was replaced with Ticagrelor,the ADP inhibition rate test was performed on the thromboelastometry chart,the test was divided into three groups according to the time interval between the blood collection time point and the last dose of Clopidogrel,the first group (24-＜36 h),the second group (36-＜96 h),and the third group (≥96 h).The general data of the three groups and the ADP inhibition rate of the thromboelastic diagrams at the A and B stages were compared,and CYP2C19 genotype was detected in 24 patients.Results The thromboelastomeric ADP inhibition rate of three groups in B stage was higher than that in A stage,the difference was statistically significant (P＜0.05).17 of the 24 patients with CYP2C19 genotypes (CYP2C19*1/*1) were normal,among the 17 cases,10 cases (58.8%) took clopidogrel and the inhibition rate of ADP was less than 30%,however,the inhibition rate of ADP increased to more than 50% in 9 of the 10 patients after replacement with Ticagrelor.Conclusion The replacement of Clopidogrel with Ticagrelor has better anti-platelet aggregation effect,and the treatment of Ticagrelor in patients with acute coronary syndrome has better anti-platelet aggregation effect.Even in patients with normal metabolism,there may be resistance to Clopidogrel,and the anti-platelet aggregation effect is improved after replacement with Ticagrelor.

Key words： Clopidogrel Ticagrelor Thromboelastography Platelet Adenosine diphosphate inhibition rate

基金资助:国家自然科学基金资助项目（81801284）

通讯作者: 吴雪梅（1982-），博士，副教授，主要从事药物临床及基础研究

作者简介: 王光亮（1982-），硕士，主治医师，主要从事心血管药物临床及基础研究

引用本文:

王光亮; 吴雪梅. 氯吡格雷更换为替格瑞洛抗血小板聚集疗效的前后对比[J]. 中国当代医药, 2020, 27(1): 157-161.
WANG Guang-liang; WU Xue-mei. Before and after comparison of the anti-platelet aggregation effect of Clopidogrel replaced to Ticagrelor. 中国当代医药, 2020, 27(1): 157-161.

链接本文:

http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2020/V27/I1/157

[1]	Hiatt WR，Fowkes FG，Heizer G，et al.Ticagrelor versus clopidogrel in symptomatic peripheral artery disease[J].N Engl J Med，2017，376（1）：32-40.
[2]	Nanarskas JJ，Montoya TN.Switching from ticagrelor or prasugrel to clopidogrel[J].Cardiol Rev，2018，26（2）：107-111.
[3]	Sahlén A，Varenhorst C，Lagerqvist B，et al.Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction：experiences from SWEDEHEART registry[J].Eur Heart J，2016，37（44）：3335-3342.
[4]	Ferguson LP，Duong P，Pearce KF，et al.Monitoring of antiplatelet therapy in children on ventricular assist device support：comparison of multiplate and thromboelastography platelet mapping[J].ASAIO J，2019，65（1）：84-93.
[5]	Liu J，Nie XY，Zhang Y，et al.CYP2C19*2 and other allelic variants affecting platelet response to clopidogrel tested by thrombelastography in patients with acute coronary syndrome[J].Chin Med J （Engl），2015，128（16）：2183-2188.
[6]	Fu Z，Dong W，Shen M，et al.Relationship between hyporesponsiveness to clopidogrel measured by thrombelastography and in stent restenosis in patients undergoing percutaneous coronary intervention[J].Clin Biochem，2014，47（16-17）：197-202.
[7]	Wallentin L，Becker RC，Budaj A，et al.Ticagrelor versus clopidogrel in patients with acute comnary syndmmes[J].N Engl J Med，2009，361（11）：1045-1057.
[8]	Winter JL，Lindegjeld DS，Veas N，et al.Angiographic and electrocardiographic parameters of myocardial reperfusion in angioplasty of patients with ST elevation acute myocardial infarction loaded with ticagrelor or clopidogrel （MICAMITICLO trial）[J].Cardiovasc Revasc Med，2014，15（5）：284-288.
[14]	陈明志.替格瑞洛在老年心肌梗死急诊冠状动脉介入治疗中的作用研究[J].中国当代医药，2015，22（36）：79-81.
[15]	许晶晶，唐晓芳，宋莹，等.急性心肌梗死行急诊冠状动脉介入治疗患者CYP2C19 基因多态性对抗血小板药物作用的影响[J].中华心血管杂志，2017，45（2）：116-120.
[9]	Gurbel PA，Bliden KP，Butler K，et al.Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies：the RESPOND study[J].Circulation，2010，12l（10）：1188-1199.
[10]	Kim C，Shin DH，Hong SJ，et al.One-year clinical outcomes of ticagrelor compared with clopidogrel after percutaneous coronary intervention in patients with acute myocardial infarction：from Korean health insurance review and assessment data[J].J Cardiol，2019，73（3）：191-197.
[11]	Zhao HL，Chen XH.Ticagrelor versus clopidogrel in high bleeding risk patients with acute coronary syndromes treated with drug-eluting stents[J].Int J Cardiol，2019，279：56.
[12]	Chan HW，Kim HJ，Yoo JS，et al.Clopidogrel versus Ticagrelor for secondary prevention after coronary artery bypass grafting[J].J Clin Med，2019，8（1）：E104.
[13]	Wang D，Yand XH，Zhang JD，et al.Compared efficacy of clopidogrel and ticagrelor in treating acute coronary syndrome：a meta-analysis[J].BMC Cardiovasc Disord，2018，18（1）：217.
[16]	Kumar V，Kumari K，Talwar KK，et al.Clinical safety profile of ticagrelor compared to clopidogrel in 1208 patients：real world evidence[J].Egypt Heart J，2018，70（4）：375-378.
[17]	Jiang Z，Zhang R，Sun M，et al.Effect of clopidogrel vs ticagrelor on platelet aggregation and inflammation markers after percutaneous coronary intervention for ST-elevation myocardial infarction[J].Can J Cardiol，2018，34（12）：1606-1612.
[18]	Dayoub EJ，Nathan AS，Khatana SAM，et al.Use of prasugrel and ticagrelor in stable ischemic heart disease after percutaneous coronary intervention，2009-2016[J].Circ Cardiovasc Interv，2019，12（1）：e007434.
[19]	Liu L，Liao H，Zhong S，et al.Effects of switching ticagrelor to clopidogrel on cardiovascular outcomes in patients with acute coronary syndrome[J].Medicine（Baltimore），2018，97（48）：e13381.
[20]	Gao CZ，Ma QQ，Wu J，et al.Comparison of the effects of ticagrelor and clopidogrel on inflammatory factors，vascular endothelium functions and short-term prognosis in patients with acute st-segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention：a pilot study[J].Cell Physiol Biochem，2018，48（1）：385-396.
[21]	Kim C，Kim BK，Hong SJ，et al.Randomized comparison of strut coverage between ticagrelor and clopidogrel in acute myocardial infarction at 3-month optical coherence tomography[J].Yonsei Med J，2018，59（5）：624-632.
[22]	Dehghani P，Lavoie A，Lavi S，et al.Effects of ticagrelor versus clopidogrel on platelet function in fibrinolytic-treated STEMI patients undergoing early PCI[J].Am Heart J，2017，192：105-112.
[23]	Jariwala P，Bhatia H，Kumar EAP.Sub-acute stent thrombosis secondary to ticagrelor resistance-Myth or reality[J].Indian Heart J，2017，69（6）：804-806.