阿司匹林、氯吡格雷及西洛他唑预防和治疗老年冠脉支架植入术后血小板高反应性的临床效果观察

目的:探讨阿司匹林、氯吡格雷及西洛他唑预防和治疗老年冠脉支架植入术后血小板高反应性的临床效果。方法:选择60例拟行冠脉支架植入术的老年患者,随机地分为加用或未加用200 mg西洛他唑负荷剂量组。术前、术后24小时及术后30天时检测和比较各组患者的血小板聚集功能。结果:三联抗血小板治疗组的PRU、ARU及P2Y12%inhibition值均较两联抗血小板治疗组显著降低,差异具有统计学意义(P0.05)。三联抗血小板治疗和两联负荷剂量的抗血小板治疗的给药时间(第一次投药至冠脉介入治疗的时间间隔)分别为10.2小时(95%可信区间:7.4-13.1小时)和7.8小时(95%可信区间:4.5-11.2小时),三联抗血小板治疗组术前HPPR(83.3%和46.7%,P=0.003)、术后24小时(36.7%和13.3%,P=0.018)及术后30天HPPR(40.0%和16.7%,P=0.045)的发生率均较两联抗血小板治疗组明显降低(P0.05)。在术后30天的随访观察期间,两联抗血小板治疗组2例患者出现支架内血栓,并进行了血运重建术;无1例心源性死亡、缺血性卒中及出血性并发症的发生。两组次要终点的发生率比较无显著性差异(P0.05)。结论:在两联抗血小板聚集治疗的基础上附加200 mg西洛他唑可显著降低冠状动脉支架植入术后血小板的高反应性。

Clinical Research on the Effect of Asprine, Clopidogrel and Cilostazol on the Prevention and Treatment of Elderly Patients Planning for Percutaneous Coronary Intervention

Objective:To investuge the clinical efficacy of asprine, clopidogrel and cilostazol in the prevention and treatment of elderly patients Planning for Percutaneous Coronary Intervention.MethodsSixty elderly patients undergoing coronary intervention were enrolled and randomly treated by 300 mg of aspirin and clopidogrel with or without 200 mg of cilostazol. All loading doses were given at least 3 h before percutaneous coronary intervention and followed by dual or triple maintenance-dose therapy. The platelet function tests were performed just before and at 24 h and 30 days after percutaneous coronary intervention by light transmittance aggregometry and VerifyNow P2Y12 assay.:Results:The P2Y1 2 reaction units (PRU), aspirin reaction units (ARU) and P2Y1 2 % inhibition value were significantly decreased in the triple antiplatelet therapy group than those of the dual antiplatelet therapy group(P<0.05). The time interval of loading doses, dose-to-PCI time were 10.2 hours (95% CI: 7.4-1 3.1 hours) in the triple antiplatelet therapy group, and 7.8 hours (95% CI: 4.5-11 .2 hours) in the dual antiplatelet therapy group. The HPR rates were significantly reduced in the triple antiplatelet therapy group than those of the dual platelet therapy group before coronary interventin (83.3% and 46.7%, P=0.003), at 24 hours (36.7% and 1 3.3%, P=0.018) and 30 days (40.0% and 16.7%, P=0.045) after coronary intervention. During the 30 days'' follow-up period, 2 cases of in-stent thrombosis were found in the dual antiplatelet therapy group and received coronary revascularization; no cardiac death, ischemic stroke and bleeding complications was found. There was no significant difference in the incidence of secondary end points between two groups (P>0.05).Conclusion:Adjunctive 200 mg cilostazol in addition to the dual antiplatelet therapy could significantly reduce the incidence of HPR after coronary stent intervention.