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目的比较急性心肌梗死患者行急诊冠状动脉介入治疗后,服用替格瑞洛与氯吡格雷抗血小板效果的差异。方法入选因急性心肌梗死行急诊冠状动脉介入术并接受负荷及维持剂量抗血小板药物治疗的患者,其中氯吡格雷组131例,替格瑞洛组58例。术后24-48小时应用Verifynow检测残余血小板反应单位(PRU),并随访。结果189例患者中,高残余血小板反应(RPRU≥230)者51例,占比26.98%。氯吡格雷组平均血小板反应单位195.8(26~329)。替格瑞洛组平均血小板反应单位101.8(6~322)。替格瑞洛组高残余血小板反应发生率显著低于氯吡格雷组(p<0.0001)。30天及6个月随访结果显示,MACCE事件、出血及卒中的发生率,在两组之间无明显差异。结论服用负荷及维持剂量的替格瑞洛或氯吡格雷24小时后,仍有较大比例患者存在血小板抑制不充分,但替格瑞洛对血小板的抑制作用明显强于氯吡格雷。
Objective To compare the antiplatelet effects of ticagrelor and clopidogrel after acute coronary intervention in patients with acute myocardial infarction. Methods A total of 131 patients in the clopidogrel group and 58 in the ticagrelor group were enrolled in this study. Patients undergoing emergency PCI with acute myocardial infarction undergoing load and maintenance dose of antiplatelet drugs were enrolled. Verifynow detected residual platelet response units (PRU) 24-48 hours after surgery and were followed up. Results Of the 189 patients, 51 patients had high residual platelet response (RPRU≥230), accounting for 26.98%. Clopidogrel group average platelet response unit 195.8 (26 ~ 329). Ticagrelor group average platelet response unit 101.8 (6 ~ 322). The incidence of high residual platelet reaction was significantly lower in the ticagrelor group than in the clopidogrel group (p <0.0001). The 30-day and 6-month follow-up results showed no significant difference in MACCE events, bleeding and stroke among the two groups. CONCLUSION: Twenty-four hours after loading and maintenance of ticagrelor or clopidogrel, there is still a large proportion of patients with inadequate platelet inhibition, but ticagrelor is more effective than clopidogrel on platelet inhibition.