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目的评估不同维持剂量氯吡格雷对择期PCI的ACS患者血小板聚集率的影响,探讨高维持剂量氯吡格雷对ACS患者的有效性及安全性。方法选择接受药物治疗、择期PCI的急性冠脉综合征患者150例,随机分为2组(各75例),2组均服用300mg负荷量氯吡格雷,然后分别给予氯吡格雷150mg/d、75mg/d治疗14d,14d后所有患者接受75mg/d氯吡格雷治疗直至PCI术后1年。分别于服药前、服药后第14天采2组患者静脉血,采用光学比浊法测定血小板聚集率(PA),同时计算血小板聚集抑制率(PAI)。观察住院14天内2组终点事件发生情况。结果试验组和对照组服药前血小板聚集率的差别无统计学意义(89.63±4.89vs.90.27±4.84,p>0.05);试验组服药第14天的血小板聚集率较对照组明显下降(41.36±5.13vs.51.69±3.98,p<0.05),血小板聚集抑制率较对照组明显增强(48.27±6.29vs.38.58±5.48,p<0.05),均有统计学差异。住院14天内,两组均无心血管死亡、严重的颅内出血和严重血小板减少,亚急性血栓形成发生率(1.3%vs4.0%,P>0.05)相近,轻微出血发生率(2.7%vs4.0%,P>0.05)无统计学差异。结论对高危急性冠脉综合症患者,150mg/日高氯吡格雷维持量可以明显降低血小板聚集率,从而降低血栓事件,且不增加短期出血风险,具有较好的耐受性和安全性。
Objective To evaluate the effect of different maintenance doses of clopidogrel on platelet aggregation in ACS patients undergoing elective PCI and to evaluate the efficacy and safety of high-maintenance-dose clopidogrel in patients with ACS. Methods A total of 150 patients with acute coronary syndrome undergoing elective PCI were randomly divided into 2 groups (75 in each). Both groups received clopidogrel at a dose of 300 mg and were given clopidogrel 150 mg / d, 75 mg / d for 14 days. After 14 days, all patients received 75 mg / d of clopidogrel until 1 year after PCI. The blood samples were taken from the patients in the two groups before 14 days after taking the medicine. The platelet aggregation rate (PA) and platelet aggregation inhibition rate (PAI) were measured by optical turbidimetry. Observe the incidence of end-point events in two groups within 14 days of hospitalization. Results There was no significant difference in the platelet aggregation rate between the experimental group and the control group (89.63 ± 4.89 vs.90.27 ± 4.84, p> 0.05). The platelet aggregation rate of the experimental group on the 14th day was significantly lower than that of the control group (41.36 ± 5.13 vs.51.69 ± 3.98, p <0.05). The rate of inhibition of platelet aggregation was significantly higher than that of the control group (48.27 ± 6.29 vs.38.58 ± 5.48, p <0.05), both of which were statistically different. Within 14 days of hospitalization, there were no cardiovascular deaths, severe intracranial hemorrhage and severe thrombocytopenia in both groups. The incidence of subacute thrombosis (1.3% vs 4.0%, P> 0.05) was similar with mild bleeding (2.7% vs 4.0 %, P> 0.05) no statistical difference. CONCLUSIONS: High-dose clopidogrel at 150 mg / day significantly reduces platelet aggregation in high-risk patients with acute coronary syndromes, thereby reducing thrombotic events without increasing the risk of short-term bleeding and providing better tolerability and safety.