替格瑞洛联合西洛他唑在经皮冠状动脉介入治疗术后低体重患者中抗血小板治疗的安全性和有效性

摘要

Objective To explore the efficacy and safety of ticagrelor plus cilostazol of different dosage in the treatment of low-weight patients after PCI.Methods A total of 148 consecutive ACS patients (body weight ≤ 65 kg) past PCI and with aspirin intolerance were enrolled and randomly divided into four groups.Patients given cilostazol 50mg twice daily plus clopidogrel 75 mg daily were named as the CC50 mg group.Patients in the CC100 mg group were given cilostazol 100 mg twice daily plus clopidogrel 75 mg daily.The TCS0 mg group were given cilostazol 50 mg twice daily plus standard ticagrelor 90mg twice daily and the TC100 mg group were given cilostazol 50 mg twice daily plus standard ticagrelor 90 mg twice daily.All patients were followed up clinically for 6 months.The clinical endpoints were MACEs and bleeding events.Platelet aggregation at 7 and 30 days after treatment the incidence of clinical endpoints during followup were compared between the four groups.Results Patients in the TC100mg group had the lowest platelet aggregation rates tested on both the 7th and 30th day after treatment among all the 4 groups.After 6 months of follow up,the MACEs rate was not significantly different between the four groups (P =0.930).Bleeding events rates in the TC100 mg group the highest among the 4 but without groups significant differences.Conclusions In ACS patients with low body weight ≤ 65 kg) past PCI and with aspirin intolerance,cilostazol 50mg twice daily plus ticagrelor is a safe and efficacious therapeutic regimen.%目的 探讨经皮冠状动脉介入治疗(PCI)术后低体重患者替格瑞洛联合不同剂量西洛他唑抗血小板治疗的疗效与安全性.方法 纳入体重≤65 kg,阿司匹林不耐受的急性冠状动脉综合征(ACS)患者148例随机分为四组,即氯吡格雷分别联合西洛他唑50 mg组(CC50 mg组)和西洛他唑100 mg组(CC100 mg组),以及替格瑞洛分别联合西洛他唑50 mg组(TC50 mg组)和西洛他唑100 mg组(TC100 mg组).分别于治疗后第7天和第30天检测血小板聚集程度比较分析.随访6个月,观察主要不良心血管事件发生率.结果 治疗后第7天检测血小板聚集程度,TC 100 mg组花生四烯酸(AA)诱导的血小板聚集程度明显低于CC50 mg组、CC100 mg组、TC50 mg组[(0.71±0.63)比(1.22 ±0.79),P =0.029、[(0.71±0.63)比(1.03±0.65),P =0.031]、[(0.71±0.63)比(1.11±1.02),P=0.034];TC50 mg组腺苷二磷酸(ADP)诱导的血小板聚集程度显著低于CC50 mg组[(2.03±2.50)比(3.23±2.60),P=0.025];TC100mg组ADP诱导的血小板聚集程度明显低于CC50 mg组、CC100 mg组、TC50 mg组[(1.86±1.24比(3.23±2.60),P=0.018] (1.86±1.24)比(3.09 ±2.12),P=0.019]、[(1.86±1.24)比(2.03±2.50),P=0.012],差异均有统计学意义.第30天复查血小板聚集程度,TC100 mg组AA诱导的血小板聚集程度明显低于CC50 mg组、CC100 mg组、TC50 mg组[(0.82±0.76)比(1.26±0.87),P=0.021]、[(0.82±0.76)比(1.15±0.66),P=0.028]、[(0.82±0.76)比(1.11±0.79),P=0.031];TC50 mg组ADP诱导的血小板聚集程度显著低于CC50 mg组[(2.04±1.70)比(3.03 ±1.98),P=0.027];TC100mg组ADP诱导的血小板聚集程度明显低于CC50 mg组、CC100 mg组、TC50 mg组[(1.78士1.07)比(3.03 ±1.98),P=0.007]、[(1.78±1.07)比(2.09±1.52),P=0.009]、[(1.78±1.07)比(2.04±1.70),P=0.009],差异均有统计学意义.随访6个月,主要不良心血管事件发生率,四组比较,差异无统计学意义.总出血事件比较,CC50 mg组总出血风险低于其他三组,差异无统计学意义.结论 低体重(≤65 kg) ACS患者PCI术后抗血小板治疗,替格瑞洛联合西洛他唑50 mg抗血小板治疗安全有效,且出血风险小.