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目的探讨氯吡格雷低反应性与冠状动脉支架内血栓的关系,评估氯吡格雷剂量加倍后的疗效。方法连续入选9例经冠状动脉造影确诊的支架内血栓患者为观察组,连续入选100例接受支架植入治疗的冠心病患者为对照组。用光学血小板聚集仪检测花生四烯酸(AA)和二磷酸腺苷(ADP)诱导的血小板聚集率(PLAA和PLADP)。将PLAA>20%、PLADP>40%分别定义为阿司匹林和氯吡格雷低反应性,对观察组氯吡格雷低反应者加倍剂量至150mg/d,随访PLADP及临床事件。结果观察组氯吡格雷低反应的发生率高于对照组(100%vs.27%)(P<0.01);观察组PLADP水平显著高于对照组[(53.6±6.3)%vs.(31.9±14.0)%](P<0.01);观察组氯吡格雷剂量加倍后,血小板聚集率显著降低[(53.6±6.3)%vs.(37.0±10.9)%](P<0.01)。观察组与对照组均未检出阿司匹林低反应患者。结论氯吡格雷低反应性是冠状动脉支架内血栓形成的危险因素。氯吡格雷剂量加倍可显著降低残余血小板聚集率,可能减少支架内血栓形成事件的发生。
Objective To investigate the relationship between clopidogrel hyporesponsiveness and coronary stent thrombosis and evaluate the efficacy of doubled clopidogrel dose. Methods Nine patients with coronary stent thrombosis confirmed by coronary angiography were selected as the observation group. One hundred consecutive patients with coronary artery disease undergoing stent implantation were selected as the control group. Platelet aggregation rates (PLAA and PLADP) induced by arachidonic acid (AA) and adenosine diphosphate (ADP) were measured by optical platelet aggregation. PLAD> 20% and PLADP> 40% were defined as aspirin and clopidogrel hyporesponsiveness, respectively. Patients in the observation group were doubly dosed with clopidogrel to a dose of 150 mg / day, followed up for PLADP and clinical events. Results The incidence of low-response clopidogrel in the observation group was significantly higher than that in the control group (100% vs.27%, P <0.01). The PLADP level in the observation group was significantly higher than that in the control group [(53.6 ± 6.3)% vs (31.9 ± 14.0)%] (P <0.01). After doubling the dose of clopidogrel in observation group, the platelet aggregation rate was significantly decreased (53.6 ± 6.3% vs 37.0 ± 10.9%, P <0.01). No aspirin hyponatremia was observed in the observation group and the control group. Conclusion Clopidogrel hyporesponsiveness is a risk factor for coronary stent thrombosis. Doubled the dose of clopidogrel can significantly reduce the residual platelet aggregation rate, may reduce the incidence of stent thrombosis.