摘要目的 评估常规剂量及双倍剂量氯吡格雷治疗老年急性冠状动脉脉综合征(ACS)经皮冠状动脉介入治疗(PCI)术后氯毗格雷抵抗患者的疗效与安全性,为老年患者应用抗血小板药物提供临床依据. 方法 本研究为随机对照临床试验,将老年急性冠状动脉综合征PCI术后氯吡格雷抵抗者(血小板抑制率＜30％)108例,随机分为对照组54例(氯吡格雷75 mg,1次/d),试验组54例(氯吡格雷150 mg,1次/d).观察服药前、服药后7、30、90及180 d血栓弹力图吡啶二磷酸腺苷(ADP)诱导的血小板抑制率及主要不良心血管事件和出血、呼吸困难等不良反应的发生率. 结果 与对照组比较,试验组治疗后7、30、90及180 d血小板抑制率明显升高,分别为(22.4±4.5)％和(37.6±4.5)％、(22.6±4.3)％和(38.8±4.7)％、(22.7±4.6)％和(38.5±4.5)％、(23.7±4.3)％和(38.9±4.6)％(均P＜0.05);试验组主要不良心血管事件发生率较对照组降低(3.7％和35.1％)(x2=15.133,P＜0.001);试验组出血及呼吸困难发生率较对照组高,但差异无统计学意义(均P＞0.05). 结论 老年急性冠状动脉综合征PCI术后氯吡格雷抵抗患者,双倍剂量的氯吡格雷疗效优于常规剂量,且安全性良好.

abstractsObjective To evaluate the efficacy and safety of double-dosage Clopidogrel in elderly patients with Clopidogrel resistance after percutaneous coronary intervention(PCI).Methods The randomized control trials design was used in this study.108 senile ACS patients with Clopidogrel resistance(platelet inhibition rate＜ 30 ％) were randomized into control group(Clopidogrel 75 mg/d,n =54)and experimental group(Clopidogrel 150 mg/d,n=54).Blood platelet inhibition rate of ADP,major adverse cardiovascular events and main side effects were observed before and 7 d,30 d,90 d and 180 d after intervention.Results Compared with control group,the experimental group was associated with significantly increased platelet inhibition rate on 7 d (22.4 ± 4.5) ％ vs.(37.6 ± 4.5)％,30 d(22.6±4.3)％ vs.(38.8±4.7)％,90 d(22.7±4.6)％ vs.(38.5±4.5)％,and 180 d (23.7±4.3)％ vs.(38.9±4.6)％ after treatment(all P＜0.05).Furthermore,the incidence of main adverse cardiovascular events was also significantly lower in the experimental group(3.7％ vs.35.1％,x2 =15.133,P＜0.001).Meanwhile,the incidence of bleeding and dyspnea were higher in experimental group,but there was no significant difference between the two groups.Conclusions Compared with general dosage,double-dosage of Clopidogrel offers better curative effect and good safety in elderly ACS patients with Clopidogrel resistance after PCI.