氯吡格雷抵抗与对策.ppt

434例患者CYP2C19等位基因频率分布 * 434例患者CYP2C19基因型频率分布不同性别CYP2C19基因型和等位基因频数频率分布 * 434例患者CYP2C19代谢型频率分布 * 血小板聚集的抑制: Onset References Gurbel PA, Bliden KP, Butler K, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of 替格瑞洛 versus 氯吡格雷 in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation. 2009;120:2577–2585. * In Period 1 (14 ± 2 days), the last dose of study drug was administered in the morning. In Period 2 (14 ± 2 days), all nonresponders switched treatment. All patients received concomitant aspirin therapy (75 to 100 mg once daily) in addition to study drug. Gurbel PA, Bliden KP, Butler K et al. Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies. The RESPOND Study. Circulation. 2010;121:1188–1199. * * 1. The CURE Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494-502. 2. Plavix? (clopidogrel bisulfate) Prescribing Information. 所有 patients administered 替格瑞洛 exhibited a 10% absolute reduction in platelet reactivity compared with 75% of patients administered 氯吡格雷 (p=0.005)[Gurbel 2010:E] Only 13% of patients administered 氯吡格雷 achieved a 30% absolute reduction in platelet reactivity compared with 75% of patients administered 替格瑞洛 (p0.001)[Gurbel 2010:E] Reductions of 50% were only observed in patients administered 替格瑞洛 (13% vs. 0%; p=0.046)[Gurbel 2010:E] There was no interaction in treatment efficacy between centres (p=0.0998) or time of measurement (p=0.2429)[Gurbel 2010:F] Gurbel PA, et al. Circulation 2010;121:1188–1199. * 替格瑞洛 significantly reduced high platelet reactivity in a greater proportion of patients than 氯吡格雷[Gurbel 2010:Q] This difference was observed in comparisons with both 氯吡格雷 反应者 and 无-反应者s The McNemar 无-parametric test was used to compare proportional data from matched pairs This is suitable for this pop