冠心病抗血小板治疗现状及进展_韩雅玲.pptVIP

氯吡格雷抵抗患者合用GPI的疗效 * This slide shows the study design. This is a single center, randomized, open-label trial. A total of 1253 consecutive patients admitted with ACS were enrolled. After successful coronary stenting, 1212 patients were randomly assigned to receive dual antiplatelet therapy or triple antiplatelet therapy. The primary end point was major adverse cardiac and cerebral events, defined as the composite of CV death, MI, stroke or TVR. The secondary end points were bleeding events and premature withdrawal of study drugs. * Key subgroup analysis showed that clinically or angiographically high-risk patients benefited more from triple antiplatelet treatment. Which indicated that angiographically high-risk factors, as well as clinical risk factors, are important for the decision-make of antiplatelet strategy. A comprehensive consideration of clinical and angiographic characteristics for each patient is helpful for the choice of dual or triple antiplatelet therapy. * * * * * * * * This figure shows the cumulative hazard for MACCE of different antipletelet regimen. The two curves separated obviously at the first 6 months. Although there was a significant trend of increased primary event at 6~7 months in triple antiplatelet group, the benefit of triple antiplatelet therapy maintained to 1 year. 在预先设定的PCI队列，分别研究一级疗效终点和二级疗效终点在不同亚组间的均一性。首先观察一级疗效终点，可发现波立维高剂量组的临床获益具有均一性，无论入院诊断、性别、年龄、有无糖尿病史、是否院内使用GP拮抗剂等，高剂量波立维治疗都是明显获益的。另外，最近倍受关注的PPI，在此试验中也得到进一步证实：不论用或不用PPI，都不影响高剂量波立维治疗组的显著获益，这说明PPI不干扰波立维的疗效。本试验观察到了两个显著的交互作用，一个是吸烟，研究发现吸烟者比不吸烟者接受高剂量波立维治疗显著获益。另一个是ASA不同剂量的交互影响，从一级终点可看出，高剂量ASA治疗的患者似乎接受高剂量波立维治疗临床获益更为明显，但从右面一列次级疗效终点分析，吸烟仍然是有显著交互影响的，而此时ASA两个不同剂量组的临床获益没有明显差异了，都表现为接受高剂量波立维治疗明显获益 150mg/d氯吡格雷维持量抑制血小板作用更强 ADP诱导的血小板聚集率 P2Y12活性单位 (VerifyNow) ISAR-CHOICE-2研究结论 Eur Heart J 2007 28(15):1814-9 2型糖尿病病人高维持量氯吡格雷治疗研究 （OPTIMUS研究） 75mg组 (n=20) 150mg组 (n=20) 75mg 30d 75mg 30d 150mg 30d 75mg 30d Circulation. 2007;115:708-716 高维持量氯吡格雷治疗临床研究 ——沈阳军区总医院经验 ACS R 氯吡格雷