• 【DeBakey VAD儿童泵栓的另一种治疗策略: 使用氯吡格雷作为溶栓剂。】 复制标题 收藏 收藏
    DOI:10.1016/j.healun.2006.03.013 复制DOI
    作者列表:Studer MA,Kennedy CE,Dreyer WJ,Price JF,Moffett BS,Teitel ER,Carberry KE,Morales DL,McKenzie ED,Chang AC
    BACKGROUND & AIMS: :Our institution has used the DeBakey VAD Child as a bridge to heart transplantation in select pediatric patients. Pump thrombus is a potentially serious complication with few available treatment options. Only surgical device exchange or the use of tissue plasminogen activator are reported in the literature. We report the use of clopidogrel as an alternative thrombolytic agent in the presence of pump thrombus in an adolescent patient with a DeBakey VAD Child heart pump.
    背景与目标: : 我们的机构已将DeBakey VAD儿童用作某些儿科患者进行心脏移植的桥梁。泵血栓是一种潜在的严重并发症,几乎没有可用的治疗选择。文献中仅报道了手术设备交换或组织纤溶酶原激活剂的使用。我们报告了在患有DeBakey VAD儿童心脏泵的青少年患者中,在存在泵血栓的情况下使用氯吡格雷作为替代溶栓剂。
  • 【氯吡格雷在冠心病患者中的当代应用。】 复制标题 收藏 收藏
    DOI:10.1007/BF02938373 复制DOI
    作者列表:Parikh SA,Beckman JA
    BACKGROUND & AIMS: :Antiplatelet agents have long served as the cornerstone of pharmacologic therapy to prevent atherothrombotic events. The thienopyridines have risen to prominence as both an alternative and adjunctive treatment to aspirin monotherapy. These agents prevent platelet aggregation by selectively and irreversibly blocking the platelet ADP P2Y12 receptor. In this article we focus on the use of clopidogrel in the contemporary management of coronary artery disease. We assess the use of clopidogrel following revascularization for coronary artery disease with percutaneous coronary intervention, particularly after deployment of drug-eluting stents. Finally, we address some aspects of clopidogrel resistance.
    背景与目标: 长期以来,抗血小板药物一直是预防动脉粥样硬化血栓形成事件的药物治疗的基石。噻吩并吡啶作为阿司匹林单一疗法的替代和辅助治疗已日益突出。这些药物通过选择性和不可逆地阻断血小板ADP P2Y12受体来防止血小板聚集。在本文中,我们重点介绍了氯吡格雷在当代冠状动脉疾病治疗中的应用。我们评估了经皮冠状动脉介入治疗冠状动脉疾病血运重建后氯吡格雷的使用情况,尤其是在部署药物洗脱支架后。最后,我们讨论了氯吡格雷抵抗的一些方面。
  • 【氯吡格雷前负荷方案对动脉粥样硬化患者阿司匹林的急性抗血栓作用。】 复制标题 收藏 收藏
    DOI:10.1161/01.atv.20.10.2316 复制DOI
    作者列表:Helft G,Osende JI,Worthley SG,Zaman AG,Rodriguez OJ,Lev EI,Farkouh ME,Fuster V,Badimon JJ,Chesebro JH
    BACKGROUND & AIMS: :There is a need for a rapid antithrombotic effect after the administration of antiplatelet drugs in the setting of acute coronary syndromes and percutaneous interventions. Clopidogrel, a new thienopyridine derivative, is an efficient antiplatelet agent. However, the standard regimen of clopidogrel (75 mg/d) requires 2 to 3 days before significant antithrombotic effects. Patients with stable arterial disease on chronic aspirin therapy (n=20) were treated with clopidogrel either with a front-loaded regimen, 300 mg the first day and 75 mg/d the next 7 days, or with a standard regimen, 75 mg/d for 8 days. Blood thrombogenicity was assessed by quantification of platelet-thrombus formation in an ex vivo perfusion chamber, by ADP-induced platelet aggregation, and by ADP-induced fibrinogen binding. At 2 hours, mean total thrombus area with the standard regimen was not significantly reduced. In contrast, at 2 hours, the mean total thrombus area with the front-loaded regimen was significantly decreased by 23.1+/-8.5% versus baseline (P<0.05). ADP-induced platelet aggregation (with 5 and 10 micromol/L) was also significantly (P<0.05) reduced with the front-loaded regimen at 2 hours, with the mean platelet aggregation being 82.2+/-4.4% and 81.8+/-4.5%, respectively, versus baseline. Similarly, flow cytometry demonstrated a significant decrease (P<0. 05) in the ADP-induced fibrinogen binding (with 0.12 and 0.6 micromol/L) at 2 hours in this front-loaded regimen group (36.1+/-2. 0% and 53.2+/-9.3%). With the standard regimen, platelet activity was not significantly reduced at 2 hours. Our data suggest that a front-loaded regimen of clopidogrel added to aspirin achieves a significant antithrombotic effect at 2 hours in patients with known atherosclerotic disease on chronic aspirin therapy. This provides a rationale for using front-loaded clopidogrel in combination with aspirin in percutaneous coronary interventions.
    背景与目标: : 在急性冠状动脉综合征和经皮介入治疗的情况下,使用抗血小板药物后需要快速的抗血栓形成作用。氯吡格雷是一种新的噻吩吡啶衍生物,是一种有效的抗血小板药物。然而,氯吡格雷的标准方案 (75 mg/d) 需要2至3天才能产生明显的抗血栓形成作用。接受慢性阿司匹林治疗 (n = 20) 的稳定动脉疾病患者接受氯吡格雷治疗,采用前负荷方案,第一天300 mg,接下来7天75 mg/d,或者采用标准方案,75 mg/d,持续8天。通过量化离体灌注室中的血小板-血栓形成,ADP诱导的血小板聚集和ADP诱导的纤维蛋白原结合来评估血液的血栓形成性。2小时时,标准方案的平均总血栓面积没有明显减少。相反,在2小时时,与基线相比,前负荷方案的平均总血栓面积显着减少了23.1/-8.5% (P<0.05)。ADP诱导的血小板聚集 (5和10微摩尔/升) 也显著降低 (P<0.05),前负荷方案在2小时,平均血小板聚集分别为82.2 +/-4.4% 和81.8 +/-4.5%,与基线相比。类似地,流式细胞术显示ADP诱导的纤维蛋白原结合 (0.12和0.6 micromol/L) 在2小时前加载方案组 (36.1 +/-2. 0% 和53.2 +/-9.3%) 显着降低 (P <0.05)。在标准方案中,血小板活性在2小时没有明显降低。我们的数据表明,在阿司匹林中加入氯吡格雷的前负荷方案在接受慢性阿司匹林治疗的已知动脉粥样硬化疾病的患者中,在2小时内可获得显着的抗血栓形成作用。这为在经皮冠状动脉介入治疗中使用前载氯吡格雷与阿司匹林联合提供了依据。
  • 【通过不同血小板功能测试评估的氯吡格雷后血小板反应性对接受PCI治疗的东亚患者缺血性事件的预测价值。】 复制标题 收藏 收藏
    DOI:10.3109/09537104.2013.815341 复制DOI
    作者列表:Zhang HZ,Kim MH,Jeong YH
    BACKGROUND & AIMS: :Abstract An accumulating number of studies are revealing that platelet reactivity above specific cut-off scores leads to exponentially increased rates of post-percutaneous coronary intervention (PCI) ischemic events. To evaluate the optimal predictive values for three different platelet function measurement assays of platelet reactivity on early clinical outcomes in Korean patients undergoing PCI, we enrolled 228 patients receiving clopidogrel prior to PCI. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow P2Y12 assay, and multiple electrode platelet aggregometry (MEA). The primary endpoint was the 30-day occurrence of ischemic events after PCI. MACE occurred in 36 patients (15.8%), including 35 patients (15.4%) with periprocedural MI and the death of one patient (0.4%). ADP-induced LTA and VerifyNow values (pre- and post-PCI) were significantly higher in patients with the subsequent occurrence of periprocedural MI, but the MEA assay data (PCI and post-PCI) displayed no significant differences (pre-PCI p=0.25 and post-PCI p=0.33). ROC curve analysis demonstrated HPR values for LTA (pre-PCI, >66% and post-PCI, >53 %, all p<0.001), VerifyNow (pre-PCI, >347 PRU and post-PCI >272 PRU, all p<0.001) and MEA (pre-PCI, >50 U and post-PCI >39 U, all p>0.05). The platelet reactivity measurements by LTA and the VerifyNow assay can discriminate the risk of 30-day ischemic events after PCI. The predictive cut-off values for adverse events are dependent on sampling time.
    背景与目标: : 摘要越来越多的研究表明,超过特定临界值的血小板反应性导致经皮冠状动脉介入治疗 (PCI) 后缺血性事件的发生率呈指数增加。为了评估三种不同的血小板功能测量测定对接受PCI的韩国患者早期临床结局的最佳预测值,我们招募了228例在PCI之前接受氯吡格雷的患者。通过透光率聚集法 (LTA),VerifyNow P2Y12测定和多电极血小板聚集法 (MEA) 测量血小板反应性。主要终点是PCI术后30天发生缺血事件。MACE发生在36例患者 (15.8% 例) 中,其中35例 (15.4% 例) 患有围手术期MI,1例死亡 (0.4% 例)。在随后发生围手术期MI的患者中,ADP诱导的LTA和VerifyNow值 (PCI前和PCI后) 显着较高,但MEA测定数据 (PCI和PCI后) 显示无显着差异 (PCI前p = 0.25和PCI后p = 0.33)。ROC曲线分析显示了LTA (PCI前,> 66% 和PCI后,> 53%,所有p<0.001) 、VerifyNow (PCI前,> 347 PRU和PCI后> 272 PRU,所有p<0.001) 和MEA (PCI前,> 50 U和PCI后> 39 U,所有p>0.05)。通过LTA和VerifyNow分析进行的血小板反应性测量可以区分PCI后30天缺血事件的风险。不良事件的预测临界值取决于采样时间。
  • 【急性冠脉综合征患者氯吡格雷和阿司匹林双重抗血小板治疗的持续时间。】 复制标题 收藏 收藏
    DOI:10.1093/eurheartj/eht438 复制DOI
    作者列表:Varenhorst C,Jensevik K,Jernberg T,Sundström A,Hasvold P,Held C,Lagerqvist B,James S
    BACKGROUND & AIMS: AIMS:Dual antiplatelet treatment (DAPT) is a cornerstone in the treatment of acute coronary syndrome (ACS) but the optimal treatment duration is unclear. We aimed to evaluate the effect of DAPT duration with clopidogrel and aspirin on the recurrence of ischaemic events and bleeding in a large, unselected ACS population. METHODS AND RESULTS:We performed a prospective, observational cohort study of patients in Sweden (n = 56 440) admitted for ACS, with prescribed DAPT and hospitalized between January 2006 and July 2010. Patients were obtained from the SWEDEHEART register and data were merged with registers from the National Board of Health and Welfare. Depending on dispensed clopidogrel tablets, patients were divided into groups based on DAPT duration with clopidogrel and aspirin (3 months: 84-100 clopidogrel tablets (t); >3 months: >100 t; 6 months: 168-200 t; >6 months: >200 t). For the combined primary endpoint, defined as all-cause death, stroke, or re-infarction, only patients with an uneventful first 3-month period (no death, stroke, re-infarction, bleeding, stent thrombosis, or revascularization) were included. The incidence of the primary endpoint was 45 events per 1000 person-years in the >3 months DAPT group compared with 65 events per 1000 person-years in the 3 months DAPT group [adjusted HR 0.84, 95% CI (0.75; 0.95)]. Bleeding was more common in the >3 months treatment group (adjusted HR 1.56, 95% CI (1.18; 2.07), but the number of events was small. For >6 vs. 6 months DAPT, the adjusted HR for the combined endpoint was 0.75 with 95% CI (0.59; 0.95). CONCLUSION:In this contemporary, large real-life ACS population, DAPT for more than 3 months compared with a shorter duration was associated with a lower risk of death, stroke, or re-infarction. TRIAL REGISTRATION:Clinicaltrials.gov (NCT01623700).
    背景与目标:
  • 【与缺血性心力衰竭患者的阿司匹林相比,氯吡格雷与NT-proBNP的增加较小。】 复制标题 收藏 收藏
    DOI:10.1016/j.cardfail.2006.04.003 复制DOI
    作者列表:Jug B,Sebestjen M,Sabovic M,Keber I
    BACKGROUND & AIMS: BACKGROUND:Aspirin has been associated with adverse heart failure outcomes, probably because of a blunting interaction with angiotensin-converting enzyme (ACE) inhibitors. Therefore, we hypothesized that clopidogrel when compared with aspirin would be associated with a slower progression of heart failure as determined by levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP). METHODS AND RESULTS:In an open-label, randomized, 2-treatment, 2-period crossover study, 18 patients with ischemic heart failure (14 post-myocardial infarction, left ventricular ejection fraction 0.32 +/- 0.08), median age 73, New York Heart Association class II (11 patients) or III (7 patients), all taking ACE inhibitors were included. Patients were randomized to 8 weeks of aspirin 100 mg/day followed by 8 weeks of clopidogrel 75 mg/day, or the reversed sequence. Blood levels of NT-proBNP were measured using sandwich immunoassay. Patients on aspirin experienced an 8-times greater increase in log-transformed values of NT-proBNP compared with patients on clopidogrel (average change 4.757% versus 0.597%; P = .0395 for intervention, P = .4453 for period, P = .4046 for sequence). We observed no change in functional class, 6-minute walking test, creatinine levels, or electrolytes. CONCLUSION:Aspirin is associated with a greater increase in natriuretic peptides (log-transformed NT-proBNP levels), implying that aspirin therapy is associated with a more progressive course of heart failure.
    背景与目标:
  • 【氯吡格雷对冠心病粘附分子,止血和纤维蛋白溶解的影响。】 复制标题 收藏 收藏
    DOI:10.1097/FJC.0b013e31817d2f2e 复制DOI
    作者列表:Walter T,Szabo S,Kazmaier S,Swoboda S,Suselbeck T,Brueckmann M,Borggrefe M,Beyer ME,Hoffmeister HM
    BACKGROUND & AIMS: BACKGROUND:The interaction among inflammation, Hemostasis, and fibrinolysis plays a major role in the genesis of coronary artery disease (CAD). The aim of the study was to compare the effect of clopidogrel plus aspirin versus aspirin alone on cellular adhesion molecules on leukocytes, soluble adhesion molecules, and molecular markers of coagulation and fibrinolysis in patients with CAD. METHODS:In this randomized, placebo-controlled, and double-blind study, 42 patients with chronic angina pectoris were included. All patients were treated with aspirin (ASA). Twenty-three patients received clopidogrel additionally (75 mg/day with a 300-mg loading dose) for 14 days. Nineteen patients received placebo additionally. Soluble adhesion molecules (sICAM-1, sVCAM-1, sP-selectin), surface expression of CD54, CD11a, CD11b, CD40, CD40L, CD41, CD42b, and CD62L on lymphocytes, monocytes, and neutrophils, and markers of hemostasis and fibrinolysis (TAT, PAP, D-dimers) were measured. RESULTS:In the ASA + clopidogrel group, no change in surface expression of cellular adhesion molecules on leukocytes and on plasma levels of sICAM-1, sVCAM-1, sP-selectin, TAT, PAP, and D-dimers was detectable. CONCLUSIONS:Clopidogrel plus aspirin for 2 weeks did not result in a detectable benefit versus sole aspirin therapy regarding cellular adhesion molecules on leukocytes, plasma markers of coagulation, fibrinolysis, and soluble adhesion molecules in patients with CAD.
    背景与目标:
  • 【在主要使用第二代药物洗脱支架后随机分配至6或12个月氯吡格雷的患者中,DAPT评分的验证。】 复制标题 收藏 收藏
    DOI:10.1160/TH17-02-0101 复制DOI
    作者列表:
    BACKGROUND & AIMS: :The DAPT score is a recently-proposed decision tool for guiding optimal duration of dual antiplatelet therapy (DAPT). It showed modest accuracy in prior derivation and validation cohorts of patients with ≥12 months DAPT. This study was aimed to evaluate the validity of the DAPT score in a cohort of patients with 6 or 12 months DAPT after implantation of predominantly second-generation drug-eluting stents. We analyzed data of patients enrolled in the ISAR-SAFE trial. Patients were classified into low (<2) or high (≥2) DAPT score groups. Primary ischaemic (all-cause death, myocardial infarction, definite stent thrombosis or stroke) and bleeding (TIMI major or minor) outcomes were analyzed in the low and high DAPT score groups. Data of 3976 patients were available for DAPT score calculation. 2407 patients (60.5 %) were classified in the low DAPT score group and 1569 patients (39.5 %) in the high DAPT score group. In the low DAPT score group there were no significant differences between 6 and 12 months DAPT regarding ischaemic (1.0 % vs. 1.4 %, HR=0.74, 95 % CI, 0.35-1.57; p=0.43) or bleeding outcomes (0.3 % vs. 0.8 %, HR=0.44, 95 % CI, 0.13-1.42; p=0.17). In the high DAPT score group there were also no significant differences between 6 and 12 months DAPT regarding ischaemic (1.9 % vs. 1.8 %, HR=1.02, 95 % CI, 0.49-2.14; p=0.96) or bleeding (0.3 % vs. 0.5 %, HR=0.51, 95 % CI, 0.09-2.78; p=0.44) outcomes. In conclusion, the DAPT score failed to show a differential treatment effect in patients receiving 6 or 12 months DAPT after contemporary drug-eluting stent implantation.
    背景与目标: : DAPT评分是最近提出的用于指导双重抗血小板治疗 (DAPT) 最佳持续时间的决策工具。在 ≥ 12个月DAPT的患者的先前推导和验证队列中,它显示出适度的准确性。这项研究旨在评估DAPT评分在植入主要是第二代药物洗脱支架后6或12个月的DAPT患者队列中的有效性。我们分析了参加ISAR-SAFE试验的患者的数据。患者分为低 (<2) 或高 (≥ 2) DAPT评分组。在低和高DAPT评分组中分析了原发性缺血性 (全因死亡,心肌梗塞,明确的支架血栓形成或中风) 和出血 (TIMI主要或次要) 结局。3976例患者的数据可用于DAPT评分计算。低DAPT评分组2407例 (60.5   %),高DAPT评分组1569例 (39.5   %)。在低DAPT评分组中,DAPT在缺血 (1.0   % vs. 1.4   %,HR = 0.74,95   % CI,0.35-1.57; p = 0.43) 或出血结果 (0.3   % vs. 0.8   %,HR = 0.44,95  % CI,0.13-1.42; p = 0.17)。在高DAPT评分组中,在缺血 (1.9   % vs. 1.8   %,HR = 1.02,95   % CI,0.49-2.14; p = 0.96) 或出血 (0.3   % vs. 0.5   %,HR = 0.51,95% CI,0.09-2.78; p = 0.44) 结果。总之,在当代药物洗脱支架植入后接受6或12个月DAPT的患者中,DAPT评分未能显示出不同的治疗效果。
  • 【泮托拉唑和埃索美拉唑对氯吡格雷抑制血小板的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.ahj.2008.09.017 复制DOI
    作者列表:Siller-Matula JM,Spiel AO,Lang IM,Kreiner G,Christ G,Jilma B
    BACKGROUND & AIMS: BACKGROUND:Clopidogrel is activated by CYP2C19, which also metabolizes proton pump inhibitors (PPI). As proton pump inhibitors are metabolized to varying degrees by CYP2C19, we hypothesized that the reported negative omeprazole-clopidogrel drug interaction may not be a class effect. METHODS:Responsiveness to clopidogrel was assessed by the vasodilator-stimulated phosphoprotein phosphorylation (VASP) assay and aggregometry (Multiplate Analyzer) in 300 patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). RESULTS:The mean platelet reactivity index (PRI, assessed by the VASP assay) was nearly the same in patients with (n = 226; PRI = 51%) or without PPI treatment (n = 74; PRI = 49%; P = .724). Likewise, the adenosine diphosphate-induced platelet aggregation did not differ significantly between patients with or without PPI treatment (45 vs. 41 U; P = .619). Similarly, there was no difference in the PRI or the adenosine diphosphate-induced platelet aggregation between patients with pantoprazole (n = 152; PRI = 50%; aggregation = 47 U), esomeprazole (n = 74; PRI = 54%; aggregation = 42 U), or without PPI (n = 74; PRI = 49%; aggregation = 41 U; P = .382). CONCLUSION:In contrast to the reported negative omeprazole-clopidogrel drug interaction, the intake of pantoprazole or esomeprazole is not associated with impaired response to clopidogrel.
    背景与目标:
  • 【药物洗脱支架植入后氯吡格雷的使用和长期临床结果。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2007-01-10
    来源期刊:JAMA
    DOI:10.1001/jama.297.2.joc60179 复制DOI
    作者列表:Eisenstein EL,Anstrom KJ,Kong DF,Shaw LK,Tuttle RH,Mark DB,Kramer JM,Harrington RA,Matchar DB,Kandzari DE,Peterson ED,Schulman KA,Califf RM
    BACKGROUND & AIMS: CONTEXT:Recent studies of drug-eluting intracoronary stents suggest that current antiplatelet regimens may not be sufficient to prevent late stent thrombosis. OBJECTIVE:To assess the association between clopidogrel use and long-term clinical outcomes of patients receiving drug-eluting stents (DES) and bare-metal stents (BMS) for treatment of coronary artery disease. DESIGN, SETTING, AND PATIENTS:An observational study examining consecutive patients receiving intracoronary stents at Duke Heart Center, a tertiary care medical center in Durham, NC, between January 1, 2000, and July 31, 2005, with follow-up contact at 6, 12, and 24 months through September 7, 2006. Study population included 4666 patients undergoing initial percutaneous coronary intervention with BMS (n = 3165) or DES (n = 1501). Landmark analyses were performed among patients who were event-free (no death, myocardial infarction [MI], or revascularization) at 6- and 12-month follow-up. At these points, patients were divided into 4 groups based on stent type and self-reported clopidogrel use: DES with clopidogrel, DES without clopidogrel, BMS with clopidogrel, and BMS without clopidogrel. MAIN OUTCOME MEASURES:Death, nonfatal MI, and the composite of death or MI at 24-month follow-up. RESULTS:Among patients with DES who were event-free at 6 months (637 with and 579 without clopidogrel), clopidogrel use was a significant predictor of lower adjusted rates of death (2.0% with vs 5.3% without; difference, -3.3%; 95% CI, -6.3% to -0.3%; P = .03) and death or MI (3.1% vs 7.2%; difference, -4.1%; 95% CI, -7.6% to -0.6%; P = .02) at 24 months. However, among patients with BMS (417 with and 1976 without clopidogrel), there were no differences in death (3.7% vs 4.5%; difference, -0.7%; 95% CI, -2.9% to 1.4%; P = .50) and death or MI (5.5% vs 6.0%; difference, -0.5%; 95% CI, -3.2% to 2.2%; P = .70). Among patients with DES who were event-free at 12 months (252 with and 276 without clopidogrel), clopidogrel use continued to predict lower rates of death (0% vs 3.5%; difference, -3.5%; 95% CI, -5.9% to -1.1%; P = .004) and death or MI (0% vs 4.5%; difference, -4.5%; 95% CI, -7.1% to -1.9%; P<.001) at 24 months. However, among patients with BMS (346 with and 1644 without clopidogrel), there continued to be no differences in death (3.3% vs 2.7%; difference, 0.6%; 95% CI, -1.5% to 2.8%; P = .57) and death or MI (4.7% vs 3.6%; difference, 1.0%; 95% CI, -1.6% to 3.6%; P = .44). CONCLUSIONS:The extended use of clopidogrel in patients with DES may be associated with a reduced risk for death and death or MI. However, the appropriate duration for clopidogrel administration can only be determined within the context of a large-scale randomized clinical trial.
    背景与目标:
  • 【替格瑞洛与氯吡格雷对急性ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗患者炎症因子、血管内皮功能及短期预后的影响比较】 复制标题 收藏 收藏
    DOI:10.1159/000491768 复制DOI
    作者列表:Gao CZ,Ma QQ,Wu J,Liu R,Wang F,Bai J,Yang XJ,Fu Q,Wei P
    BACKGROUND & AIMS: BACKGROUND/AIMS:Acute ST-segment elevation of myocardial infarction (STEMI) is the most severe type of acute coronary syndrome (ACS). Particular attention has been focused on studying the pathogenesis of STEMI, and how to prevent thrombosis, reduce inflammatory reaction, stabilize plaques and improve vascular endothelial functions to preserve the survived myocardium. This study aimed to compare the anti-inflammatory endothelium-protective effects, clinical prognosis, and relevant bleeding risks of ticagrelor versus clopidogrel in patients with STEMI who underwent urgent percutaneous coronary intervention (PCI) and provide certain experimental evidence and a theoretical basis for the selection of safe and effective drugs and their proper dosage, thereby further guiding clinical medication. METHODS:We sequentially enrolled 193 patients (104 males and 89 females) admitted to hospital due to acute STEMI. These patients underwent urgent PCI between December 2013 and May 2015 and met the inclusion criteria. They were assigned (1: 1) into two groups according to different treatments, 97 patients in the ticagrelor group (treatment group), and 96 patients in the clopidogrel group (control group). Levels of hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and endothelial cell-specific molecule 1 (ESM-1) taken at admission and 24 h, 4 days, and 7 days after administration, as well as the correlation between the levels of IL-6, hs-CRP, and ESM-1, were determined in the two groups. At the same time, the effects of treatment with ticagrelor and clopidogrel on the efficacy endpoint events (ischemic and safety) were explored. RESULTS:No statistically significant difference was found in the levels of hs-CRP, IL-6, or ESM-1 at admission between the two groups (P> 0.05); Their levels were significantly elevated 24 h after administration, with statistical differences between two groups (P< 0.05). Furthermore, a downward trend with statistically significant differences was found on Day 4 and Day 7 (P< 0.05); ESM-1 levels increased along with increases of hs-CRP and IL-6 levels, indicating ESM-1 was positively correlated with hs-CRP (r=0.523, P< 0.001) and IL-6 (r=0.431, P< 0.001); and the occurrence rates of ischemic endpoint events at 30 days were lower in the treatment group than in the control group. The occurrence of safety endpoint events was higher than in the control group; however, no statistically significant difference was found (P> 0.05). CONCLUSIONS:Compared with clopidogrel, ticagrelor appears to rapidly reduce the prevalence of inflammatory reactions and stabilize the functions of vascular endothelium to improve the stability of atherosclerotic plaque and decrease the occurrence rate of thrombosis as well as ischemic outcome events without any obvious increase in the risk of bleeding in patients with acute STEMI receiving urgent PCI. This renders it a potential drug for clinical practice. At the same time, measurement of ESM-1, a new biological marker for vascular endothelial function disorder, could possibly become a simple, effective, and practical new method for clinical evaluation of risk stratification of patients with acute STEMI at admission.
    背景与目标:
  • 【阿司匹林联合氯吡格雷与阿司匹林单独用于预防心血管事件高危患者的心血管事件。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2018-08-14
    来源期刊:JAMA
    DOI:10.1001/jama.2018.9641 复制DOI
    作者列表:Donadini MP,Bellesini M,Squizzato A
    BACKGROUND & AIMS: Clinical Question:Among patients at high risk for or with established cardiovascular disease (ie, history of peripheral artery disease, stroke, or coronary artery disease without a coronary stent), is the addition of clopidogrel to aspirin associated with lower risk of mortality and cardiovascular events compared with aspirin alone? Bottom Line:Clopidogrel plus aspirin is associated with a reduced risk for myocardial infarction and ischemic stroke and an increased risk for major bleeding compared with aspirin alone among patients at high risk for or with an established cardiovascular disease but without a coronary stent. However, combined therapy is not associated with lower mortality.
    背景与目标:
  • 【静脉注射康格瑞洛和口服替格瑞洛作为氯吡格雷在急性干预中的替代品。】 复制标题 收藏 收藏
    DOI:10.1136/neurintsurg-2020-015841 复制DOI
    作者列表:Linfante I,Ravipati K,Starosciak AK,Reyes D,Dabus G
    BACKGROUND & AIMS: BACKGROUND:Dual antiplatelet therapy (DAP) is necessary to prevent thromboembolic events during carotid stenting, stent-assisted coil embolization, and implant of flow diverters (FD). However, DAP in the acute phase may be challenging. An intravenous alternative, cangrelor, has rapid onset, short plasma half-life, and more reliable antiplatelet action for acute interventions. The study objective was to evaluate feasibility and safety of IV cangrelor during acute neuroendovascular surgery procedures. METHODS:We performed a retrospective analysis of our database of patients treated with stent-assisted coil embolization, FD placement for aneurysmal subarachnoid hemorrhage (aSAH), or stenting for acute internal carotid artery (ICA) occlusion where IV cangrelor was used. Morbidity, mortality, incidence of thromboembolic events, hemorrhages, and 90-day outcomes were reported. RESULTS:Ten patients were found in our database from June 2018 through January 2019. Four patients had aSAH, four had middle cerebral artery strokes with tandem lesions, one had an ICA occlusion, and one had a vertebral artery aneurysm. One of the ten patients experienced a thrombotic event. One patient developed new post-procedural bleeding and two had worsening intracranial hemorrhage. Five patients were discharged home in stable condition, two to acute rehabilitation, one to a nursing facility, and two others expired (likely the result of the severe and evolving strokes). Of the eight who were discharged, six (75%) had a good 90-day functional outcome (modified Rankin Scale 0-2). CONCLUSION:Acute administration of IV cangrelor with or without oral ticagrelor is a feasible antiplatelet treatment option for acute neuroendovascular procedures.
    背景与目标:
  • 【与氯吡格雷相比,质疑替格瑞洛声称的明确支架血栓形成率降低: 来自FDA报告的见解。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijcard.2013.04.149 复制DOI
    作者列表:Dinicolantonio JJ,Biondi-Zoccai G
    BACKGROUND & AIMS: :Ticagrelor has been promoted to reduce the rate of definite stent thrombosis compared to clopidogrel from the The Platelet Inhibition and Patient Outcomes (PLATO) trial. However, several issues prevent this statement from being accurate, (1) stent thrombosis was an exploratory endpoint in PLATO--cases were retrospectively and prospectively adjudicated, (2) Sampling/ascertainment bias most likely lead to these conclusions, (3) Stent thromboses were not confirmed by an angiographic core lab (a requirement by the ARC definition for 'definite stent thrombosis'), (4) The integrity of the mortality and MI data from the PLATO trial have recently been challenged. A statement that ticagrelor reduces definite stent thrombosis versus clopidogrel cannot be justified.
    背景与目标: : 从血小板抑制和患者结果 (PLATO) 试验中,与氯吡格雷相比,替格瑞洛已被推广以降低确定的支架内血栓形成率。然而,有几个问题阻碍了这一说法的准确性,(1) 支架血栓形成是PLATO的探索性终点-病例是回顾性和前瞻性裁决的,(2) 抽样/确定偏差最有可能导致这些结论,(3) 血管造影核心实验室未确认支架血栓形成 (ARC定义对 “确定的支架血栓形成” 的要求),(4) PLATO试验的死亡率和MI数据的完整性最近受到挑战。与氯吡格雷相比,替格瑞洛减少明确的支架内血栓形成的说法是不合理的。
  • 【氯吡格雷、替格瑞洛或普拉格雷双联抗血小板治疗的胃肠道出血风险无差异。】 复制标题 收藏 收藏
    DOI:10.3390/jcm9051526 复制DOI
    作者列表:Laredo V,Revilla-Marti P,Sostres C,García S,Carrera-Lasfuentes P,Lanas Á
    BACKGROUND & AIMS: :The risk for gastrointestinal bleeding from dual antiplatelet therapy (DAPT) with new antiplatelets (prasugrel/ticagrelor) compared to clopidogrel is unclear. AIM:To determine the risk and type of major (gastrointestinal bleeding requiring hospitalization) and minor (anemia and iron deficiency) gastrointestinal events with different types of DAPT. METHODS:Retrospective observational cohort study of patients who started DAPT after percutaneous coronary intervention. Follow-up was censored after 12 months of DAPT, when a major gastrointestinal event occurred, or when DAPT was discontinued. RESULTS:Among 1,327 patients (54.03% were treated with clopidogrel-based DAPT, 38.13% with ticagrelor-based DAPT, and 7.84% with prasugrel-based DAPT), 29.5% had at least one gastrointestinal event. Patients taking clopidogrel-DAPT were older, with more comorbidities, and higher gastrointestinal risk compared to those taking other DAPT regimens. Adjusted hazard ratios (HRs) showed no between-group differences in the risk for major (clopidogrel vs. new antiplatelets: HR 0.996; 95% confidence interval 0.497-1.996) and minor (HR 0.920; 0.712-1.189) gastrointestinal events. Most patients received proton pump inhibitors while on DAPT (93.3%) and after withdrawal (83.2%). CONCLUSION:Prasugrel- or ticagrelor-based DAPT was not associated with increased gastrointestinal bleeding risk when compared to clopidogrel-DAPT. New antiplatelets do not necessarily need to be restricted to patients with low gastrointestinal risk.
    背景与目标:

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