| 谭明娟,潘玉琴.经皮冠状动脉介入治疗术后服用替格瑞洛与氯吡格雷的出凝血指标比较[J].安徽医药,2019,23(12):2490-2493. |
| 经皮冠状动脉介入治疗术后服用替格瑞洛与氯吡格雷的出凝血指标比较 |
| The observation of ticagrelor and clopidogrel on coagulation parameters in patients after PCI |
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| DOI：10.3969/j.issn.1009?6469.2019.12.040 |
| 中文关键词: 急性冠状动脉综合征 替格瑞洛 氯吡格雷 心脏外科手术 血小板计数 血小板聚集 凝血酶时间 部分促凝血酶原时间 经皮冠状动脉介入治疗 |
| 英文关键词: Acute coronary syndrome Ticagrelor Clopidogrel Cardiac surgical procedures Platelet count Platelet ag? gregation Thrombin time Partial thromboplastin time Percutaneous coronary intervention |
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| 中文摘要: |
| 目的探讨经皮冠状动脉介入治疗(PCI)术后病人服用替格瑞洛或氯吡格雷对机体出凝血指标的影响。方法回顾分析南京市第一医院 2015年 11月至 2016年 7月间 80例 PCI术后急性冠状动脉综合征病人服用替格瑞洛或者氯吡格雷这两种药物后血小板、凝血常规、血栓弹力图的变化情况。其中替格瑞洛组病人 50例，氯吡格雷组病人 30例。替格瑞洛组病人服用剂量 90 mg，一次 1片，每日两次；氯吡格雷组病人服用剂量 25 mg，一次 3片，每日 1次。均选择用药 1周后的各项检测指标。结果服用替格瑞洛和氯吡格雷治疗后均能引起血小板计数［治疗后分别为(177±45)×109/L和(179±52)×109/L］下降，与治疗前［(192±59)×109/L和(191±60)×109/L］比较均差异有统计学意义(P＜0.05)。并且氯吡格雷在治疗后引起血小板分布宽度［治疗前后分别为(13.7±2.6)%和(14.6±2.2)%］增加(P＜0.05)。进一步分析两组药物治疗前后血小板基础值的差值，发现氯吡格雷引起血小板计数、大血小板比率、血小板分布宽度以及血小板比积这 4个参数变化的幅度均大于替格瑞洛(P＜0.05)。在凝血常规方面，替格瑞洛治疗后活化部分凝血活酶时间(APTT)［治疗前后分别为(30.9±3.80)s和(33.1±4.40)s］和凝血酶时间(TT)［治疗前后分别为(18.8±1.76)s和(21.0±2.60)s］值高于治疗前，差异有统计学意义(P＜0.05)。而氯吡格雷治疗后与治疗前比较， APTT和 TT值未发生明显变化(P＞0.05)。通过分析血栓弹力图发现，替格瑞洛［治疗前后分别为(59.1±6.31)mm和(48.2±5.90)mm］和氯吡格雷［治疗前后分别为(57.7±6.05)mm和(50.5±5.65)mm］治疗均能使血小板聚集功能减低，差异有统计学意义(P＜0.05)，并且替格瑞洛治疗后引起的血小板聚集功能降低幅度更大。结论替格瑞洛比氯吡格雷有更强的抑制血小板的功能，同时其不引起血小板破坏性的下降。 |
| 英文摘要: |
| Objective To study the effects of the two drugs，ticagrelor and clopidogrel，on coagulation parameters of patients after percutaneous coronary intervention(PCI).Methods A retrospective analysis was made of the parameter changes in platelet，coagu?lation and thrombus elastic map of 80 acute coronary syndrome patients who underwent PCI and were treated with ticagrelor orclopidogrel from November 2015 to July 2016 in Nanjing First Hospital.There were 50 patients in ticagrelor group and 30 patientsin clopidogrel group.Patients in ticagrelor group took 1 tablet of 90 mg ticagrelor twice daily while those in clopidogrel group took 3tablets of 25 mg clopidogrel once daily.The detection indexes were collected one week after medication in both groups.Results It was found that ticagrelor［before and after treatment:(192±59)×109/L vs.(177±45)×109/L］and clopidogrel［(191±60)×109/L vs.(179±52)×109/L］could cause a decrease in platelet count after treatment.There was statistically significant difference before and after treatment(P＜0.05).And clopidogrel resulted in the increase in platelet distribution width after treatment［before and af? ter treatment:(13.7±2.6)% vs.(14.6±2.2)%］(P＜0.05).Further analysis of the difference in the baseline value of platelet be?tween the two groups before and after treatment indicated that clopidogrel resulted in greater changes in the platelet count，plateletlarge cell ratio，platelet distribution width，and plateletcrit than ticagrelor(P＜0.05).After treatment with ticagrelor，the values of ac? tivated partial thromboplastin time(APTT)［ before and after treatment:(30.9±3.80)s vs.(33.1±4.40)s］and thrombin time(TT)［(18.8±1.76)s vs.(21.0±2.60)s］were significantly higher than before treatment；the differences were statistically significant(P＜ 0.05).However，APTT and TT values did not change significantly after treatment with clopidogrel compared with before treatment (P＞0.05).By analyzing the thromboelastogram，it was found that both ticagrelor［before and after treatment:(59.1±6.31)mm vs.(48.2±5.90)mm］and clopidogrel［(57.7±6.05)mm and(50.5±5.65)mm］treatment can reduce platelet aggregation function；the differences were statistically significant(P＜0.05)，and the decrease in platelet aggregation function caused by ticagrelor treatmentwas greater.Conclusion Ticagrelor has more potent inhibition of platelet aggregation than clopidogrel，meanwhile it may not cause a destructive decrease in platelet. |
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