[1]李荔荣,任少华,郝旭东,等.替格瑞洛在氯吡格雷抵抗的颅内动脉瘤病人介入术后的应用[J].中国临床神经外科杂志,2022,27(05):390-392.[doi:10.13798/j.issn.1009-153X.2022.05.018]
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替格瑞洛在氯吡格雷抵抗的颅内动脉瘤病人介入术后的应用()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年05期
页码:
390-392
栏目:
经验介绍
出版日期:
2022-05-31

文章信息/Info

文章编号:
1009-153X(2022)05-0390-03
作者:
李荔荣任少华郝旭东王力军
030012太原,山西省人民医院神经外科(李荔荣、任少华、郝旭东、王力军)
关键词:
颅内动脉瘤支架辅助栓塞抗血小板治疗氯吡格雷抵抗替格瑞洛
分类号:
R743.9;R815.2
DOI:
10.13798/j.issn.1009-153X.2022.05.018
文献标志码:
B
摘要:
目的 探讨替格瑞洛联合阿司匹林在氯吡格雷抵抗的颅内动脉瘤病人支架辅助栓塞术后的应用效果。方法 回顾性分析2014年1月至2021年12月收治的214例支架辅助栓塞治疗的颅内动脉瘤的临床资料。术后112例应用阿司匹林+氯吡格雷抗血小板治疗(A+C组),102例应用阿司匹林+替格瑞洛抗血小板治疗(A+T组)。术后随访3个月,观察缺血事件和出血事件发生情况。结果 术后3个月,共发生缺血性事件37例(17.3%),其中A+T组10例,A+C组27例;无严重出血事件,轻中度出血8例,其中A+T组5例,A+C组3例。A+T组脑梗死或短暂性脑缺血发作发生率(8.9%)明显低于A+C组(21.4%;P<0.05),而两组出血事件发生率无统计学差异(P>0.05)。多因素Cox回归分析显示,高血压病(HR=1.18;95% CI 1.05~1.51;P=0.025)、年龄≥50岁(HR=1.23;95% CI 1.07~1.89;P=0.012)是术后缺血事件的独立危险因素,而基于血小板功能换用替格瑞洛(HR=0.57;95% CI 0.38~0.85;P=0.011)是术后缺血事件的保护因素。结论 颅内动脉瘤支架辅助栓塞术后应血栓弹力图检测结果合理选择抗血小板治疗药物。对于存在氯吡格雷抵抗的病人,建议更换为替格瑞洛,可显著降低术后缺血性卒中事件发生率。

参考文献/References:

[1] Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management [J]. Nat Rev Neurol, 2016, 12: 699-713.
[2] Brown RD Jr, Broderick JP. Unruptured intracranial aneu- rysms: epidemi- ology, natural history, management options, and familial screening [J]. Lancet Neurol, 2014, 13: 393- 404.
[3] Kang DH, Kim BM, Kim DJ, et al. MR-DWI-positive le- sions and symptomatic ischemic complications after coiling of unruptured intracranial aneurysms [J]. Stroke, 2013, 44 (3): 789-791.
[4] Pierot L, Spelle L, Vitry F, et al. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study [J]. Stroke, 2008, 39(9): 2497-2504.
[5] Higashi E, Matsumoto S, Nakahara I, et al. Clopidogrel response predicts thromboembolic events associated with coil embolization of unruptured intracranial aneurysms: a prospective cohort study [J]. PLoS One, 2021, 16(4): e0249766.
[6] Hwang G, Jung C, Park SQ, et al. Thromboembolic compli- cations of elective Coil embolization of unruptured aneury- sms: the effect of oral antiplatelet preparation on peripro- cedural thromboembolic complication [J]. Neurosurgery, 2010, 67(3): 743-748.
[7] Gurbel PA, Bliden KP, Hiatt BL, et al. Clopidogrel for coro- nary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity [J]. Circulation, 2003, 107(23): 2908-2913.
[8] Pan Y, Chen W, Xu Y, et al. Genetic polymorphisms and clopidogrel efficacy for acute ischemic stroke or transient ischemic attack: a systematic review and meta-analysis [J]. Circulation, 2017, 135(1): 21-33.
[9] Wang Y, Chen W, Wang Y, et al. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial [J]. BMJ, 2019, 365: l2211.
[10] Verdoia M, Pergolini P, Nardin M, et al. Ticagrelor and prasugrel in acute coronary syndrome: a single-arm cross- over platelet reactivity study [J]. J Cardiovasc Med (Hagerstown), 2021, 22(9): 686-692.
[11] Kim CH, Hwang G, Kwon OK, et al. P2Y12 reaction units threshold for implementing modified antiplatelet preparation in coil embolization of unruptured aneurysms: a prospective validation study [J]. Radiology, 2017, 282(2): 542-551.
[12] Adeeb N, Griessenauer CJ, Foreman PM, et al. Use of plate- let function testing before Pipeline embolization device placement: a multicenter cohort study [J]. Stroke, 2017, 48 (5): 1322-1330.
[13] Li W, Zhu W, Wang A, et al. Effect of adjusted antiplatelet therapy on preventing ischemic events after stenting for intracranial aneurysms [J]. Stroke, 2021, 52(12): 3815- 3825.
[14] Wang Y, Zhao X, Lin J, et al. Association between CYP2C19 loss-of-function allele status and efficacy of clopidogrel for risk reduction among patients with minor stroke or transient ischemic attack [J]. JAMA, 2016, 316: 70-78.

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备注/Memo

备注/Memo:
基金项目:山西省重点研发计划(201803D31164)
更新日期/Last Update: 2022-06-30