阿司匹林与氯吡格雷抗血小板凝聚不良反应临床分析
To Analyze the Adverse Drug Reaction of Asprin and Clopidogrel during the Treatment for Platelet Aggregation

作者: 黄之训 * , 沈筱云 , 周陶然 , 钱石静 :上海市同济医院药剂科,上海; 张惠芳 :上海市北医院,上海;

关键词: 阿司匹林氯吡格雷不良反应分析Aspirin Clopidogrel Adverse Drug Reaction Analysis

摘要: 目的:分析阿司匹林、氯吡格雷在抗血小板聚集治疗中的ADR及影响ADR结果的危险因素,为临床用药提供参考。方法:以2009-2012年上海ADR中心数据库阿司匹林和氯吡格雷病例为基数,通过年龄或单抗和双抗治疗随机分组进行回顾性分析,以报告类型、严重程度、原患疾病、用药原因、ADR致器官损害、ADR起始发病日、ADR结果作为观察指标,使用SPSS软件进行分析。结果:单抗和双抗两组基线特征比较差异无统计学意义(p > 0.05)。两组观察指标相关性检查及单因素独立危险因素比较,严重程度、出血、ADR结果和ADR最初阶段发病p < 0.05;多因素Logistic回归分析,ADR未好转OR = 3.404、95% CI 1.518~7.634;ADR周内发病OR = 3.329、95% CI 0.86~12.884。结论:双抗组的缺血、出血事件几率高于单抗组,单抗组未好转几率是双抗组的2.44倍,可能与抗血小板药物抵抗、合并用药的相互作用及剂量不足有关。长期抗血小板治疗应综合评估患者缺血、出血风险,制定个体化的预防措施和给药方法,在抗血小板效果与降低出血风险之间以取得平衡和最大获益。

Abstract: Objective: To analyze the adverse drug reaction and their risk factors of Aspirin and Clopidogrel during the treatment for platelet aggregation, providing reference for clinical medication. Methods: Based on 2009-2012 database of Shanghai ADRs center, ADR cases about Aspirin and Clopidogrel were analyzed retrospectively through age groups or randomized by combination and independence for retrospective analysis. Also the types of reports, severity of diseases, the original disease, the reason of medication, organ damage by ADR, as well as the initial period and results of ADRs were applied as the observation indexes and were analyzed by using the SPSS software. Results: In the groups of combination and independence, their p value of baseline characteristics was above 0.05 (p > 0.05), which indicated no statistical significance. In contrast, p values of observation index correlation test, report types, severity, bleeding part, ADR results and the initial period of ADR were below the level of 0.05 (p < 0.05). Comparing the independent risk factors between these two groups, the result of p values of severity reports, death or life threat, bleeding, ADR results, and ADR onset of three months was the same (p < 0.05). The result of multivariable Logistic regression analysis was received forward step by step, ADR didn’t recover, OR was 3.404, 95% CI was 1.518 - 7.634; For weeks of the ADR onset, OR was 3.329, 95% CI was 0.86 - 12.884. Conclusion: The percentage of ischemia and bleeding in the combined group was higher than that of independent group, and the unrecovered ratio in the independent group was 2.44 times than that in the combined group, which might be related to antiplatelet resistance, combined interaction and low dosage. In the long-term antiplatelet therapy, ischemia, risk of bleeding should be involved in the comprehensive evaluation, and it should develop an individual preventive measure and medication for keeping balance and getting maximum benefits between antiplatelet effects and reducing the risk of bleeding.

文章引用: 黄之训 , 张惠芳 , 沈筱云 , 周陶然 , 钱石静 (2015) 阿司匹林与氯吡格雷抗血小板凝聚不良反应临床分析。 医学诊断, 5, 29-35. doi: 10.12677/MD.2015.53006

参考文献

[1] 赵助飞, 王飞 (2011) 氯吡格雷治疗急性冠脉综合症的临床疗效及其对血小板P选择素和C反应蛋白的影响. 中国药房, 36, 3411-3413.

[2] 李敏, 刘玲, 葛良, 等 (2013) 血栓弹力图评价抗血小板药物疗效对颅内外动脉支架术后再狭窄的影响. 中华老年多器官疾病杂志, 2, 120-124.

[3] Lemesle, G., Delhayc, C., Sudre, A., Broucq-sault, D., Rosey, G., Bauters, C., et al. (2009) Impact of high loading and maintenance dose of clopidogrel within the first 15 days after percutaneous coronary intervention on patient outcomc. American Heart Journal, 157, 375-382.
http://dx.doi.org/10.1016/j.ahj.2008.09.013

[4] 何倩, 焦洁茹, 赵雅洁, 等 (2012) 阿司匹林抵抗的相关临床研究. 诊断学理论与实践, 6, 593-598.

[5] 刘玲, 杨防, 李敏, 等 (2012) 血栓弹力图评价患者颅内外动脉狭窄支架置入术后抗血小板聚集药物的疗效. 中国脑血管病杂志, 2, 67-71.

[6] Yamagami, H., Sakai, N., Matsumaru, Y., Sakai, C., Kai, Y., Sugiu, K., et al. ( 2012) Periprocedural cilostazol trcayment and restenosis after carotid artery stenting: The Retrospective Study of In-Stent Restenosis after Carotid Artery Stenting (ReSISteR-CAS). Journal of Stroke and Cerebrovascular Diseases, 21, 193-199.
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2010.06.007

[7] 唐发宽, 林乐健 (2010) 血栓弹力图检测老年冠心病患者经皮冠状动脉介入治疗后血小板反应性. 中华老年心脑血管病杂志, 10, 879-881.

[8] Hallas, J., Dall, M., Andries, A., Andersen, B.S., Aalykke, C., Hansen, J.M., et al. (2006) Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: Population based case-control study. BMJ, 333, 726-730.
http://dx.doi.org/10.1136/bmj.38947.697558.AE

[9] Ertugrul, D.T., Tutal, E., Yildiz, M., Akin, O., Yalçın, A.A., Üre, Ö.S., et al. (2010) Aspirin resistance is associated with glycemic contrl, the dose of aspirin, and obesity in type 2 diabetes mellitus. The Journal of Clinical Endocrinology & Metabolism, 95, 2897-2901.
http://dx.doi.org/10.1210/jc.2009-2392

[10] Ajjan, R., Storey, R.F. and Grant, P.J. (2008) Aspirin resistance and diabetes mellitus. Diabetologia, 51, 385-390.
http://dx.doi.org/10.1007/s00125-007-0898-3

[11] Curbel, P.A., Bliden, K.P., Hialt, B.L. and O’Connor, C.M. (2003) Clopidogrel for coronary stenting: Response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation, 107, 2908-2913.
http://dx.doi.org/10.1161/01.CIR.0000072771.11429.83

[12] Gilard, M., Arnaud, B., Cornily, J.C., Le Gal, G., Lacut, K., Calvez, G., et al. (2008) Influence of omeprazole on the antiplatelet action of clopidogrel ussociated with aspirin: The randomized, double blind OCLA (Omeprazole Clopidgrel Aspirin) study. Journal of the American College of Cardiology, 51, 256-260.
http://dx.doi.org/10.1016/j.jacc.2007.06.064

[13] Lau, W.C., Waskell, L.A., Watkins, P.B., Neer, C.J., Horowitz, K., Hopp, A.S., et al. (2003) Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: A new drug-drug interaction. Circulation, 107, 32-37.
http://dx.doi.org/10.1161/01.CIR.0000047060.60595.CC

[14] Ho, P.M., Maddox, T.M., Wang, L., Fihn, S.D., Jesse, R.L., Peterson, E.D., et al. (2009) Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA, 301, 937-944.
http://dx.doi.org/10.1001/jama.2009.261

分享
Top