改良抗血小板药物方案在血小板高反应性未破裂颅内动脉瘤患者介入栓塞中的疗效及安全性

目的 评价改良抗血小板药物方案在有血小板高反应性（high on-treatment platelet reactivity，HTPR）的颅内未破裂动脉瘤（unruptured intracranial aneurysms，UIA）患者介入栓塞中的疗效和安全性。方法 采取随机平行对照的方法连续入选有HTPR的UIA患者166例，行血管内介入治疗术，并根据抗血小板药物剂量分为标准剂量组（给予阿司匹林100 mg 1次/d+氯吡格雷75 mg 1次/d（n=83）]及修改剂量组给予阿司匹林300 mg 1次/d+氯吡格雷75 mg 1次/d或阿司匹林100 mg 1次/d+氯吡格雷75 mg 1次/d+西洛他唑100 mg 2次/d（n=83）]，疗程为3个月。采用3种方法多时点的检测血小板功能。比较两组患者脑梗死和血管内血栓形成等不良缺血事件和出血事件的发生率。结果 修改剂量组在各时点的血小板反应性均低于标准剂量组，且差异有统计学意义；修改剂量组较标准剂量组不良缺血事件发生率显著降低，差异有统计学意义（8.4%vs 1.2%，HR=0.132，95% CI 0.016~1.101，P=0.030）；修改剂量组出血事件发生率高于标准剂量组，但差异无统计学意义。结论 修改剂量抗血小板方案可以在不增加出血事件发生率的情况下降低有HTPR的UIA患者介入术后不良缺血事件的发生。

Efficacy and safety of modified antiplatelet preparation in patients with high ontreatment platelet reactivity after endovascular coiling for unruptured intracranial aneurysms

Objective To evaluate the efficacy and safety of modified antiplatelet preparation in patients with high on-treatment platelet reactivity(HTPR) after endovascular coiling for unruptured intracranial aneurysms(UIA).Methods In the randomized, parallel designed clinical trial, 166 patients colling for UIA with HTPR were assigned to receive either 100 mg of aspirin and 75 mg of clopidogrel bisulfate once daily for 3 months(n=83) or 300 mg of aspirin and 75 mg of clopidogrel bisulfate once daily, or 100 mg of aspirin and 75 mg of clopidogrel bisulfate once daily and cilostazol twice daily for 3 months(n=83). Platelet function was serially measured at various time points by 3 assessment methods. Adverse ischemia events(stroke and intravascular thrombosis) and bleeding events were evaluated.Results Patients with HTPR was fewer in modified group compared with standard group at various time points. The adverse ischemia events occurred in fewer patients in modified group than in standard group(8.4% vs 1.2%,HR=0.132,95% CI:0.016-1.101,P=0.030). There was no statistical difference in the rate of bleeding events between modified group and standard group.Conclusion Modified antiplatelet preparation for patients with HTPR compared with standard antiplatelet preparation reduced the adverse ischemia events rate in coiling for an unruptured aneurysm without increasing bleeding.