生物谷援引：根據(jù)一項(xiàng)新研究指出,，接受經(jīng)皮冠狀動(dòng)脈介入（PCI）的ST段上升心肌梗塞（STEMI）的病患,，預(yù)先以?xún)杀秳┝康腸lopidogrel（Plavix）治療,，可以降低心臟血管事件死亡風(fēng)險(xiǎn)近一半。
研究人員發(fā)現(xiàn)在裝設(shè)心血管支架前,，給予患者至少600毫克的 clopidogrel,，而不是標(biāo)準(zhǔn)300 毫克之劑量，可以減少裝設(shè)心血管支架之主要并發(fā)癥：血栓形成的風(fēng)險(xiǎn),。此外,，大劑量并不會(huì)增加嚴(yán)重出血的風(fēng)險(xiǎn)。這項(xiàng)研究有重要的臨床意義,。
抗血栓形成的治療目標(biāo)是避免患者于PCI之后發(fā)生血栓形成的并發(fā)癥,，并且使手術(shù)后的出血減到最小并節(jié)省治療費(fèi)用。通常第一次給予Clopidogrel的劑量為300毫克,，之后每天投予75毫克,；所有病患同時(shí)接受由醫(yī)師決定的血栓溶解治療以及aspirin；接受血栓解治療的病患同時(shí)也使用48小時(shí)的heparin,。
這項(xiàng)研究將于2007 年5月9 日- 12 日于奧蘭多舉行的第30屆美國(guó)心血管造影和介入治療學(xué)會(huì)年會(huì)中提出,。
（編譯/姜欣慧） (資料來(lái)源 : Bio.com)
英文原文：
High-dose Anticlotting Drug Cuts Heart Attack, Death Risk In Half
05/14/07 -- Pretreatment with double-dose anticlotting medication just before percutaneous coronary intervention (PCI) cuts the combined risk of heart attack and cardiac death by half, according to a new study.
Researchers found that giving patients at least 600 mg of clopidogrel before stenting, rather than the standard 300-mg dose, halved the risk of major complications associated with blood clotting, or thrombosis. In addition, the higher dose did not increase the risk of serious bleeding.
"This research has important clinical and cost implications," said Giuseppe G. Biondi-Zoccai, M.D., an assistant professor of cardiology at the University of Turin, in Turin, Italy. "The goal of antithrombotic management for PCI is to maximize protection from thrombotic complications during and shortly after PCI, while minimizing bleeding and costs."
Clopidogrel interferes with the action of platelet cells, which stimulate the formation of blood clots. Interventional cardiologists give patients a loading dose of this medication before PCI to protect against blood clotting. After the procedure, most patients take a lower daily dose (75 mg) for up to a year, depending on the type of stent used to prop open the clogged coronary artery.
To evaluate the effect of the clopidogrel loading dose, researchers from University of Turin and Virginia Commonwealth University, in Richmond, performed a meta-analysis of data from 10 studies involving more than 1,500 patients. Roughly half of the patients were pretreated with 300 mg of clopidogrel and the other half with 600 mg. A few received either 450 mg or 900 mg of clopidogrel.
Overall, pretreatment with high-dose clopidogrel (600 mg or more) was associated with a 50 percent reduction in the risk of cardiac death or nonfatal heart attack, both during the initial hospitalization and within 30 days of the PCI procedure, a finding that was highly statistically significant (p=0.009). There was no statistically significant increase in major or minor bleeding (p=0.55 and p=0.98, respectively). Findings remained the same when the analysis was restricted to 7 randomized controlled trials only. Further analysis showed that the higher the underlying risk of complications related to blood clotting, the greater the benefit from high-dose clopidogrel.
The study was presented at the 30th Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions, May 9--12, 2007, in Orlando, FL by Antonio Abbate, M.D., an assistant professor of medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA.
Source: Society for Cardiovascular Angiography and Interventions
