慢性的なクロピドグレル療法の有無または有無で冠動脈疾患の患者に600mgのクロピドグレル投与量
Adnan Kastrati1, Nicolas von Beckerath, Alexander Joost
1Deutsches Herzzentrum and 1 Medizinische Klinik rechts der Isar; Technische Universität, Munich, Germany. kastrati@dhm.mhn.de.
Circulation
|July 21, 2004
まとめ
クロピドグレルによるさらなる血小板抑制は,維持療法を受けている患者でも達成可能である. 600mgの負荷用量は,標準用量を上回る抗血小板効果を著しく強化します.
科学分野:
- 心臓病学 心臓病学
- 薬理学 薬理学とは
- 血液学 ヘマトロジ
背景:
- 現在のクロピドグレルの用量戦略では,血小板機能抑制を最大化することができない可能性があります.
- クロピドグレルの高濃度の負荷用量の影響を評価することは,抗血小板治療の最適化に不可欠です.
研究 の 目的:
- 慢性的なクロピドグレル療法を受けた患者と,それ以前に接触していない患者で600mgのクロピドグレル充填用量の抗血小板効果を比較するために.
- 既定の負荷および維持レジメンを超えてさらなる血小板抑制を達成できるかどうかを判断する.
主な方法:
- 冠動脈血管造影を施したアスピリン治療を受けた患者を対象とした前向きな研究.
- クロピドグレル未使用患者と,クロニック 75 mg/日クロピドグレル治療を受けている患者2つのグループが評価されました.
- 600mgのクロピドグレル投与前と6時間後に血小板の集積と受容体発現を分析した血液サンプル.
主要な成果:
- クロピドグレル未使用の患者では,600 mgの充填量はADP誘発の血小板凝集を有意に減少させた (90%から51%).
- 慢性療法を受けている患者では,600 mgの負荷は,維持用投与量を超えてさらなる有意な抑制 (52%から33%) をもたらしました.
- 両グループは,グリコプロテインIIb/IIIaとP-セレクチン受容体発現の有意な阻害を示した.
結論:
- クロピドグレルの600mgの負荷用量は,標準用量よりも大きな血小板阻害を達成することができ,すでに維持療法を受けている患者でもそうである.
- クロピドグレルのより高い用量は臨床的に有益であり,有効性と安全性のさらなる調査を正当化する可能性があります.
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