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血小板功能测试以指导临时机械循环支持患者的康格勒尔剂量或作为程序的桥梁
Margaret M Buck1, Chelsea I Barry2, Courtney A Montepara2,3
1Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA.
概括
血小板功能测试 (PFT) 指导高风险患者的康格雷罗尔剂量降低了成本,并保持了疗效. 这种方法可以防止支架血栓形成,同时允许个性化药物水平.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 干预心脏病学 干预心脏病学
背景情况:
- 康格洛尔是一种静脉注射的P2Y12抑制剂,用于皮肤穿刺冠状动脉干预 (PCI) 后,特别是在需要机械循环支持或作为程序桥梁的患者中使用.
- 康格洛尔的最佳剂量对于平衡疗效 (预防支架血栓形成) 和安全性 (尽量减少出血) 至关重要.
研究的目的:
- 评估使用血小板功能测试 (PFT) 指导成年患者用康格雷洛剂量的有效性和安全性.
- 评估PFT指导剂量对临床结果的影响,包括支架血栓形成和主要心血管不良事件.
- 根据PFT结果确定个性化格罗尔剂量的成本效益.
主要方法:
- 在2021年3月至2022年11月接受康格罗尔治疗期间接受PFT (VerifyNow P2Y12测定) 的成年患者的回顾性审查.
- 患者开始服用标准的康格雷勒剂量 (0.75毫克克/公斤/分钟),随后根据P2Y12反应单位 (PRU) 值进行剂量调整,以保持85-208.8的治疗范围.
- 收集的数据包括坎格雷勒剂量,PRU值,治疗范围中的时间,以及临床结果,如支架血栓,主要心血管不良事件和出血.
主要成果:
- 在42名患者中,有90.5%的患者需要机械循环支持,9.5%的患者接受了康格罗尔作为通往手术的桥梁.
- 康格勒维护剂量的中位数为0.5mcg/kg/min,其中66.6%的患者中位数达到目标PRU范围 (85-208).
- 没有报告发生支架血栓形成的病例. 严重出血发生在38.1%的患者中. 与实证剂量相比,PFT指导剂量导致药物成本的中位数节省1605.60美元.
结论:
- 以血小板功能测试为指导的格罗尔剂量是管理高风险心血管患者的可行策略.
- 这种个性化的方法有效地预防了支架血栓形成,并可能带来显著的成本节省.
- 进一步研究PFT指导的康格罗尔疗法可以优化患者护理和资源利用.
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