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目的探讨硫酸氢氯吡格雷应用治疗不稳定型心绞痛的临床疗效和安全性及远期心血管事件的发生率。比较硫酸氢氯吡格雷联合应用阿司匹林与单用阿司匹林对急性不稳定型心绞痛治疗的有效性及安全性。方法我们将出现症状后24h内就诊的168例不稳定型心绞痛口才随机分成两组,在服用阿司匹林100mg,每日1次的基础上接受硫酸氢氯吡格雷(84例,即刻300mg,随后75mg,每日1次),安慰剂(84例)治疗持续9～12个月。结果硫酸氢氯吡格雷组治疗1个月后68例不稳定型心绞痛患者的症状和心电图有明显改善,总有效率80.95%,无效者16例,无效率19.05%。安慰剂组58例患者的症状和心电图有明显改善,总有效率69.05%,无效者26例,无效率30.95%。随访观察12个月,主要终点为综合心血管死亡。非致死性心肌梗死的发生率硫酸氢氯吡格雷,组9.52%,安慰剂组13.10%。硫酸氢氯吡格雷组发生出血的患者略多于安慰剂组(2.7% vs 2.4%),但未出现危及生命的出血。结论新型抗血小板药物硫酸氢氯吡格雷和阿司匹林联合应用可明显地改善不稳定型心绞痛的症状及预后,优于单独应用阿司匹林的效果,安全,有效,无严重不良反应。
Objective To investigate the clinical efficacy and safety of clopidogrel bisulfate in the treatment of unstable angina pectoris and the incidence of long-term cardiovascular events. To compare the efficacy and safety of aspirin with aspirin alone in the treatment of acute unstable angina pectoris. Methods 168 cases of unstable angina pectoris treated within 24 hours after symptom onset were randomized into two groups. Patients received aspirin 100 mg once daily and received clopidogrel hydrogen sulfate (84, 300 mg immediately, followed by 75 mg, Once daily), placebo (84 patients) for 9 to 12 months. Results The symptoms and electrocardiogram of 68 patients with unstable angina pectoris after 1 month of clopidogrel bisulfate treatment were significantly improved. The total effective rate was 80.95%, the ineffective rate was 16 and the ineffective rate was 19.05%. 58 patients in the placebo group had significantly improved symptoms and ECG, with a total effective rate of 69.05%, ineffective in 26 cases and inefficiency rate of 30.95%. Follow-up observation of 12 months, the main endpoint of comprehensive cardiovascular death. The incidence of non-fatal myocardial infarction was clopidogrel hydrogen sulfate, 9.52% in the group and 13.10% in the placebo group. Patients in the clopidogrel hydrogen sulfate group had slightly more bleeding than those in the placebo group (2.7% vs 2.4%), but no life-threatening bleeding occurred. Conclusions The combination of the new antiplatelet drug clopidogrel bisulfate and aspirin can obviously improve the symptoms and prognosis of unstable angina pectoris, which is superior to the effect of aspirin alone. It is safe, effective and has no serious adverse reactions.