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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Influence of Diabetes Mellitus and Cigarette Smoking on Variability of the Clopidogrel-Induced Antiplatelet Effect and Efficacy of Active Management of the Target P2Y12 Reaction Unit Range in Patients Undergoing Neurointerventional Procedures
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Influence of Diabetes Mellitus and Cigarette Smoking on Variability of the Clopidogrel-Induced Antiplatelet Effect and Efficacy of Active Management of the Target P2Y12 Reaction Unit Range in Patients Undergoing Neurointerventional Procedures

机译：糖尿病和吸烟对接受神经介入治疗的患者中氯吡格雷诱导的抗血小板作用的变异性和目标P2Y12反应单位范围的主动管理功效的影响

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Background: Optimal antiplatelet inhibition is essential in patients undergoing neurointerventional procedures; however, variability in response to clopidogrel can contribute to thromboembolic and hemorrhagic complications. The present study evaluated the influence of diabetes mellitus and cigarette smoking on clopidogrel reactivity. Methods: Between 2011 and 2013, 71 consecutive patients underwent aneurysmal coil embolization (CE) or carotid artery stenting (CAS) and received clopidogrel (75 mg daily) and aspirin (100 mg daily) before the treatment. The patients were divided into 2 groups: CE (n = 31) and CAS (n = 40). The patients underwent prospective assessment of preoperative platelet function using VerifyNow assay and received adjunctive cilostazol (200 mg daily, triple antiplatelet therapy) in case of clopidogrel hyporesponse. Patients with clopidogrel hyper-response underwent clopidogrel dose reduction (clopidogrel, 12.5-50 mg daily). Results: Clopidogrel resistance was noted in 15 patients (37.5%) in the CAS group and in 4 patients (12.9%) in the CE group (P = .031). Clopidogrel hyper-response was noted in 2 patients (5%) in the CAS group and in 11 patients (54.8%) in the CE group (P < .001). There was a significant difference in the baseline clinical characteristics between the 2 groups. In the multivariate logistic regression analysis, diabetes and age were independent predictors of clopidogrel hyporesponse, whereas current smoker was an independent predictor of clopidogrel hyper-response. Conclusions: Significant differences in baseline clinical characteristics were present when comparing patients undergoing endovascular treatment of unruptured cerebral aneurysms and carotid artery stenosis. Diabetes mellitus and current smoker status were independent factors related to reactivity to clopidogrel.
机译：背景：在进行神经介入治疗的患者中，最佳的抗血小板抑制作用至关重要。然而，对氯吡格雷反应的差异可能导致血栓栓塞和出血并发症。本研究评估了糖尿病和吸烟对氯吡格雷反应性的影响。方法：2011年至2013年间，连续71例患者在治疗前接受了动脉瘤线圈栓塞（CE）或颈动脉支架置入术（CAS），并接受了氯吡格雷（每天75 mg）和阿司匹林（每天100 mg）。患者分为两组：CE（n = 31）和CAS（n = 40）。对患者进行术前血小板功能的前瞻性评估，采用VerifyNow分析，并在氯吡格雷反应不良的情况下接受西洛他唑辅助治疗（每天200 mg，三重抗血小板治疗）。氯吡格雷反应过度的患者应降低氯吡格雷剂量（氯吡格雷，每日12.5-50 mg）。结果：CAS组15例（37.5％）和CE组4例（12.9％）出现氯吡格雷抵抗（P = .031）。 CAS组2例（5％）和CE组11例（54.8％）出现氯吡格雷高反应性（P <.001）。两组之间的基线临床特征存在显着差异。在多元logistic回归分析中，糖尿病和年龄是氯吡格雷反应低下的独立预测因素，而当前吸烟者是氯吡格雷反应高下的独立预测因素。结论：比较接受血管内治疗的未破裂脑动脉瘤和颈动脉狭窄患者的基线临床特征存在显着差异。糖尿病和当前吸烟者状况是与氯吡格雷反应性相关的独立因素。

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