JACC: 吗啡和氯吡格雷不要同时用!增加ACS患者缺血事件风险

2020-01-26 朱朱 中国循环杂志

临床上,吗啡是缓解急性冠脉综合征胸痛的药物之一。但机制性研究显示,吗啡可能会影响口服抗血小板药物(二磷酸腺苷受体拮抗剂)的抗血小板效果。

临床上,吗啡是缓解急性冠脉综合征胸痛的药物之一。但机制性研究显示,吗啡可能会影响口服抗血小板药物(二磷酸腺苷受体拮抗剂)的抗血小板效果。

近期发表在JACC上的EARLY ACS研究结果提示,在非ST段抬高型急性冠脉综合征患者中,如果冠脉造影前已用氯吡格雷预处理,如果应用吗啡就会显着增加缺血事件发生风险,包括死亡、心肌梗死、心肌缺血复发、血栓栓塞性紧急治疗。

分析显示,在应用氯吡格雷进行预处理的患者中,吗啡的应用导致96 h时缺血事件发生风险增加40%,30天时死亡或心肌梗死发生风险也有增加趋势(OR=1.29,P=0.072),主要是48小时内事件发生风险增加了54%。

而在没有应用氯吡格雷进行预处理的患者中,应用吗啡并不会增加上述不良心血管事件的发生风险。



述评专家指出,临床医生应注意,在急性冠脉综合征患者的治疗过程中,如果氯吡格雷与吗啡同时应用的话,需要考虑在最后一次应用吗啡等阿片类药物后6~8小时再给一次负荷剂量氯吡格雷,以使抗血小板药物达到最优治疗水平。

该研究纳入5438例应用氯吡格雷进行预处理的非ST段抬高型急性冠脉综合征患者,以3462例未应用氯吡格雷进行预处理的患者作为对照。

原始出处:


2、Storey RF, et al. Opiates and Clopidogrel Efficacy: Lost in Transit?. J Am Coll Cardiol, 2020, 75

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    2020-08-08 hbwxf
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    2020-01-28 yaanren
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    2020-01-28 showtest
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  6. [GetPortalCommentsPageByObjectIdResponse(id=1854640, encodeId=d3e5185464012, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Aug 08 13:55:00 CST 2020, time=2020-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279338, encodeId=8b9512e933899, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Tue Jan 28 11:55:00 CST 2020, time=2020-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326469, encodeId=9034132646904, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Jan 28 11:55:00 CST 2020, time=2020-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346569, encodeId=bb651346569d4, content=<a href='/topic/show?id=2013391531d' target=_blank style='color:#2F92EE;'>#吗啡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39153, encryptionId=2013391531d, topicName=吗啡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Tue Jan 28 11:55:00 CST 2020, time=2020-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574999, encodeId=f89e15e49995d, content=<a href='/topic/show?id=52ab188e48' target=_blank style='color:#2F92EE;'>#ACS患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1887, encryptionId=52ab188e48, topicName=ACS患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bf9f16042984, createdName=neurosurgeon, createdTime=Tue Jan 28 11:55:00 CST 2020, time=2020-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=378542, encodeId=33bc3e8542d9, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/icyLhIGqru6gIknBJqfuPhRvIvBCic3jbz4PVDcMREDl6iaWw7opPo99JEXWc0tmIrGaXGPP0y58DKDiajZfV2qR3qXdCgwIyhVq/0, createdBy=d71a1955931, createdName=QFXL123456, createdTime=Sun Jan 26 23:52:52 CST 2020, time=2020-01-26, status=1, ipAttribution=)]
    2020-01-26 QFXL123456

    学习了

    0

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