rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2012-8-2-12-25rpcardio-544Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯRESIDUAL PLATELET REACTIVITY DURING THERAPY WITH INHIBITORS OF CYCLOOXIGENASE OR ADENOSINE DIPHOSPHATE RECEPTORSОСТАТОЧНАЯ РЕАКТИВНОСТЬ ТРОМБОЦИТОВ НА ТЕРАПИИ ИНГИБИТОРАМИ ЦИКЛООКСИГЕНАЗЫ ИЛИ РЕЦЕПТОРОВ АДЕНОЗИНДИФОСФАТАЛомоносоваА. А.LomonosovaA. A.

аспирант кафедры кардиологии

МазурН. А.MazurN. A.

д.м.н., профессор, заведующий кафедры кардиологии

mazur@land.ruЗолозоваЕ. А.ZolozovaE. A.

к.м.н., доцент кафедры кардиологии

СаютинаЕ. В.SayutinaE. V.

к.м.н., ассистент кафедры кардиологии

ЧигиневаВ. В.ChiginevaV. V.

к.м.н., доцент кафедры кардиологии

ШестаковаН. В.ShestakovaN. V.

к.м.н., доцент кафедры кардиологии

Российская медицинская академия последипломного образованияРоссияRussian Medical Academy of Postgraduate EducationRussian Federation20120301201682168172Copyright © Lomonosova A.A., Mazur N.A., Zolozova E.A., Sayutina E.V., Chigineva V.V., Shestakova N.V., 20152015Ломоносова А.А., Мазур Н.А., Золозова Е.А., Саютина Е.В., Чигинева В.В., Шестакова Н.В.Lomonosova A.A., Mazur N.A., Zolozova E.A., Sayutina E.V., Chigineva V.V., Shestakova N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/544

Aim. To compare effects of acetylsalicylic acid (ASA) and two clopidogrel drugs on residual platelet aggregative reactivity (RPAR). Material and methods. Patients (n=40) with ischemic heart disease aged under 70 years were involved into the crossover study. Clinical examination included questionnaire survey , blood pressure (BP) measurement, ECG registration, 24-hour ECG and BP monitoring, determination of blood levels of total cholesterol, high density lipoproteins, triglycerides, transaminases, and creatinine, complete blood cell count, including platelets number and hemoglobin level. Besides evaluation of the platelet aggregation by optical aggregometry was performed initially , after one week ASA treatment and after every next 3 week clopidogrel treatment period.  Results. RPAR during ASA monotherapy was 56.4±0.3%. There were no significant differences in effects of original and generic clopidogrel on RPAR. Сlopidogrel therapy reduced RPAR more significantly (42.2±0.2%) than ASA monotherapy did (p=0.0003). Authors proposed definition for high level of RPAR during therapy - it is platelet aggregation more than 46%. Data analysis taking into account this criterion showed that a number of patients with high RPAR was 70 and 30% among patients treated with enterosoluble ASA and clopidogrel, respectively. Conclusion. Study results show that a significant number of patients receiving antiplatelet monotherapy does not achieve the target level of RPAR(<46%). These results may be a rationale for combined therapy in patients of this type.

Цель. Сравнить влияния ацетилсалициловой кислоты (АСК) и двух препаратов клопидогрела на остаточную агрегационную реактивность тромбоцитов (ОАРТ). Материал и методы. В перекрестное исследование были включены 40 больных в возрасте до 70 лет , у которых имелась хроническая ишемическая болезнь сердца. Методы обследования включали опрос на наличие стенокардии, измерение артериального давления (АД), регистрацию ЭКГ покоя, суточное мониторирование ЭКГ и АД, определение содержания в крови общего холестерина, липопротеинов высокой плотности, триглицеридов, трансаминаз и креатинина, определение общего анализа крови, включая количество тромбоцитов и уровень гемоглобина. Также определяли агрегацию тромбоцитов с помощью световой агрегометрии в начале исследования, через одну нед лечения АСК, а затем по окончании каждого 3-недельного периода лечения препаратами клопидогрела. Результаты. На монотерапии АСК ОАРТ составила 56,4±0,3%. Результаты сравнения эффективности оригинального клопидогрела и его дженерика продемонстрировали отсутствие значимых различий в их влиянии на ОАРТ . Терапия препаратами клопидогрела приводила к значимо меньшему уровню ОАРТ (42,2±0,2%), чем монотерапия АСК (р=0,0003). Анализ данных с учетом предложенного критерия высокой ОАРТ (более 46%) на терапии показал, что количество таких больных, принимавших кишечнорастворимую форму АСК, составило 70%, а на терапии препаратами из группы клопидогрела — 30%.  Заключение. Полученные данные указывают на то, что у значительного числа больных на монотерапии дезагрегантами не достигается целевой уровень (<46%) снижения ОАРТ, что может служить обоснованием для назначения им комбинированной терапии.

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The authors declare that there are no conflicts of interest present.