Clopidogrel Bisulfate

冠状动脉疾病（CAD）是常见心脏疾病，由于为心肌供血的冠状动脉部分或全部受阻，患者可能出现心绞痛、心梗等后果。在CAD的长期管理中，数十年来，阿司匹林单药治疗一直是二级预防的常规推荐方案。然而，相关证据大多来源于早期较小规模的研究。近年来，随着P2Y12抑制剂（如氯吡格雷）的广泛应用，不同用药策略的选择也备受关注。 近期，《柳叶刀》（The Lancet）发表的一项荟萃分析全面评估了CAD患者的两种长期单药治疗策略，结果显示氯吡格雷可更有效预防主要不良心脑血管事件，尤其是减少心梗和卒中（俗称“中风”），且出血风险较低。 截图来源：The Lancet 该研究通过系统检索，共纳入7项随机对照试验，覆盖28982例患者的个体数据，中位随访时间达2.3年。这些试验比较了氯吡格雷单药与常规推荐方案（阿司匹林单药）在已停止或从未开始双联抗血小板治疗的CAD确诊患者中的效果，患者已接受过的治疗策略不限（经皮冠状动脉介入治疗、冠状动脉搭桥术或单纯药物治疗）。 研究的主要疗效终点为主要不良心脑血管事件（MACCE），包括心血管死亡、心肌梗死和卒中。结果显示，在最长5.5年的随访时间内，氯吡格雷组MACCE发生率为2.61起/100人-年，显著低于常规推荐药物组的2.99起/100人-年，MACCE风险降低14%（HR 0.86，95%CI 0.77~0.96，p=0.0082）。其中，心肌梗死和卒中风险分别显著降低24%（HR 0.76，95%CI 0.66~0.89，p=0.0004）和21%（HR 0.79，95%CI 0.66~0.96，p=0.018）。两组的心血管死亡和全因死亡率无显著差异。 研究还进行了广泛的亚组分析，包括年龄、性别、地域、CAD症状（慢性/急性）、既往心梗/卒中史、糖尿病、肾功能等多个维度，结果显示氯吡格雷降低MACCE风险的疗效优势在多个关键亚组中一致。即使是在ABCD-GENE评分较高（提示对氯吡格雷的反应可能较差）的患者中，其疗效仍不劣于常规推荐药物。这支持了这些研究结果对广泛CAD患者的普遍适用性。 在关键次要疗效终点方面，氯吡格雷组的净不良心脑血管事件（NACE）发生率也显著更低（3.16起/100患者-年 vs 3.54起/100患者-年），风险降低11%（HR 0.89，95%CI 0.81~0.98，p=0.023）。 在安全性方面，氯吡格雷并未增加主要出血风险（HR=0.94，95%CI 0.74~1.21，p=0.64），两组在包括胃肠道出血在内的各类出血终点方面均无统计学差异。 这项研究综合现有证据支持，对于CAD患者，长期抗血小板单药治疗可优先选择氯吡格雷。 点击文末“阅读原文/Read more”，即可访问期刊官网阅读完整论文。 推荐阅读 中风急救，溶栓时间窗可大幅延至24小时！浙大二院楼敏团队研究问鼎JAMA 中风复发风险降低34%！《柳叶刀》：这类患者抗凝不用等，4天内用药更好 JACC发表阜外李静/刘佳敏团队成果：强化降压＜120 mmHg，出血性中风风险减半！ 《柳叶刀》子刊超5万人研究：他汀可安全降低中风、心梗和死亡风险，高龄人群也受益 封面图来源：123RF 参考资料 [1] Marco Valgimigli, et al., (2025). Clopidogrel versus aspirin for secondary prevention of coronary artery disease: a systematic review and individual patient data meta-analysis. The Lancet, DOI: 10.1016/S0140-6736(25)01562-4 免责声明：本文仅作信息交流之目的，文中观点不代表药明康德立场，亦不代表药明康德支持或反对文中观点。本文也不是治疗方案推荐。如需获得治疗方案指导，请前往正规医院就诊。 版权说明：欢迎个人转发至朋友圈，谢绝媒体或机构未经授权以任何形式转载至其他平台。转载授权请在「医学新视点」微信公众号留言联系。 如有其他合作需求，请联系wuxi_media@wuxiapptec.com 分享，点赞，在看，传递医学新知

The commonly prescribed blood thinner clopidogrel should replace aspirin as a routine pill for preventing heart attacks and strokes in people who already have at least some degree of heart disease, researchers reported at the European Society of Cardiology Congress. Pooled data on nearly 29,000 patients with coronary artery disease who had participated in seven earlier randomized trials showed that those taking clopidogrel had a 14% lower risk of major adverse cardiovascular or cerebrovascular events, including heart attack, stroke, or cardiovascular death, compared to those taking aspirin, during an average follow-up of 5.5 years. "These results suggest that clopidogrel should be considered the preferred long-term antiplatelet medication for patients with established coronary artery disease," the researchers said. Clopidogrel is the generic name of the widely used blood clot preventer Plavix, sold by Bristol Myers Squibb and Sanofi. Several companies sell generic clopidogrel including Aurobindo Pharma, Sun Pharma and Teva Pharmaceuticals. Rates of anticoagulant-related side effects like ulcers and major bleeding were similar between the two drugs, dispelling concerns that clopidogrel might lead to more bleeding complications, the researchers said. The researchers said their analysis included many types of patients and subgroups to ensure the findings, which were also published in The Lancet, applied broadly. "Even patients who might respond less well to clopidogrel due to genetic or clinical factors still benefited from its use over aspirin," the researchers said in a statement. Because clopidogrel is widely available and inexpensive, the study's findings have the potential to influence clinical guidelines worldwide and improve patient outcomes, the researchers said. RECYCLED PACEMAKERS IMPROVE ACCESS IN LOW-INCOME NATIONS Cardiac pacemaker devices can be reconditioned to provide new hope for patients in low- and middle-income countries, researchers said at the ESC meeting in Madrid. In Kenya, Mexico, Mozambique, Nigeria, Paraguay, Sierra Leone and Venezuela, 306 patients with a life expectancy of at least two years, a clear medical need for pacemaker therapy and no financial means to acquire one were randomly assigned to receive a reconditioned pacemaker or a new pacemaker. The researchers' primary concern was that reconditioned devices, which had been removed from other patients, might transmit infections when re-implanted. A year after the pacemakers were implanted, the incidence of procedure-related infections was 1.6% for those in the reconditioned pacemaker group and 3.1% for those who got new devices. The results demonstrate that the older devices were non-inferior to new ones, the researchers said in a statement. There were no device malfunctions in either group. The study was conducted by doctors at the University of Michigan-based Project My Heart Your Heart, which collects pacemakers removed from cadavers by funeral directors. "Patients in many low- and middle-income countries still have very limited access to cardiac pacing despite its routine use in higher-income countries," study leader Dr. Thomas Crawford from the University of Michigan said in a statement. "Indeed, access to pacemaker implantation is around 200-fold lower in Africa than in Europe," Crawford said. Project My Heart Your Heart developed a comprehensive protocol for cleaning, functional testing and sterilizing reconditioned devices, and has U.S. approval for their export to countries whose governments have provided permission for pacemaker importation, he added. (Reporting by Nancy Lapid; Editing by Bill Berkrot)