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高龄PCI患者术后6个月应用不同抗血小板方案的有效性和安全性研究
作者:郑若龙  徐卓文  陈新军  杨增芯 
单位:东南大学医学院附属江阴医院 心血管内科, 江苏 江阴 214400
关键词:替格瑞洛 氯吡格雷 PCI术 血小板聚集率 
分类号:R541.4
出版年·卷·期(页码):2020·39·第一期(56-60)
摘要:

目的: 探讨不同抗血小板方案在高龄经皮冠脉介入(PCI)患者术后6个月的有效性和安全性。方法: 入选2016年4月至2018年4月于我院行PCI术后6个月高龄患者106例(年龄 ≥ 70岁),术后6个月续服用阿司匹林100 mg qd+氯吡格雷剂量75 mg qd,入选后随机分为氯吡格雷组(n=36,给予阿司匹林100 mg qd+氯吡格雷75 mg qd)、低剂量氯吡格雷组(n=36,给予阿司匹林100 mg qd+氯吡格雷50 mg qd)和替格瑞洛组(n=34,给予阿司匹林100 mg+替格瑞洛60 mg bid)。收集所有患者一般临床资料,并在入组前、入组后1个月、入组后3个月抽血检测血小板聚集率(PAR),并随访所有患者6个月的出血事件和主要不良心脏事件(MACE)发生情况。方法: 低剂量氯吡格雷组患者PAR水平在入组治疗1个月和3个月时检测都较入组前明显增高(P<0.05);替格瑞洛组患者PAR水平在入组治疗1个月和3个月时检测都较入组前明显降低(P<0.05)。入组后6个月氯吡格雷组患者只有极少数患者PAR在50%以上,替格瑞洛组患者PAR全都低于50%,低剂量氯吡格雷组有大量患者PAR超过50%。三组患者出血事件率没有统计学差异(χ2=1.301,P=0.624)。三组患者在6个月随访过程中累计MACE发生率进行Log-rank检验发现存在统计学差异(χ2=5.351,P=0.039)。方法: 对于高龄PCI患者术后6个月使用替格瑞洛60 mg bid代替传统的氯吡格雷具有更好的抗血小板聚集作用,MACE发生率更低,且出血风险并不增加。

Objective: To investigate the effect and safety of different antiplatelet regimens on elder patients undergoing PCI after 6 months. Methods: From April 2016 to April 2018, a total of 106 patients (over 70 years old) undergoing PCI after 6 months were enrolled and divided into clopidogrel group (n=36, aspirin 100 mg qd+ clopidogrel 75 mg qd), low-dose clopidogrel group (n=36, aspirin 100 mg qd+ clopidogrel 50 mg qd) and ticagrelor group (n=34, aspirin 100 mg qd+ ticagrelor 60 mg bid). All enrolled patients took aspirin 100 mg qd and clopidogrel 75 mg qd for six months. General clinical data of all patients were collected. Platelet aggregation rate (PAR) was detected at enrollment, one month and three months after enrollment. Hemorrhage and major adverse cardiac event (MACE) were recorded for six months. Results: Compared with before enrollment, levels of PAR in low-dose clopidogrel group were higher those that one month and three months after enrollment (P<0.05). Levels of PAR in ticagrelor group one month and three months after enrollment were lower than that of before enrolled level (P<0.05). Very few patients had PAR levels above 50% in clopidogrel group six months after enrollment, and PAR levels of all patients were below 50% in ticagrelor group six months after enrollment. A large number of patients had PAR levels above 50% in low-dose clopidogrel group six months after enrollment. There was no statistical significance of hemorrhage event among the three groups (χ2=1.301,P=0.624). Log-rank analysis showed that:there was a statistical difference in the cumulative incidence of MACE among the three groups during the 6-month follow-up (χ2=5.351,P=0.039). Conclusion: In elderly patients with PCI, the use of ticagrelor 60 mg bid to replace the traditional clopidogrel at 6 months after surgery has a better anti-platelet aggregation effect, with a lower incidence of MACE and no increased risk of bleeding.

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