摘要
目的 研究血栓弹力图指导的三种抗血小板治疗策略对经皮冠状动脉介入(PCI)术后高龄急性冠脉综合征(ACS)患者临床预后的影响。方法 筛选2020年1月至2021年9月心内科住院的高龄(≥75岁),且行PCI的ACS患者372例,PCI术后72 h行血栓弹力图检测,根据检测结果对氯吡格雷抑制率≥30%者行常规抗血小板治疗(常规组:阿司匹林+氯吡格雷);将氯吡格雷抑制率<30%者随机分为2组:替格瑞洛组(阿司匹林+替格瑞洛),西洛他唑组(阿司匹林+氯吡格雷+西洛他唑)。3组均随访3个月,统计主要不良心血管事件(MACEs)(心血管死亡、非致死性心肌梗死、卒中或靶血管血运重建)发生率及出血发生率。结果 常规组MACEs事件发生率为9.7%,西洛他唑组MACEs事件发生率为6.6%,2组差异无统计学意义(P>0.05);替格瑞洛组MACEs事件发生率为2.2%显著低于常规组的9.7%(P<0.05),但替格瑞洛组轻微出血风险高于常规组(P<0.05)。结论 血栓弹力图指导的抗血小板治疗对ACS患者PCI术后的药物选择有一定指导意义,高龄ACS患者应权衡缺血和出血风险,高缺血风险的高龄ACS患者可谨慎使用替格瑞洛。
Objective To explore the prognosis effect of three different thromboelastography-guided antiplatelet therapy(APT)in elderly patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods Totally 372 elderly ACS patients(≥75 years old)admitted by the Department of Cardiology and receiving PCI were selected from Jan 2020 to Sep 2021.Thrombelastogram examination was performed at postoperative 72th hour.The patients with the inhibition rate of Clopidogrel≥30%were subject to routine APT based on examination results(routine group:Aspirin+Clopidogrel);the patients with the inhibition rate of Clopidogrel<30%were randomly divided into two groups:ticagrelor group(Aspirin+Ticagrelor)and cilostazol group(Aspirin+Clopidogrel+Cilostazol).A 3-month follow-up was performed to calculate the incidence of major adverse cardiovascular events(MACEs)(cardiovascular mortality CVM,non-fatal myocardial infarction MI,stroke or target vessel revascularization TVR)and hemorrhage.Results The incidence of MACEs in routine group and cilostazol group was 9.7%and 6.6%,respectively,and the inter-group difference wasn't statistically significant(P>0.05);the incidence of MACEs in ticagrelor group was 2.2%,being significantly lower than that in routine group(P<0.05),while the risk of slight hemorrhage in ticagrelor group was significantly higher than that in routine group(P<0.05).Conclusion The thromboelastography-guided APT delivers certain guidance significane on ACS patients after PCI.The elderly ACS patients should balance the risk of ischemia and hemorrhage,and the elderly ACS patients with high risk of ischemia are supported to be administered with Ticagrelor cautiously.
作者
刘星
魏小刚
吴琳
朱磊
张元莉
宋博超
陈浩
LIU Xing;WEI Xiaogang;WU Lin(Department of Cardiovascular Medicine,Shijiazhuang People’s Hospital,Hebei,Shijiazhuang 050000,China)
出处
《河北医药》
CAS
2022年第13期1982-1984,1988,共4页
Hebei Medical Journal
基金
河北省医学科学研究课题计划(编号:20211521)。
