摘要
目的:观察急性冠状动脉综合征(ACS)高龄患者经皮冠状动脉介入治疗(PCI)后长期联合应用阿司匹林和氯吡格雷的安全性。方法:将接受PCI的416例ACS患者分为非高龄组(A组,年龄<75岁,n=315例)和高龄组(B组,年龄≥75岁,n=101例)。随访观察2组患者一般情况、冠心病危险因素、合并用药、支架植入情况及2组在PCI后双联抗血小板治疗情况,比较2组患者使用阿司匹林和氯吡格雷负荷量比例、坚持双联抗血小板治疗的时间及不良反应(出血、血小板减少、白细胞减少)发生率,并用多元Logistic回归分析与出血相关的危险因素。结果:B组中高血压病史患者多,而A组中高脂血症、吸烟史患者多(P<0.05)。阿司匹林和氯吡格雷负荷量、阿司匹林长期维持及氯吡格雷维持时间组间差异无统计学意义(P>0.05)。2组出血发生率分别为3.2%和4.0%(P>0.05),血小板及白细胞减少发生率组间差异无统计学意义(P>0.05)。多元Logistic回归分析结果提示阿司匹林长期维持治疗、氯吡格雷维持治疗时间超过12个月、合并使用质子泵抑制剂是ACS患者PCI后长期使用双联抗血小板药并发出血的独立危险因素[比值比(OR)分别为0.048、5.396、0.181,均P<0.05],而高龄、高脂血症、高血压、吸烟史、抗凝治疗、阿司匹林负荷量治疗、氯吡格雷负荷量治疗等均非其独立危险因素(P>0.05)。结论:75岁以上的高龄ACS患者PCI后长期双联抗血小板治疗的出血发生率与75岁以下人群相比并未明显增加,但长期双联抗血小板治疗仍需注意防止出血并发症的发生。
Objective To investigate the safety of long term dual therapy with aspirin and clopidogrel after percutaneous coronary intervention （PCI） in very elderly patients with acute coronary syndrome （ACS）. Methods Four hundred and sixteen ACS patients undergone PCI were retrospectively studied and divided into group A （age 〈 75 years, n=315） and group B （age ≥75 years,n=101）. The general condition, coronary risk factors, combined use of drugs, stent implantation and dual antiplatelets therapy with aspirin and clopidogrel after PCI of the two groups were analyzed. The loading dose, duration as well as incidence of side effects of the auti-platelet therapy （including hemorrhagic events, thrombocytopeuia and leukopenia） were compared between the two groups. Multiple-logistic regression analysis was performed to investigate the related risk factors of hemorrhagic events. Results The loading dose and duration of the dual therapy were not significantly different between the two groups （P〉0.05）. The incidence of bleeding was 3.2% in group A and 4.0% in group B （P〉0.05）. There were no significant differences in thrombocytopenia and leukopenia between the two groups （P〉0.05）. Logistic regression analysis showed that taking aspirin as well as clopidogrel more than 12 months and therapy with proton pump inhibitors added were independent risk factors of hemorrhagic events （OR values were 0.048, 5.396 and 0.181, respectively, P〈0.05）. Conclusions Dual antiplatelets therapy with aspirin and clopidogrel after PCI in age ≥75 years patients with ACS does not increase more obviously than that in age 〈75 years patients. It should be paied attention to prevent hemorrhagic events while using long term dual antiplatelets therapy with aspirin and clopidogrel.
出处
《内科理论与实践》
2009年第3期196-199,共4页
Journal of Internal Medicine Concepts & Practice
