摘要
目的比较使用西洛他唑、阿司匹林、氯吡格雷三联抗血小板治疗与阿司匹林、氯吡格雷二联治疗在老年患者药物洗脱支架置入术后的疗效和安全性。方法前瞻性将234例入选的老年冠心病患者随机分为两组，其中三联治疗组118例，术前服用阿司匹林100mg／d，氯吡格雷负荷量300mg或600mg，加用西洛他唑200mg／d，且西洛他唑用至术后6个月，改为二联治疗；两种药物联合治疗（二联治疗组）116例，术前用阿司匹林100mg／d，氯吡格雷负荷量300mg或600mg，氯吡格雷应用1年停用，改单用阿司匹林。主要终点随访两年的全因死亡和心脏主要不良事件、心脑血管主要不良事件事件，次要终点是再次发生心绞痛，再次心肌梗死，再次血运重建手术和出血事件。结果三联治疗组再发心绞痛、再次血运重建各1例（发生率分别为0．85％）；二联治疗组再发心绞痛、再次血运重建各8例（发生率分别为6．90％），差异有统计学意义（均为χ2=4．27，P〈0．05）。三联治疗组无新发心肌梗死、全因死亡、脑卒中和出血事件；二联治疗组新发心肌梗死、全因死亡、脑卒中事件各1例，无出血事件，两组比较差异无统计学意义（均P〉0．05）。结论老年人药物洗脱支架术后在应用阿司匹林和氯吡格雷的基础上加用西洛他唑，可降低再发心绞痛和再次血运重建发生率，具有较高的安全性。
Objective To evaluate the therapeutic effect and security of triple antiplatelet with cilostazol in the elderly after drug-eluting stent implantation and compare it with double antiplatelet treatment. Methods 234 elderly patients with coronary disease were randomly divided into two groups. 118 cases in the triple antiplatelet group were treated with clopidogrel （300 or 600 mg/d） and aspirin（100 mg/d） in addition with cilostazol（200 mg/d） from pre-surgery to 6 month after surgery, then received double antiplatelet treatment. 116 cases in the double antiplatelet group were treated with Aspirin（100 rag/d） and clopidogrel（300 or 600 mg/d）, then clopidogrel was ceased after 1 year and used only Aspirin. The main parameters during follow-up included all-cause death, major adverse cardiovascular events （MACE） and major adverse cardiac and cerebrovascular event （MACCE）, the secondary parameters during follow-up were recurrence of angina pectoris, myocardial infarction, revascularization and hemorrhage within 2 years. Results The recurrence of angina pectoris and revascularization were found in 1 case （0. 85%） and 1 case （0. 85%） respectively in the triple antiplatelet group, while 8 cases（6.90%） and 8 cases （6.90%） in the double antiplatelet group, with significant difference between the two groups（both ）χ2 =4.27 ,P%0.05）. All-cause death, myocardial infarction, cerebral apoplexy and hemorrhage were not found in the triple antiplatelet group, while 1 case of death,1 case with myocardial infarction, 1 case with apoplexy and no hemorrhage appeared in the double antiplatelet group, with no significant difference between the two groups（P〉0.05）. Conclusions The triple antiplatelet added with cilostazol in the elderly after drug-eluting stent implantation may decrease the recurrence of angina pectoris and revaseularization with higher security.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2012年第3期185-188,共4页
Chinese Journal of Geriatrics
关键词
药物洗脱支架
血小板
冠状动脉疾病
Drug-eluting stent
Blood platelet
Coronary artery disease
