老年急性冠脉综合征患者应用替罗非班治疗出血危险因素分析  

Risk factors of bleeding complication of tirofiban in elderly patients with acute coronary syndrome

作　　者：武强[1] 王曙霞[2] 郭豫涛[2] 张璐[2] 蔡军[1] 

机构地区：[1]解放军总医院国际医学中心,北京100853 [2]解放军总医院老年心内科,北京100853

出　　处：《心脏杂志》2011年第2期218-220,共3页Chinese Heart Journal

基　　金：中央保健专项资金科研资助项目课题(205)

摘　　要：目的:分析老年急性冠脉综合征(ACS)患者应用替罗非班抗血小板治疗出血的危险因素。方法:67例年龄大于60岁的老年ACS患者接受替罗非班持续静脉滴注36～48 h,观察用药开始至停药3 d内患者出血情况,并对出血可疑危险因素进行单因素和多因素Logistic回归分析。结果:发生出血6例(9%),其中重度出血1例,轻度出血5例。多因素Logistic回归分析表明吸烟,OR=3.2,95%CI 2.2-4.6;年龄每增加10岁,OR=1.4,95%CI 1.1-1.7;血小板聚集率每减少10%,OR=1.6,95%CI 1.2-1.9;肌酐清除率每减少10 ml/min,OR=1.2,95%CI 1.0-1.4;抗凝药及抗血小板药每增加一个,OR=4.2,95%CI 2.0-5.2。结论:抗血小板与抗凝药联合应用,吸烟、高龄、血小板聚集率降低、肌酐清除率降低为老年ACS患者应用替罗非班抗血小板治疗出血的主要危险因素。AIM： To evaluate the risk factors of bleeding complication of tirofiban in elderly patients with acute coronary syndrome（ACS）.METHODS： A total of 67 patients（60 years） with ACS were enrolled from August 2008 to February 2009 and were all given aspirin,clopidogrel,low molecular weight heparin,tirofiban and other anti-ischemic therapy.Tirofiban was given continuously for 36-48 h.Possible risk factors of bleeding complication analyzed included age,sex,smoking,hypertension,diabetes mellitus,blood platelet number,platelet aggregation,body mass index and creatinine clearance rate.RESULTS： Of the six bleeding patients,one patient experienced severe bleeding and five experienced mild bleeding.The results of multivariate stepwise logistic regression analysis indicated that smoking（OR=3.2,95% CI 2.2-4.6）,age（increasing every 10 years,OR=1.4,95% CI 1.1-1.7）,platelet aggregation（decreasing 10% OR=1.6,95% CI 1.2-1.9）,creatinine clearance（decreasing 10 ml/min OR=1.2,95% CI 1.0-1.4）,and anticoagulants and antiplatelet drugs（increasing one drug,OR=4.2,95% CI 2.0-5.2） were risk factors for bleeding complication of tirofiban in elderly patients with ACS.CONCLUSION： Anticoagulants combined with antiplatelet drugs,smoking,age,platelet aggregation and creatinine clearance are risk factors for bleeding complication of tirofiban in elderly patients with acute coronary syndrome.

关 键 词：替罗非班 出血 急性冠脉综合征 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病] R973.2[医药卫生—内科学]