双倍剂量氯吡格雷对老年患者介入术后心血管缺血事件及出血事件发生率的影响  

Effect of double clopidogrel dose on incidence of cardiovascular ischemic and bleeding events in elderly patients after PCI

作　　者：林乐健[1] 唐发宽[1] 华宁[1] 陆宏[1] 唐雪正[1] 

机构地区：[1]解放军309医院心内科,北京100091

出　　处：《中华老年心脑血管病杂志》2016年第1期28-31,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：解放军309医院面上课题资助(2014MS-004)

摘　　要：目的双倍剂量氯吡格雷对老年患者PCI术后心血管缺血事件及出血事件发生率的影响。方法采用血栓弹力图检测仪检测氯吡格雷的药物效果,筛选PCI术后对氯吡格雷药物不敏感老年患者140例,随机分为对照组70例及试验组70例,对照组每天服用100mg阿司匹林及75mg氯吡格雷,试验组每天服用100mg阿司匹林及150mg氯吡格雷,检测12个月后氯吡格雷的药物效果,同时观察2组12个月后心血管事件以及出血事件发生率。结果试验组PCI术后12个月心血管病死亡、支架内血栓、不稳定性心绞痛、心肌梗死及心血管事件总发生率显著低于对照组(0%vs 2.9%,8.6%vs 17.1%,17.1%vs 28.6%,5.7%vs 11.4%,31.4%vs 60.0%,P<0.05,P<0.01)。试验组氯吡格雷抑制率显著高于对照组[(68.5±5.1)%vs(42.3±7.2)%,P<0.01]。试验组消化道出血、脑出血发生率显著高于对照组(17.1%vs 4.3%,8.6%vs 1.4%,P<0.01)。结论老年患者PCI术后服用双倍剂量氯吡格雷可降低心血管缺血事件发生率,同时出血风险亦有所升高,临床上应定期随访观察。Objective To study the effect of double clopidogrel dose on the incidence of cardiovascular ischemic and bleeding events in elderly patients after PCI.Methods The effect of clopidogrel on the incidence of cardiovascular ischemic and bleeding events in elderly patients after PCI was detected by thrombelastography.One hundred and forty elderly patients insensitive to clopidogrel after PCI were divided into control group（n=70）and experimental group（n=70）.The effect of clopidogrel was detected and the incidence of cardiovascular ischemic and bleeding events was recorded 12 months after the patients in control group were given 100 mg aspirin and 75 mg clopidogrel daily and those in experimental group were given 100 mg aspirin and 150 mg clopidogrel daily.Results The total incidence of cardiovascular death,stent thrombosis,unstable angina pectoris,myocardial infarction and cardiovascular events was significantly lower in experimental group than in control group after PCI（0% vs 2.9%,8.6% vs 17.1%,17.1% vs 28.6 %,5.7%vs 11.4%,31.4%vs 60.0%,P〈0.05,P〈0.01）.The inhibition rate of clopidogrel and the incidence of gastrointestinal and cerebral bleeding events were significantly higher in experimental group than in control group（68.5%±5.1%vs 42.3±7.2%,P〈0.01;17.1%vs 4.3%,8.6%vs1.4%,P〈0.01）.Conclusion Double clopidogrel dose can reduce the incidence of cardiovascular ischemic events and increase the risk of bleeding in elderly patients after PCI.Such patients should thus be regularly followed up in clinical practice.

关 键 词：血栓弹力描记术 阿司匹林 血小板聚集抑制剂 出血 

分 类 号：R541.4[医药卫生—心血管疾病]