阿司匹林剂量对高龄老年患者血小板功能的影响  

Dose-response of aspirin on platelet function in very elderly patients

作　　者：冯雪茹[1] 刘梅林[1] 刘芳[1] 范琰[1] 田清平[1] 

机构地区：[1]北京大学第一医院老年内科,北京100034

出　　处：《北京大学学报（医学版）》2016年第5期835-840,共6页Journal of Peking University:Health Sciences

基　　金：国家国际科技合作专项(2013DFA30860)资助~~

摘　　要：目的：观察阿司匹林100 mg/d更换为40 mg/d后血小板聚集率变化,评估高龄老年患者对阿司匹林的反应性,分析阿司匹林相关出血的影响因素。方法：入选537例服用阿司匹林100 mg/d（7 d以上）的年龄≥80岁老年患者,根据心血管疾病风险、出血风险评估和花生四烯酸诱导的血小板聚集率（arachidonic acid-induced platelet aggregation,AA-Ag）,100例患者更换为阿司匹林40 mg/d。观察阿司匹林更换为40 mg/d的患者AA-Ag水平及变化,以及3个月内出血情况和上消化道症状变化。结果：537例高龄老年患者服用阿司匹林100 mg/d时的AA-Ag平均10.27%±5.34%（0.42%～28.78%）,下四分位数为5.80%;阿司匹林40 mg组减量前AA-Ag平均为5.00%±2.32%,其中71.00%的患者AA-Ag〈5.80%。40 mg组患者黑便或便潜血阳性、其他部位出血、上消化道症状和消化道出血史明显高于100 mg组。服用阿司匹林40 mg/d后AA-Ag增加至11.21%±4.95%（2.12%～28.84%）,AA-Ag≥20%者仅为5.00%。多因素分析显示,阿司匹林40 mg AA-Ag与100 mg AA-Ag、体重指数、血小板数正相关,阿司匹林40 mg组中有消化道出血症状的患者比率由减量前的12.00%降低至5.00%,其他部位出血由26.00%降低至8.00%,上消化道症状改善。结论：阿司匹林40 mg/d能够有效抑制高龄老年患者的血小板聚集;100 mg/d改为40 mg/d,患者出血风险降低、上消化道不适症状改善。Objective： To assess the consequences of switching aspirin dosage from 100 mg / d to40 mg / d on cardiovascular benefit,bleeding risk and platelet aggregation in very elderly patients.Methods： Arachidonic acid induced platelet aggregation（ AA-Ag） was measured in 537 patients aged 80 or older treated with aspirin（ 100 mg / d）. In the study,100 patients with low on-treatment platelet aggregation and at high risk of bleeding and low risk of cardiovascular events,were switched to aspirin（ 40 mg / d） and their platelet aggregation was measured again 7 days later. Their bleeding and upper gastrointestinal symptoms were also recorded in following 3 months. Results： The study observed a heterogeneous distributed aspirin 100 mg / d AA-Ag（ range： 0. 42% to 28. 78%） in the 537 very elderly patients. Aspirin 100 mg / d AA-Ag before the switch in aspirin 40 mg / d group was 5. 00% ± 2. 32% and the rate of the patients with low on-treatment platelet aggregation was 71. 00%. The rates of melena or occult blood positive,other minimal bleeding,upper gastrointestinal symptoms and a history of gastrointestinal bleeding in 40 mg / d group were higher than those in 100 mg / d group. On a regimen of aspirin 40 mg / d,AA-Ag increased to 11. 21% ± 4. 95%（ range： 2.12% to 28.84%） with 95.00% of the patients with AA-Ag 20% and the rate of the patients with low on-treatment platelet aggregation was 15. 00%. Multiple variable analysis revealed that aspirin 40 mg / d AA-Ag was significantly influenced by aspirin 100 mg / d AAAg,BMI and platelet counts. The rate of gastrointestinal bleeding decreased from 12. 00% to 5. 00%,and upper gastrointestinal symptoms decreased from 59. 00% to 21. 00% after the switch in 40 mg / d group. Conclusion： Switching aspirin dosage from 100 mg / d to 40 mg / d reduces the bleeding events and improves upper gastrointestinal symptoms,thus inhibiting platelet aggregation effectively in very elderly patients.

关 键 词：阿司匹林 血小板聚集 老年人 80以上 出血 剂量 

分 类 号：R973.2[医药卫生—药品]