单联抗血小板治疗PCI术后合并高出血风险疾病患者的临床观察  

Clinical observation of monotherapy with antiplatelet in patients with high risk of bleeding after PCI

作　　者：曹明英[1] 姚朱华[1] 张丽君[1] 王静[1] 张伶俐 董学涛[2] 高浩[3] CAO Mingying;YAO Zhuhua;ZHANG Lijun;WANG Jing;ZHANG Lingli;DONG Xuetao;GAO Hao(Department of Cardiology,Tianjin Union Medical Center,Tianjin 300120,China)

机构地区：[1]天津市人民医院心内一科,天津300120 [2]天津市人民医院消化内科内镜中心,天津300120 [3]天津市人民医院肛肠三科,天津300120

出　　处：《实用医学杂志》2021年第3期379-384,共6页The Journal of Practical Medicine

摘　　要：目的探讨单联抗血小板药物对患有高出血风险疾病的接受过冠状动脉介入治疗(percuta-neous coronary intervention,PCI)患者的疗效及安全性。方法选择2016年5月至2018年5月在我院诊治的患有高出血风险疾病的并接受过PCI的患者156例,根据选择血小板方案分为阿司匹林+氯吡格雷组,阿司匹林+替格瑞洛组,单用阿司匹林组,单用氯吡格雷组,单用替格瑞洛组。随访1年,监测血小板聚集率,记录严重心脏事件、心血管死亡及BARC3或5级出血事件。结果 (1)二磷酸腺苷诱导的血小板聚集率:单用阿司匹林组明显高于其他组(P <0.05),阿司匹林+替格瑞洛组和单用替格瑞洛组明显低于其他组(P <0.05)。花生四烯酸诱导的血小板聚集率:单用氯吡格雷组明显高于其他组(P <0.05),其余组之间无统计学差异(P> 0.05)。(2)单用替格瑞洛组与单用氯吡格雷组出血事件发生率明显低于其他三个组(P<0.05)。单用替格瑞洛组的心血管事件低于单用氯吡格雷组(P<0.05)。单用替格瑞洛组与阿司匹林+替格瑞洛组心血管死亡率均较低,且明显低于单用阿司匹林组及单用氯吡格雷组(P<0.05)。结论针对高出血风险的患者,单纯应用替格瑞洛治疗不增加大出血的同时、使心血管事件及死亡发生率更小。Objective To explore the efficacy and safety of single therapy with antiplatelet in patients with high bleeding risk after PCI.Methods 156 patients with high bleeding risk after PCI,who had been diagnosed and treated in our hospital from May 2016 to May 2018,were selected.According to the antiplatelet therapy regimen,they were divided into aspirin(ASA)+clopidogrel(CLO)group(24 patients),ASPL+ticagrelor(TIG)group(26 patients),ASA monotherapy group(30 patients),CLO monotherapy group(35 patients),and TIG monotherapy group(41 patients).All the patients were follow up for 1 year and were detected platelet aggregation rate and recorded serious cardiac events,cardiovascular deaths,and BARC 3 or 5 bleeding events.Results ADPinduced platelet aggregation rate was significantly higher in ASA monotherapy than in the other groups(P<0.05),and it was markedly lower in ASA+CLO group and TIG group monotherapy(P<0.05).Platelet aggregation rate induced by arachidonic acid was significant higher in CLO monotherapy group than in the other groups(P<0.05),and there were no significant differences among the other groups(P>0.05).The incidence of bleeding events was significantly lower in TIG or CLO monotherapy group than in the other three groups(P<0.05).The cardiovascular events in TIG monotherapy group were lower than those in CLO monotherapy group(P<0.05).Cardiovascular mortality in TIG monotherapy or ASA+TIG group was lower,and was significantly lower than that in ASA or CLO monotherapy group(P<0.05).Conclusions For patients with high bleeding risk,ticagrelormonotherapy does not increase major bleeding while reduces the incidence of cardiovascular events and deaths.

关 键 词：经皮冠状动脉介入治疗 出血 血小板聚集抑制剂 阿司匹林 替格瑞洛 氯吡格雷 

分 类 号：R541.4[医药卫生—心血管疾病]