小剂量替格瑞洛在老年急性冠脉综合征冠脉介入治疗术后的有效性及安全性研究  

Efficacy and Safety of Low-dose Ticagrelor in Older Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

作　　者：刘大一[1] 潘震华[1] 李颖[1] 王智昊[2] Liu Dayi;Pan Zhenhua;Li Ying;Wang Zhihao(Department of Cardiology,Daqing Oilfield General Hospital,Daqing 163001;Department of Geriatrics,the First Hospital of Jilin University,Changchun 130021)

机构地区：[1]大庆油田总医院心内科,大庆163001 [2]吉林大学第一医院老年病科,长春130021

出　　处：《国际老年医学杂志》2021年第5期257-260,共4页International Journal of Geriatrics

基　　金：黑龙江省卫生计生委科研课题(2017-436);吉林省自然科学基金(20200201319JC)。

摘　　要：目的观察VerifyNow-P2Y12检测替格瑞洛对老年急性冠脉综合征(ACS)冠脉介入治疗(PCI)术后抗血小板聚集的有效性及安全性。方法选取老年ACS且PCI术后患者100例,均给予替格瑞洛90 mg 2次/d口服,在PCI术后7~10 d进行VerifyNow-P2Y12测定,100例(100%)患者P2Y12反应单位(PRU)值≤117,79例(79%)患者PRU值≤80,PRU均值48.2,其中有12例(12%)PRU值<10,鉴于PRU值过低存在出血倾向,换用硫酸氢氯吡格雷片,且从研究中剔除这12例患者。把剩余88例随机分为减量组44例(替格瑞洛45 mg 2次/d口服)和标准剂量组44例(替格瑞洛90mg 2次/d口服)。1周后对减量组再次测定PRU值,并比较两组PRU值。观察两组12个月心血管事件和出血等不良事件。结果1周后减量组44例(100%)PRU值≤118,26例(59.1%)患者PRU值≤80,PRU均值82.3。两组12个月内均未发生急性再发心肌梗死、心源性死亡及脑血管意外。按TIMI标准,替格瑞洛减量组心血管事件和出血等不良事件低于标准剂量组(P<0.05)。结论老年ACS患者PCI术后小剂量替格瑞洛口服45 mg 2次/d安全有效,且出血事件低于替格瑞洛口服90 mg 2次/d。Objective To investigate the efficacy and safety of low-dose ticagrelor in antiplatelet aggregation after percutaneous coronary intervention(PCI)in older patients with acute coronary syndrome(ACS).Methods 100 older ACS patients received ticagrelor 90 mg orally twice a day after PCI.The patients underwent VerifyNow-P2Y12 detection on 7-10 days after PCI.There were 100 patients(100%)with PRU≤117,79 patients(79%)with PRU≤80,and the mean of PRU was 48.2.There were 12 patients(12%)with PRU<10 among 100 patients.These 12 patients were removed from the study because of high risk of bleeding with ticagrelor.The remaining 88 patients were randomly divided into low-dose group(ticagrelor 45 mg twice a day)and standard dose group(ticagrelor 90 mg twice a day).After 1 week of treatment,PRU was measured in low-dose group.Adverse events such as cardiovascular events and bleeding at 12 months after PCI were compared between the two groups.Results After 1 week of treatment,in low-dose group,there were 44 cases(100%)with PRU≤118,26 cases(59.1%)with PRU≤80,and the mean of PRU was 82.3.At 12 months after PCI,no acute re-infarction,cardiac death or cerebrovascular events occurred in both groups.According to TIMI,the incidence of adverse events was lower in low-dose group than that in standard dose group(P<0.05).Conclusion Ticagrelor 45 mg twice a day was safe and effective in older ACS patients undergoing PCI,and the incidence of bleeding events was lower than ticagrelor 90 mg twice a day.

关 键 词：VerifyNow检测 替格瑞洛 急性冠脉综合征 冠脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]