摘要
目的:探索替格瑞洛联合阿司匹林对老年急性心肌梗死(AMI)患者血小板功能及临床预后的影响。方法:纳入2013年10月至2014年10月期间在我院就诊的老年(≥65岁)AMI患者200例,随机分为氯吡格雷组(n=101)和替格瑞洛组(n=99),分别给予负荷量阿司匹林300 mg+氯吡格雷600 mg或阿司匹林300 mg+替格瑞洛180 mg,次日起改为维持剂量阿司匹林100 mg/d和氯吡格雷75 mg/d或替格瑞洛180 mg/d,用药前及用药后1、6和12个月分别检测血小板反应指数(PRI),观察主要不良心血管事件(MACE)和心肌梗死溶栓治疗(TIMI)出血事件。结果:共有196例患者完成随访,两组治疗前PRI无统计学差异;PCI术后6个月和12个月时两组PRI均较治疗前分别下降(P<0.05);与氯吡格雷组比较,替格瑞洛组在6个月和12个月时PRI降低更加明显(P<0.01);随访1年时,替格瑞洛组MACE发生率明显低于氯吡格雷组(9.2%对12.9%,P=0.01);两组TIMI出血事件发生率无差别(氯吡格雷组9.6%对替格瑞洛组10.3%,P>0.05)。结论:与氯吡格雷相比,老年AMI患者服用替格瑞洛可进一步降低MACE事件,而不增加出血风险。
Objective：To evaluate the effect of ticagrelor with aspirin on platelet activity and clinical outcome in elderly patients with of acute myocardial infarction（AMI）. Methods：A number of 200 elderly AMI patients from October 2013 to October 2014 were involved in this study,and were divided into clopidogrel group（n=101）and ticagrelor group（n=99）.A loading dose of aspirin 300 mg with clopidogrel 600 mg or ticagrelor 180 mg loading dose were prescribed respectively for the two groups.Then aspirin 100 mg/d with clopidogrel 75 mg/d or ticagrelor 180 mg/d were prescribed for maintenance dose from the next day.Platelet reaction index（PRI）was measured at the time before and 1,6,12 month after medication respectively.The major adverse cardiovascular events（MACE）and thrombolysis in myocardial infarction（TIMI）bleeding were observed. Results：196 patients finished follow-up.There was no statistical difference in PRI between two groups at baseline.PRI was decreased after medication at 6 and 12 months in both groups respectively（P〈0.05）.Compared to the clopidogrel group,PRI in ticagrelor group decreased significantly at 6 and 12 months（P〈0.01）.During 1-year follow-up,the occurrence rate of MACE in the ticagrelor group was lower than that in clopidogrel group（9.2% vs.12.9%,P=0.01）.There was no statistical difference in TIMI bleeding between two groups（clopidogrel group 9.6% vs.ticagrelor group 10.3%,P〈0.05）. Conclusion：Compared with clopidogrel,ticagrelor can further reduce the incidence of MACE without increase of TIMI bleeding.
出处
《国际心血管病杂志》
2016年第3期183-186,共4页
International Journal of Cardiovascular Disease
基金
上海市浦东新区卫生与计划生育委员会面上项目(PW2014A-16)
