摘要
背景:急性心肌梗死老年患者具有极高的死亡和出血风险。对这类患者实行抗栓治疗策略的有效性和安全性仍为未知。方法:为了更好地了解老年患者抗栓治疗的风险和获益,对ASSENT-3和ASSENT-3 PLUS试验中的ST段抬高型心肌梗死(STEMI)患者进行检测。患者分别接受替奈普酶(TNK,一种组织型纤溶酶原激活剂)联合普通肝素(UFH)或依诺肝素,或者半量TNK联合阿昔单抗及减量UFH。
Background: Elderly patients with acute myocardial infarction are at particularly high risk for death and bleeding complications. The efficacy and safety of antithrombotic strategies in these patients remain unclear. Methods: To provide more insight into the risk and benefit of antithrombotic strategies in the elderly, we examined patients from the ASSENT-3 and ASSENT-3 PLUS trials with STEMI who were treated with tenecteplase(TNK) and unfractionated heparin(UFH) or enoxaparin, or half-dose TNK with abciximab and reduced-dose UFH. Results: Older patients had a higher risk profile, and lower use of concomitant therapies and revascularization procedures. We found an interaction between age and treatment effect for the efficacy end point(P=.0007) and the efficacy plus safety end point(P< .0001). Younger patients(< 65 years) had a lower risk of the composite efficacy plus safety end point with enoxaparin(relative risk[RR] 0.84, 95%CI 0.74-0.94) or abciximab(RR 0.79, 95%CI 0.69-0.90) compared with UFH. In patients >65 years of age, the benefit of enoxaparin appeared to be offset by an increased risk of bleeding complications. The risk of the efficacy plus safety end point tended to be higher in elderly patients receiving abciximab and half-dose TNK(RR 1.18, 95%CI 0.91-1.51 for 76-85 years of age and RR 1.48, 95%CI 0.88-2.49 for >85 years of age). Conclusions: Although TNK with either enoxaparin or abciximab appeared to be more effective than with standard UHF in younger patients, these combinations tended to be less effective and even may be unsafe in the elderly. Development of new combination strategies and dosing schemes of fibrinolytics and antithrombotics with improved efficacy and safety in the elderly remains a high priority.
