老年心房颤动患者应用阿司匹林与氯吡格雷抗血栓治疗的研究

Antithrombotic treatment of elderly atrial fibrillation patients with aspirin plus clopidogrel

目的探讨老年心房颤动(AF)患者应用阿司匹林与氯吡格雷抗血栓治疗的疗效及发生阿司匹林抵抗(AR)的预测因素。方法选择2006年6月至2008年6月在我院就诊老年AF患者168例,口服阿司匹林100mg/d,2周检测血栓素B2(TXB2)、尿11-脱氢-TXB2(11-DH-TXB2)、最大血小板聚集率(maximal platelet aggregation,PAgM),根据PAgM从中筛选出AR患者41例。AR患者分别加服阿司匹林及氯吡格雷2周,测定血TXB2、尿11-DH-TXB2及PAgM。结果老年AF患者AR发生率为24.40%;非AR患者与AR患者比较,血TXB2、尿11-DH-TXB2显著下降(P<0.01);AR加服氯吡格雷患者PAgM显著降低(P<0.01),并无出血倾向(P>0.05)。结论血TXB2、尿11-DH-TXB2及PAgM可能为AR的预测因素;AR患者加服氯吡格雷可能是一种有效的抗血栓治疗方法。

Objective To clarify the efficacy of anti-thrombotic treatment of elderly atrial fibrillation （AF） patients with aspirin plus elopidogrel and the predictors of aspirin resistance （AR）. Methods 168 AF out-patient in this hospital were selected from June in 2006 to June in 2008. After they had taken aspirin 100 mg/d for two weeks, the levels of TXB2 , urine 11 -DH-TXB2 and maximal platelet aggregation rate （ PAgM ） were measured. Aspirin resistance was analyzed by examination of PAgM and 41 patients with AR were found. They took aspirin or clopidogrel 2 weeks. Their TXB2 , urine 11-DH-TXB2 and PAgM were measured again. Results 24.40%of the patients had AR. The level of TXB2 and urine ll-DH-TXB2were significantly lower in no-AR group than in AR group （P 〈 0. 01 ）. PAgM was significantly decreased after the patients in AR group took added clopidogrel for two weeks（ P 〈 0. 01 ）, and had no significant hemorrhagic tendency（ P 〉 0. 05 ）. Conclusion The level of TXB2, urine 11-DH-TXB2 and PAgM are probable predictors of AR in AF patients. Addition of clopidogrel may be an effective anti-thrombotic treatment for patients with AR.