半剂量替罗非班对高龄急性冠脉综合征患者的疗效及安全性

Safety and therapeutic effects of self-dose tirofiban on aged patients with acute coronary syndrome

目的:观察半剂量替罗非班对70岁以上高龄急性冠脉综合征(ACS)患者的疗效及安全性。方法:95例高龄ACS患者被随机分为观察组(48例)和常规治疗组(47例)。常规治疗组应用常规抗凝、抗血小板治疗,观察组另加用半剂量替罗非班。监测两组血清肌酐清除率水平及活化部分凝血酶时间(APTT)变化,观察两组的不良反应(出血、血小板减少)发生率以及住院期间的主要心血管事件(死亡、顽固性心绞痛、新的心肌梗塞)。结果:观察组和常规治疗组均存在不同程度的肾功能减退[肌酐清除率(43±16)ml/min∶(48±19)ml/min],但无显著差异,P>0.05。与常规治疗组相比,观察组APTT延长显著[用药后24h:(35.3±4.5)s∶(38.6±6.2)s,用药后48h:(39.5±5.4s)s∶(44.2±9.5)s,P均<0.05],出血事件发生率和血小板减少发生率有轻度增加,但无显著差异(P>0.05)。住院期间的主要心血管事件发生率观察组低于常规治疗组,但无显著性差异(P>0.05)。结论:对于70岁以上高龄急性冠脉综合征患者半剂量替罗非班轻度减少主要心血管事件,显著延长APTT,但不增加出血合并症,是相对安全、有效的,值得临床推荐。

Objective：To investigate safety and therapeutic effects of self-dose tirofiban in aged patients（70 years） with acute coronary syndrome（ACS）.Methods：The 95 ACS aged patients were randomly divided into observing group（n=48） and routine treatment group（n=47）.Both groups were routinely given aspirin and clopidogrel etc.Meanwhile observing group was added self-dose tirofiban.Changes of levels of serum creatinine clearance rate and activated partial thromboplastin time（APTT） in the two groups were monitored.Results：The two groups possess various degrees of renal dysfunction [creatinine clearance rate（43±16） ml/min vs.（48±19） ml/min],but no significant,P0.05.Compared with routine treatment group,APTT significantly prolonged [24h after treatment：（35.3±4.5）s vs.（38.6±6.2）s,48h after treatment：（39.5±5.4s）s vs.（44.2±9.5）s,P0.05 both],occurrence rates of bleeding and platelet reduction slightly increased（P0.05） in observing group.The occurrence rate of main cardiovascular events during hospitalization period in observing group was lower than that of routine treatment group,but without significant difference（P0.05）.Conclusion：In aged patients（70 years） with acute coronary syndrome,self-dose tirofiban slightly decrease main cardiovascular events,and no increase bleeding complication,so it is relatively effective and safe,may be recommended in clinic.