高龄冠心病患者药物支架植入术后双联抗血小板治疗的出血并发症分析

Effects of Age on Bleeding Events in Patients with Coronary Artery Disease on Dual Antiplatelet Therapy Following Drug Eluting Stent Implantation

目的 评价年龄对冠心病药患者物支架植入术后双重抗血小板治疗的出血影响.方法 将575例因急性冠脉综合征植入药物支架进行双重抗血小板治疗（阿司匹林＋氯比格雷）的患者,分成高龄组（70岁及以上,共224例）及低龄组（70岁以下,共351例）,随访6～54个月,比较两组出血发生率、出血相关死亡的发生情况.结果 高龄组与低龄组中出血事件包括消化道出血11例 vs 6例,血尿9例 vs 6例,脑出血1例 vs 2例,因出血死亡2例 vs 1例.高龄组消化道出血更常见（P＜0.05）.两组手术住院期间出血事件均占整个出血事件的大多数（18/21 vs 11/14）,未发生严重出血.院外出血3例（2例 vs 1例）,均死亡.结论 冠心病植入药物支架后双重抗血小板治疗在高龄患者中出血并发症较多见,大多发生在住院期间.定期随访大便隐血可以及时发现轻微出血,避免病情进展;严重出血者预后不佳.

Objective To evaluate effects of age on bleeding during dual antiplatelet therapy （DAPT） in coronary artery disease patients following drug eluting stent（DES） implantation. Methods In this obseational study,575 consecutive patients with coronary artery disease on DAPT after implanting DES were divided into two groups depending on age. Group A included 351 patients younger than 70 years, and group B included 224 patients older than 70 years. All patients were followed up for 6 to 54 months, and bleeding events were determined. Results There were 17 gastriointestinal bleeding events（6 patients in group A vs 11 patients in group B, P 〈 0.05 ）, urine bleeding（6 patients in group A vs 9 patients in group B）, hemorragic stroke（2 pa- tients in group A vs 1 patient in group B ）, and death due to bleeding （ 1 patient in group A vs 2 patients in group B）. Most bleeding events occurred during intervention operation hospitalization. Bleeding after discharge was associated worse prognosis. Conclusion Bleeding was more common in elderly patients on DAPT, and most of such events occurred during index hospitalization. Regular work- up of stool occult blood and urine blood may be necessary in elderly patients on DAPT.