冠状动脉支架置入1年后联合应用阿司匹林及小剂量氯吡格雷的有效性分析

Effectiveness of aspirin in combination with low dose clopidogrel after 1 year of coronary stenting

目的探讨联合应用阿司匹林及小剂量氯吡格雷在冠状动脉支架置入1年后患者中的有效性。方法回顾性分析2015年1月至2017年1月于本院行冠状动脉支架置入并采用双重抗血小板治疗(dual antiplatelet therapy,DAPT)1年后的160例患者的临床资料,依据患者实际服药情况分为实验组和对照组,每组各80例。实验组继续服用阿司匹林(100mg/次,1次/天),同时服用氯吡格雷(25 mg/次,1次/天);对照组继续服用阿司匹林(100 mg/次,1次/天)。继续服药1年后对两组患者不良心脑血管事件发生情况、心源性死亡和总死亡情况、临床并发症发生情况等指标进行比较分析。结果继续服药1年后,实验组患者心源性死亡率(2.5%)、心绞痛复发率(16.2%)、脑梗死发生率(2.5%)、心肌梗死发生率(1.3%)均低于对照组(分别为5.0%、33.8%、6.3%、5.0%),差异有显著性(P=0.017、0.027、0.016、0.035),但两组患者靶血管支架内血栓发生率差异无显著性(P>0.05)。继续服药1年后,实验组重度出血、轻度出血、白细胞减少、血小板减少等并发症发生率分别为1.3%、5.0%、3.8%、1.3%,与对照组(分别为2.5%、3.8%、5.0%、3.8%)比较差异无显著性(P>0.05)。结论阿司匹林联合小剂量氯吡格雷治疗冠状动脉支架置入术后患者,能明显降低其心源性死亡、心肌梗死、缺血性脑梗死、心绞痛的发生率,且不增加出血及血细胞减少等并发症发生率,值得临床推广应用。

Objective The efficacy of aspirin in combination with low dose clopidogrel in one year after coronary stenting was analyzed. Method A retrospective analysis was made on the clinical data of 160 patients who underwent dual antiplatelet therapy(DAPT) one year after coronary artery stenting in our hospital from January 2015 to January 2017. According to the actual medication situation of patients, the patients were divided into experimental group and control group with 80 cases each. The experimental group continued to take aspirin 100 mg once a day. At the same time, take clopidogrel 25 mg, once a day; the control group took aspirin 100 mg, once a day. One year after taking the drug, the incidence of adverse cardiovascular and cerebrovascular diseases, cardiac death and total death, and clinical complications occurred in the two groups. Result After one year of taking the drug, the heart rate mortality rate of the experimental group was 2.5%, the recurrence rate of angina pectoris was 16.2%, the incidence of cerebral infarction was 2.5%, and the incidence of myocardial infarction was 1.3%, which was lower than that of the control group(5.0%, 33.8%, 6.3%, respectively). The difference was significant(P=0.017, 0.027, 0.016, 0.035). There was no significant difference in the rate of target vessel revascularization and stent thrombosis between the two groups(P>0.05). After one year of taking the drug, the experimental group had severe hemorrhage, mild hemorrhage and leukopenia., thrombocytopenia and other undesirable complication rates were 1.3%, 5.0%, 3.8%, 1.3%, compared with the control group(2.5%, 3.8%, 5.0%, 3.8%) is low, but no significant difference(P>0.05). Conclusion Aspirin combined with low dose clopidogrel in patients undergoing coronary stenting can significantly reduce the incidence of cardiac death, myocardial infarction, ischemic stroke and angina pectoris, and can significantly improve the survival rate without increasing bleeding and the incidence of complications such as cytopenias, it is worth clinical application.