血栓弹力图在老年急性冠脉综合征患者抗血小板药物治疗中的应用

Applications of thrombelastogram in antiplatelet therapy in elderly patients with acute coronary syndrome

目的:应用血栓弹力图测定老年急性冠脉综合征(ACS)患者应用不同抗血小板药物后的血小板抑制率,评估药物疗效并寻找改善抗血小板药物抵抗的对策。方法:选取60周岁以上老年ACS患者280例,在常规药物治疗基础中给予抗血小板药物治疗,随机分为单抗组(A组)和双抗组(B组),A组随机分为阿司匹林组(A1)40例、氯吡格雷组(A2)40例、替格瑞洛组(A3)40例,B组随机分为阿司匹林+氯吡格雷组(B1)80例、阿司匹林+替格瑞洛组(B2)80例,共5组。各组患者服用药物1个月后,应用血栓弹力图测定血小板经AA途径诱导的抑制率及经ADP途径诱导的抑制率,对各组患者不同药物的血小板抑制率及抗血小板有效率进行比较,并统计患者6个月内的出血或心血管缺血等不良事件发生情况;对存在抗血小板抵抗的患者,采取加大药物剂量或更换抗血小板药物的方式以改善血小板抵抗。结果:B组抗血小板有效率明显优于A组(P<0.05),B2组经ADP途径诱导的抑制率及有效率明显优于B1组(P<0.05);A1组抗血小板无效的患者更换药物为替格瑞洛,以及B2组抗血小板无效的患者替格瑞洛加量均获得了良好的效果(P<0.05),且未增加任何出血风险(P>0.05),并可降低心血管不良事件的发生率(P<0.05)。结论:阿司匹林联合替格瑞洛双联抗血小板疗法疗效确切,并可降低心血管事件的发生率;对存在血小板抵抗患者更换或加量抗血小板药物是改善抗血小板药物抵抗,取得临床疗效的好对策,且并不增加出血风险。

Objective：To observe the curative effect of different antiplatelet drugs in elderly patients with acute coronary syndromes （ACS） and look for strategies to ameliorate the antiplatelet drug resistance through monitoring ptatelet inhibition rate by using thrombelastogram （TEG）. Method; The elderly patient with ACS（n= 280） with oral antiplatelet drugs on the basis of the routine drugs were randomly divided into single resistance group （A group） and double resistance group （B group）, the patients in group A were randomly divided into aspirin group （A1 group, n=40 cases）, clopidogrel group （A2 group, n=40） and ticagrelor group（A3 group, n=40）, while the patients in group B were randomly divided into aspirin 4- clopidogrel group （B1 group, n=80） and aspirin 4- ticagrelor group （B2 group, n=80）. The AA induced platelet inhibition rate and the ADP induced inhibition rate were measured by using TEG after one month of taking drugs. The platelet inhibition rates and antiplatelet effec- tive rates of different drugs were compared, and the bleeding or adverse events such as cardiovascular ischemia in 6 months were collected. Increasing dosage or substituting drugs were taken to improve platelet resistance. Result： The antiplatelet efficient rate in B group was obviously higher than that in group A （P〈0.05）. The ADP induced inhibition rate and the effective rate in B2 group were obviously higher than those in B1 group （P〈0.05）. The an- ti-platelet drugs failed to work in patients of A1 group were replaced with ticagrelor, while those in B2 group increased the dosage of tieagrelor. All of the above patient had good antiplatelet efficacy without an increase of bleeding risk and with an decrease of adverse cardiovascular events（P〈0.05）. Conclusion： Aspirin combination with tieagrelor dual antiplatelet therapy has obvious curative effect, can reduce the incidence of adverse events. Replace or add antiplatelet drugs are good strategies to improve the antiplatelet drug resistance, and does not increase the risk of bleeding.