替格瑞洛治疗经皮冠状动脉介入术后消化道出血的疗效观察

Observation of therapeutic effect of ticagrelor on gastrointestinal bleeding after PCI

目的观察替格瑞洛在治疗经皮冠状动脉介入治疗(PCI)术后发生上消化道出血患者中的临床疗效以及主要不良事件,以评价替格瑞洛在合并上消化道出血患者中的应用效果及安全性。方法将确诊为冠心病并行PCI术后1个月内因服用阿司匹林和氯吡格雷双重抗血小板治疗出现上消化道出血的41例患者,随机分为替格瑞洛组(n=21)和常规治疗组(n=20)。待消化道出血停止后,替格瑞洛组予替格瑞洛90 mg/次,2次/d,常规治疗组继续予阿司匹林和氯吡格雷双重抗血小板治疗。所有患者在抗血小板治疗的同时继续予标准的冠心病二级预防治疗及服用质子泵抑制剂。服药前、服药3个月后分别抽血检测血常规、肝功能和肾功能,行心电图、心脏彩超检查。并随访观察患者主要不良事件发生情况。结果两组患者缺血事件和出血事件发生率、谷丙转氨酶(ALT)、射血分数(LVEF)、左室舒张末径(LVEDD)差异无统计学意义(P>0.05)。替格瑞洛组治疗后尿酸(UA)较治疗前有所升高(P<0.05),肌酐(Cr)无明显变化;替格瑞洛组呼吸困难发生率高于常规治疗组,患者均可耐受。结论对PCI术后早期上消化道出血患者,单用替格瑞洛抗血小板治疗与常规阿司匹林加氯吡格雷双重抗血小板治疗相比,缺血事件和出血事件并不增加,且无严重不良反应。

Objective To observe the curative effect and adverse reactions of tieagrelor on patients with upper gastrointestinal bleeding after percutaneous coronary intervention(PCI).Methods 41 cases diagnosed with coronary heart disease,who were found upper gastrointestinal bleeding because of taking double antiplatelet therapy with aspirin and clopidogrel within one month after PCI were randomly divided into ticagrelor group(n=21)and conventional treatment group(n=20).After the gastrointestinal bleeding stopped,the ticagrelor group were given ticagrelor 90 mg/times for 2 times/d,and the conventional treatment group continued to receive aspirin and clopidogrel dual anti-platelet therapy.All patients continued to be treated with standard secondary prevention of coronary heart disease and the use of proton pump inhibitors while receiving antiplatelet therapy.Blood routine,liver function and renal function were detected before and 3 months after taking medicine,and electrocardiogram and cardiac color Doppler examination were performed.Occurrence of major adverse events in the two groups were followed up and observed.Results There was no statistically significant difference in the incidence of ischemic events and bleeding events,alanine transaminase(ALT),left ventricular ejective fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD)between the two groups(P>0.05).After treatment,the level of uric acid(UA)in the ticagrelor group increased(P<0.05),but creatinine(Cr)had no obvious change.The incidence of dyspnea in the ticagrelor group was higher than that in the conventional treatment group,and patients were tolerated.Conclusion For patients with early upper gastrointestinal bleeding after PCI,ischemic events and bleeding events in antiplatelet therapy with digalealin alone and conventional aspirin combined with clopidogrel double antiplatelet therapy do not increase,and no severe adverse reactions are found.