替格瑞洛联合依诺肝素对非ST段抬高性急性冠状动脉综合征的疗效评价

Efficacy of ticagrelor combined with enoxaparin in the treatment of non-ST segment elevated acute coronary artery syndrome

目的探讨替格瑞洛联合依诺肝素治疗复杂冠脉病变非ST段抬高性急性冠状动脉综合征(NSTE-ACS)的疗效及预后效果。方法选择NSTE-ACS患者164例按随机数字表法分为对照组与研究组,各82例。对照组采用替格瑞洛联合普通肝素治疗,研究组采用替格瑞洛联合依诺肝素治疗,观察并分析2组患者治疗1周和1个月后二磷酸腺苷(ADP)诱导的血小板抑制率、随访6个月后主要不良心血管事件(MACE)与不良反应情况。结果治疗1周和1个月后,2组患者血小板抑制率均显著提高,且研究组患者治疗1周后血小板抑制率(50. 10±7. 50)%显著高于对照组的(32. 20±7. 10)%,治疗1个月后血小板抑制率(59. 50±8. 30)%显著高于对照组(41. 40±8. 40)%(P <0. 05);随访6个月后,研究组患者MACE总发生率15. 85%低于对照组21. 95%,但差异无统计学意义(P> 0. 05),其中研究组患者支架内血栓和再次心肌梗死的发生率显著低于对照组(P <0. 05),但2组再次心绞痛和再次血运重建的发生率差异无统计学意义(P> 0. 05);随访6个月后,研究组患者不良反应发生率12. 20%显著低于对照组23. 17%(P <0. 05)。结论采用替格瑞洛联合依诺肝素治疗NSTE-ACS患者可取得满意疗效,与替格瑞洛联合普通肝素治疗相比,能更显著地提高血小板抑制率,抗凝效果好,减小出血风险的同时还可降低MACE发生率,安全性高且积极有效。

Objective To investigate the efficacy of ticagrelor combined with enoxaparin in the treatment of non-ST segment elevated acute coronary artery syndrome(NSTE-ACS) and its prognosis. Methods A total of 164 patients with NSTE-ACS admitted to our hospital were randomly divided into control group and study group according to the random number table method, with 82 cases per group. The control group was given ticagrelor combined with unfractionated heparinm, while the study group was conducted ticagrelor combined with enoxaparin. The adenosine diphosphate (ADP)-induced blood platelet suppression rate after 1-week and 1-month treatment, major adverse cardiovascular events (MACE) and adverse reactions after 6-month follow-up were analyzed. Results The blood platelet suppression rate was evidently improved in both groups after 1 week and 1 month of treatment, and the blood platelet suppression rates after 1-week and 1-month treatment in the study group were (50.10±7.50)%,(59.50±8.30)%, respectively, which were evidently higher than (32.20±7.10)%,(41.40±8.40)%, respectively, in the control group ( P <0.05). After 6 months of follow-up, The overall probability of MACE was evidently lower in the study group than the control group, but no significant difference was observed (15.85% vs. 21.95%, P >0.05). Among them, the probability of stent thrombosis and recurrent myocardial infarction in the study group were evidently lower than the control group( P <0.05), but no significant differences in ncidences of recurrent angina and revascularization were found( P >0.05). After 6 months of follow-up, the incidence of adverse reactions in the study group was evidently lower than that in the control group (12.20% vs. 23.17%, P <0.05). ConclusionTicagrelor combined with enoxaparin in the treatment of NSTEACS patients has satisfactory results, which can evidently improve blood platelet suppression rate, reduce the risk of bleeding, and decrease the incidence of MACE. So it is a safe therapy with better anticoagulant efficacy compared with ticagrelor combined with conventional heparin treatment.