低剂量替格瑞洛对行经皮冠状动脉介入治疗的急性冠脉综合征患者血小板聚集率及出血的影响

Effects of Low Dose Tigrillo on Platelet Aggregation and Bleeding in Patients with Acute Coronary Syndrome Undergoing Coronary Intervention

目的探讨急性冠脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)术后应用低剂量替格瑞洛对血小板聚集率及出血事件的影响。方法将2016年10月至2018年11月于普宁市人民医院接受PCI的72例ACS患者按随机数字表法分为常规组与低剂量组,每组36例。常规组术后接受常规剂量替格瑞洛治疗,低剂量组术后接受低剂量替格瑞洛治疗。比较两组治疗4周内凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)、血小板计数(PLT)、血小板聚集率(PAR)变化情况,并比较两组随访12个月内出血事件发生率。结果治疗4周内,两组PT、APTT及INR呈升高趋势,FIB呈降低趋势,差异有统计学意义(P<0.05);入组时、治疗2周及治疗4周后,两组PT、APTT、INR及FIB比较,差异无统计学意义(P>0.05)。治疗4周内,两组PLT及PAR呈降低趋势,差异有统计学意义(P<0.05);入组时、治疗2周及治疗4周后,两组PLT及PAR比较,差异无统计学意义(P>0.05)。在12个月的随访过程中,两组无BARC 4~5型出血发生,低剂量组BARC 1型、2型及3型出血发生率低于常规组,差异有统计学意义(P<0.05)。结论ACS患者行PCI术后应用低剂量替格瑞洛,可有效降低术后出血事件发生率,且不影响抗血小板聚集效果。

Objective To explore the effects of low dose tigravil on platelet aggregation rate and bleeding event after Percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).Methods A total of 72 ACS patients receiving PCI treatment which were admitted to Puning People's Hospital from October 2016 to November 2018 were selected as the research objects and were randomly divided into an routine group and a low dose group.The routine group were given routine dose of Tigrillo postoperatively and the low dose group were given low dose of Tigrillo postoperatively.The prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR),fibrinogen(FIB),platelet count(PLT),platelet aggregation rate(PAR)were compared between the 2 groups within 4 weeks of treatment.The incidence of bleeding events in the 2 groups within 12 months of follow-up were compared.Results Within 4 weeks of treatment,the PT,APTT and INR of the 2 groups showed an increasing trend,and the FIB showed a decreasing trend,and the difference was statistically significant(P<0.05);at the time of enrollment,2 weeks of treatment,and 4 weeks of treatment,the PT,APTT,and INR of the 2 groups showed a decreasing trend.The difference is statistically significant(P<0.05).Within 4 weeks of treatment,the PLT and PAR of the 2 groups showed a decreasing trend,and the difference was statistically significant(P<0.05);at the time of enrollment,2 weeks of treatment,and 4 weeks of treatment,there was no statistically significant difference between the 2 groups in PLT and PAR(P>0.05).During the 12-month follow-up,there was no BARC type 4 to 5 bleeding in the 2 groups.The incidence of BARC type 1,type 2 and type 3 bleeding in the low-dose group was lower than that in the conventional group,and the difference was statistically significant(P<0.05).Conclusion After PCI in ACS patients,low-dose ticagrelor can effectively reduce the incidence of postoperative bleeding events without affecting the effect of anti-platelet aggregation.