替格瑞洛延长双抗治疗对ACS患者PCI术后出血风险-临床获益影响

Effects of ticagrelor prolonging dual-antibody therapy on postoperative bleeding risk-clinical benefits in ACS patients after PCI

目的:探讨替格瑞洛延长双抗治疗对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后出血风险-临床获益的影响。方法:选取2017年10月~2018年9月在湖南师范大学附属湘东医院已行PCI植入药物洗脱支架,且均经服用替格瑞洛90 mg每日两次+阿司匹林100mg每日一次常规双联抗血小板治疗满一年的ACS患者204例,随机分为研究组和对照组,各102例。研究组采用替格瑞洛60 mg+阿司匹林延长双抗治疗,对照组采用安慰剂60 mg+阿司匹林治疗,采用电话随访的方式对患者进行为期12个月的随访。记录随访期间两组主要心血管不良事件(MACE)及不良反应(包括出血、呼吸困难)的发生情况。结果:随访期两组出血、呼吸困难、总不良反应发生率均较低,且均无明显差异,研究组MACE发生率明显低于对照组。结论:与常规时程双抗治疗比较,替格瑞洛60mg延长双抗治疗更能减少ACS患者PCI术后心血管事件的发生,同时不增加出血风险,在有效性与安全性之间达到了较良好的平衡。

Objective To explore the effects of ticagrelor 60mg prolonging dual-antibody therapy on postoperative bleeding risk-clinical benefits in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods During the period from October 2017 to September 2018,204 ACS patients who underwent PCI and drug eluting stent implantation in East Hunan Hospital Affiliated to Hunan Normal University were enrolled.After treated with daily routine dual anti-platelet therapy(DAPT)[ticagrelor(90mg bid),aspirin(100mg qd)]for 12 months,they were divided into control group and study group,102cases in each group.The study group was continuously treated with daily prolonged DAPT[ticagrelor(60mg),aspirin],while control group was treated with[placebo(60mg)]and aspirin.The patients were followed up by telephone for 12 months.The occurrence of major adverse cardiovascular events(MACE)and adverse reactions(bleeding,dyspnea)during follow-up was recorded.Results During follow-up,incidence rate of bleeding,dyspnea and total adverse reactions in both group were low,without significant difference between the two groups.The incidence of MACE in study group was significantly lower than that in control group.Conclusion Compared with dual-antibody therapy of routine course,ticagrelor 60mg prolonging dual-antibody therapy can more reduce occurrence of cardiovascular complications in ACS patients after PCI,without increasing bleeding risk.And there is good balance between effectiveness and safety.