不同剂量替格瑞洛对经皮冠状动脉介入治疗老年冠心病的影响

Effect of different doses of ticagrelor on percutaneous coronary intervention in the treatment of coronary heart disease in the elderly

目的探究不同剂量替格瑞洛对经皮冠状动脉介入(PCI)治疗老年冠心病患者的影响。方法选取2017年1月至2018年5月本院收治的老年冠心病患者78例,PCI后均采取抗血小板治疗,按照随机数字表法分为3组,各26例。A组口服替格瑞洛每次45 mg,每天2次,B组口服替格瑞洛每次90 mg,每天2次,C组口服氯吡格雷每次75 mg,每天1次。比较3组治疗前及治疗7 d后二磷酸腺苷(ADP)抑制率、血小板最大聚集率(MAR)、最大血凝块强度(MAADP)及不良反应发生率。结果治疗7 d后,3组MAR均较治疗前降低,且A组、B组低于C组(P<0.05),A组MAR与B组比较差异无统计学意义;治疗7 d后,3组ADP抑制率均较治疗前升高,且A组、B组高于C组(P<0.05),A组ADP抑制率与B组比较差异无统计学意义;治疗7 d后,3组MAADP均较治疗前降低,且A组、B组低于C组(P<0.05),A组MAADP抑制率与B组比较差异无统计学意义。术后随访1年,均无恶性心律失常、心肌梗死、心力衰竭、死亡等事件发生,其中B组出现皮肤瘀斑2例,将替格瑞洛减量至每次45 mg后瘀斑逐渐消退。结论每次45 mg替格瑞洛抗血小板作用与每次90 mg替格瑞洛疗效相当,优于每次75 mg氯吡格雷,但低剂量替格瑞洛能降低出血风险,不增加心血管事件。

Objective To explore the effect of different doses of ticagrelor on the treatment of elderly patients with coronary heart disease by percutaneous coronary intervention(PCI).Methods 78 elderly patients with coronary heart disease admitted to our hospital from January 2017 to May 2018 were selected.They were all treated with antiplatelet therapy after PCI.They were divided into three groups by random number table method,with 26 cases in each group.Group A received oral ticagrelor 45 mg each time,twice a day,group B received oral ticagrelor 90 mg each time,twice a day,and group C received clopidogrel 75 mg each time,once a day.The inhibition rate of adenosine diphosphate(ADP),the maximum platelet aggre-gation rate(MAR),the maximum clot intensity(MAADP)and the incidence of adverse reactions were compared among the three groups before treatment and 7 days after treatment.Results After 7 days of treatment,the MAR of the three groups were lower than before treatment,and the group A and group B were lower than that of the group C(P<0.05).There was no significant difference in MAR between the group A and group B.After 7 days of treatment,the ADP suppressed rate of three groups were higher than before treatment,and group A and group B were higher than group C(P<0.05).There was no significant difference in MAADP inhibition rate between group A and group B;after 7 days of treatment,the MAADP of the three groups were lower than before treatmen(P<0.05).There was no significant difference in the ADP inhibition rate between the group A and the group B.No malignant arrhythmia,myocardial infarction,heart failure,death and other events occurred after 1 year follow-up,there were 2 cases of skin ecchymosis in group B,the ecchymosis gradually subsided after tigritol was reduced to 45 mg each time.Conclusion The antiplatelet effect of 45 mg ticagrelor each time is equivalent to that of 90 mg ticagrelor each time,which is better than that of clopidogrel 75 mg each time.However,low dose ticagrelor can reduce the risk of bleeding without increasing cardiovascular events.