替格瑞洛片联合阿司匹林对急性心肌梗死患者静脉血栓栓塞症发生率、凝血功能及不良反应发生率的影响

Effects of ticagrelor tablets combined with aspirin on the incidence of venous thromboembolism,coagulation and incidence of adverse reactions in patients with acute myocardial infarction

目的 分析替格瑞洛片联合阿司匹林对急性心肌梗死(AMI)患者静脉血栓栓塞症(VTE)发生率、凝血功能及不良反应发生率的影响。方法 回顾性收集2020年9月至2021年10月上海市浦东新区人民医院急诊与重症医学科收治的113例AMI患者的临床治疗资料。按治疗方式分为两组,观察组47例,经皮冠状动脉介入(PCI)术后采用阿司匹林+替格瑞洛片行抗血小板治疗;对照组66例,PCI术后采用阿司匹林+氯吡格雷行抗血小板治疗。统计分析两组临床疗效、VTE发生率、血小板聚集率、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原(FIB)]及不良反应发生率。结果 观察组临床总有效率为96. 74%,高于对照组(84. 85%),但两组相比差异无统计意义(P>0.05)。观察组VTE发生率为8. 51%,显著低于对照组(27. 27%),差异有统计意义(P<0.05)。两组术后血小板聚集率均显著下降,观察组术后1、3个月血小板聚集率均明显低于对照组,差异均有统计意义(P<0.05)。两组术后PT和APTT均明显升高,FIB明显降低,观察组术后1、3个月PT和APTT值均明显高于对照组,FIB值明显低于对照组,差异均有统计意义(P<0.05)。观察组不良反应发生率为19. 15%,高于对照组(7. 58%),但差异无统计意义(P>0.05)。结论 替格瑞洛联合阿司匹林能够有效降低AMI患者PCI术后VTE发生率,有助于降低血小板聚集率,改善凝血功能指标,但呼吸困难等不良反应发生率略高,临床用药应注意不良反应监测。

Objective To analyze the effect of ticagrelor tablets combined with aspirin on the incidence of venous thromboembolism(VTE),coagulation and incidence of adverse reactions in patients with acute myocardial infarction(AMI).Methods The clinical treatment data of 113 patients with AMI admitted to the Department of Emergency and Critical Care Medicine of Shanghai Pudong New Area People's Hospital from September 2020 to October 2021 were retrospectively collected.According to the treatment methods,47 cases in the observation group were treated with aspirin+ticagrelor tablets after percutaneous coronary intervention(PCI),and 66 cases in the control group were treated with aspirin+clopidogrel after PCI.The clinical efficacy,VTE incidence,platelet aggregation rate,coagulation function index[prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)]and adverse reaction rate of the two groups were statistically analyzed.Results The total clinical effective rate in the observation group was 96.74%,which was higher than that in the control group(84.85%),but there was no significant difference between the two groups(P>0.05).The incidence of VTE in the observation group was 8.51%,and the incidence of VTE in the control group(27.27%),and the difference was statistically significant(P<0.05).The platelet aggregation rate of the two groups after operation was significantly decreased(P<0.05),the platelet aggregation rate of the observation group was significantly lower than that of the control group at 1 month and 3 months after operation,and the differences were statistically significant(P<0.05).After operation,PT and APTT increased significantly and FIB decreased significantly in the two groups,the values of PT and APTT in the observation group at 1 and 3 months after operation were significantly higher than those in the control group,and the value of FIB was significantly lower than that in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 19.15%,which was higher than that in the control group(7.58%),but the difference was not statistically significant(P>0.05).Conclusion Ticagrelor combined with aspirin can effectively reduce the incidence of VTE after PCI in patients with AMI,help to reduce platelet aggregation rate and improve coagulation function indicators,but the incidence of adverse reactions such as dyspnea is slightly higher,and clinical medication should pay attention to adverse reaction monitoring.