Prognostic evaluation of ticagrelor and clopidogrel in elderly ACS patients with intermediate metabolic type clopidogrel after PCI
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摘要: 目的:比较替格瑞洛与氯吡格雷在氯吡格雷中间代谢类型老年急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后的预后评价。方法:选取2016-01-2018-06入住我院接受PCI的氯吡格雷基因检测为中间代谢类型的老年ACS患者132例,氯吡格雷组72例,替格瑞洛组60例。替格瑞洛组给予180 mg负荷剂量嚼服后90 mg bid维持1年;氯吡格雷组给予300/600 mg嚼服后75 mg qd维持1年。观察两组治疗前后5 d血小板抑制率和随访12个月内两组患者主要不良心血管事件(MACE)及药物不良反应。结果:治疗后第5天,替格瑞洛组血小板抑制率高于氯吡格雷组(P<0.01)。12个月内两组MACE事件差异无统计学意义(P>0.05);替格瑞洛组和氯吡格雷组总出血事件分别为10例(16.7%)和3例(4.2%)(P<0.05);两组均未发生主要出血;轻微出血为7例(11.7%)和2例(2.8%)(P<0.05);呼吸困难分别为例8例(13.3%)和1例(1.4%),差异有统计学意义(P<0.01);其中轻度呼吸困难为6例(10.0%)和1例(1.4%)(P<0.05)。结论:与氯吡格雷相比替格瑞洛对氯吡格雷中间代谢类型老年ACS患者PCI术后的血小板抑制率更高,12个月内两组MACE事件无显著性差异,氯吡格雷治疗安全有效;替格瑞洛组总出血事件和呼吸困难增加,建议老年ACS患者PCI术后6个月改用替格瑞洛60 mg bid维持治疗。
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关键词:
- 替格瑞洛 /
- 氯吡格雷中间代谢 /
- 急性冠状动脉综合征 /
- 经皮冠状动脉介入治疗
Abstract: Objective:To compare the prognostic evaluation of ticagrelor and clopidogrel in elderly patients with acute coronary syndrome(ACS) with intermediate metabolic type clopidogrel after percutaneous coronary intervention(PCI).Method:The 132 cases of elderly ACS patients admitted to our hospital from January 2016 to June 2018,received PCI clopidogrel gene test as intermediate metabolic type,72 cases in clopidogrel group and 60 cases in ticagrelor group.In the ticagrelor group,180 mg loading dose was given and 90 mg was maintained twice daily for 1 year.In the clopidogrel group,75 mg was maintained once a day for 1 year after 300/600 mg chewing.The platelet inhibition rate at 5 days before and after treatment and the main adverse cardiovascular events(MACE) and adverse drug reactions were observed in the two groups.Result:Five days after treatment,the platelet inhibition rate induced by adenosine diphosphate(ADP) in the ticagrelor group was higher than that in the clopidogrel group,and the difference was statistically significant(P＜0.01).There was no significant difference in MACE events between the two groups within 12 months(P＞0.05).Total bleeding events in the ticagrelor group and clopidogrel group were 10(16.7%)and 3(4.2%)cases,respectively(P＜0.05).No major bleeding occurred in the two groups.Slight hemorrhage was reported in 7(11.7%)and 2(2.8%)cases(P＜0.05).There were 8(13.3%)and 1(1.4%)cases of dyspnea in the ticagrelor group and clopidogrel group,respectively,with statistically significant differences(P＜0.01).Mild dyspnea was found in 6(10.0%) cases and 1(1.4%) case(P＜0.05).Conclusion:In elderly ACS patients with intermediate metabolic type clopidogrel,the use of ticagrelor after PCI has a higher platelet inhibition rate,and there is no significant difference in MACE events between the two groups within 12 months.Clopidogrel is safe and effective in treatment.In the ticagrelor group,total bleeding events and dyspnea increased.So it is recommended to switch to ticagrelor 60 mg bid maintenance therapy 6 months after PCI in elderly ACS patients. -
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