血栓弹力图在老年急性冠脉综合征患者抗血小板药物治疗中的应用

发布时间：2018-03-28 02:01

本文选题：血栓弹力图　切入点：血小板抑制率　出处：《临床心血管病杂志》2017年05期

【摘要】：目的:应用血栓弹力图测定老年急性冠脉综合征(ACS)患者应用不同抗血小板药物后的血小板抑制率,评估药物疗效并寻找改善抗血小板药物抵抗的对策。方法:选取60周岁以上老年ACS患者280例,在常规药物治疗基础中给予抗血小板药物治疗,随机分为单抗组(A组)和双抗组(B组),A组随机分为阿司匹林组(A1)40例、氯吡格雷组(A2)40例、替格瑞洛组(A3)40例,B组随机分为阿司匹林+氯吡格雷组(B1)80例、阿司匹林+替格瑞洛组(B2)80例,共5组。各组患者服用药物1个月后,应用血栓弹力图测定血小板经AA途径诱导的抑制率及经ADP途径诱导的抑制率,对各组患者不同药物的血小板抑制率及抗血小板有效率进行比较,并统计患者6个月内的出血或心血管缺血等不良事件发生情况;对存在抗血小板抵抗的患者,采取加大药物剂量或更换抗血小板药物的方式以改善血小板抵抗。结果:B组抗血小板有效率明显优于A组(P0.05),B2组经ADP途径诱导的抑制率及有效率明显优于B1组(P0.05);A1组抗血小板无效的患者更换药物为替格瑞洛,以及B2组抗血小板无效的患者替格瑞洛加量均获得了良好的效果(P0.05),且未增加任何出血风险(P0.05),并可降低心血管不良事件的发生率(P0.05)。结论:阿司匹林联合替格瑞洛双联抗血小板疗法疗效确切,并可降低心血管事件的发生率;对存在血小板抵抗患者更换或加量抗血小板药物是改善抗血小板药物抵抗,取得临床疗效的好对策,且并不增加出血风险。
[Abstract]:Objective: to determine the platelet inhibition rate of elderly patients with acute coronary syndrome (ACS) by thromboelastography. Methods: 280 patients over 60 years old with ACS were treated with antiplatelet drugs on the basis of routine drug therapy. Group A was randomly divided into two groups: aspirin group (n = 40), clopidogrel group (n = 40), tigrilol group (n = 40) and group B (n = 80): clopidogrel group (n = 80) and aspirin tigrilol group (n = 80). After taking drugs for one month, thromboelastography was used to determine the inhibition rate of platelet induced by AA pathway and ADP pathway. The platelet inhibition rate and antiplatelet effective rate of different drugs in each group were compared, and the occurrence of adverse events such as bleeding or cardiovascular ischemia within 6 months was counted. Results the antiplatelet effective rate of group B was significantly better than that of group A (group A) induced by ADP pathway, and that of group B was significantly better than that of group B (group B1). Patients with ineffective anti-platelet therapy were treated with tigrilol. In group B2, tigriloglycan had a good effect with no increased risk of bleeding, and could reduce the incidence of adverse cardiovascular events (P0.05). Conclusion: aspirin combined with tigloroside can reduce the incidence of cardiovascular adverse events (P0.05). Conclusion: the combination of aspirin and tigloroside can reduce the incidence of adverse cardiovascular events. Combined antiplatelet therapy is effective. The replacement or dosage of antiplatelet drugs in patients with platelet resistance is a good strategy to improve anti-platelet drug resistance and obtain clinical efficacy without increasing the risk of bleeding.
【作者单位】：潍坊市人民医院重症医学科;潍坊市人民医院心内科;
【分类号】：R541.4

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