高龄老年冠心病患者抗血小板药物使用及效果

摘要

目的：分析高龄老年冠状动脉粥样硬化性心脏病（冠心病）患者服用抗血小板药物情况及治疗效果。方法回顾性纳入2013年6月至2014年12月间在北京军区总医院干四科住院治疗的高龄老年（年龄≥75岁）冠心病患者75例，分为双联抗血小板组（n=32）、单用阿司匹林组（n=16）、单用氯吡格雷组（n=12）及未服用抗血小板药物组（n=15）。比较双联抗血小板组、阿司匹林组、氯吡格雷组患者凝血功能及血栓弹力图指标。结果75例高龄老年冠心病患者中双联抗血小板占42.7%，单用阿司匹林占21.3%，单用氯吡格雷占16.0%，未服用抗血小板药物占20.0%。双联抗血小板组、阿司匹林组、氯吡格雷组3组患者在年龄、性别构成、常规凝血指标及血小板计数方面无统计学差异（P＜0.05）。97.9%服用阿司匹林治疗者花生四烯酸（AA）诱导的血小板聚集抑制率（IRAA）＞50%，70.5%服用氯吡格雷治疗者二磷酸腺苷（ADP）诱导的血小板聚集抑制率（IRADP）≥30%。双联抗血小板组、阿司匹林组、氯吡格雷组3组患者R、K、Angle、MA值水平无统计学差异（P＞0.05），MAADP、IRADP、IRAA存在统计学差异（P＜0.05），双联抗血小板组MAADP显著低于阿司匹林组及氯吡格雷组（P＜0.05），IRADP显著高于阿司匹林组及氯吡格雷组（P＜0.05），氯吡格雷组IRAA显著低于双联抗血小板组及阿司匹林组（P＜0.05）。结论高龄老年冠心病患者抗血小板药物使用率较高，阿司匹林与氯吡格雷均获得较好的抗血小板疗效，但阿司匹林反应低下的发生率明显低于氯吡格雷。%Objective To analyze the application and efficacy of antiplatelet drugs in elderly patients with coronary heart disease (CHD). Methods The elderly CHD patients (age≥75, n=75) were chosen from June 2013 to Dec. 2014, and divided into dual antiplatelet therapy group (antiplatelet group, n=32), aspirin group (n=16), clopidogrel group (n=12) and control group (without taking antiplatelet drugs, n=15). The indexes of coagulation function and thrombelastogram (TEG) were compared among antiplatelet group, aspirin group and clopidogrel group. Results In 75 elderly patients, 42.7% of them took dual antiplatelet drugs, 21.3% took only aspirin, 16.0%took only clopidogrel and 20.0%did not take antiplatelet drugs. The constitution of age and sex, routine coagulation indexes and platelet count (PLT) had no statistical difference among antiplatelet group, aspirin group and clopidogrel group (P<0.05). In aspirin group, IRAA>50%induced by arachidonic acid (AA) in 97.9%patients, and in clopidogrel group IRADP≥30%induced by ADP in 70.5%patients. The levels of R, K, Angle and MA had no statistical difference among antiplatelet group, aspirin group and clopidogrel group (P>0.05), and MAADP, IRADP and IRAA had statistical difference (P<0.05) among antiplatelet group, aspirin group and clopidogrel group. MAADP was significantly lower (P<0.05), and IRADP was significantly higher (P<0.05) in antiplatelet group than those in aspirin group and clopidogrel group, and IRAA was significantly lower in clopidogrel group than that in antiplatelet group and aspirin group (P<0.05). Conclusion The usage rate of antiplatelet drugs is higher in elderly CHD patients, and aspirin and clopidogrel have better efficacy of antiplatelet but incidence of aspirin low reaction is lower than that of clopidogrel low reaction.