Objective To compare the bleeding risk and curative effect in the elderly (≥75 years old ) and middle-aged patients (<60 years old) suffering from acute coronary syndrome (ACS) treated with different regimens of dual antiplatelet therapy (DAPT), aspirin combined with clopidogrel or with ticagrelor .Methods A total of 416 consecutive ACS patients admitted in our hospital from March 2014 to May 2015 were enrolled in this study.And all of them underwent thromboelastography (TEG).According to their age and antiplatelet regimen, they were divided into 4 groups, that is, <60 years old and treated with aspirin +clopidogrel (<60C group),≥75 years old and treated with aspirin +clopidogrel (≥75C group), <60 years old and treated with aspirin +ticagrelor (<60T group), and ≥75 years old and treated with aspirin +ticagrelor (≥75T group).All the patients were followed up for 1 year.The occurrences of major adverse cardiovascular events ( MACE) and bleeding events were recorded and compared in the groups.Results There were no significant differences in the occurrence of MACE , maximal amplitude ( MA) value obtained with TEG, and inhibitory rate of arachidonic acid (AA)-induced platelet aggregation (AA-IPA) in each group (P>0.05).The inhibitory rate of adenosine diphosphate-induced platelet aggregation ( ADP-IPA ) was obviously higher in the same-aged patients treated by aspirin combined with ticagrelor than those with clopidogrel (P<0.05), but no difference was found in the <60T group and ≥75T group (P =0.828), and the ADP-IPA rate was remarkably lower in the ≥75C group than the <60C group (P =0.011). The occurrence of bleeding risk was significantly higher in the same-aged patients treated with aspirin +ticagrelor than with clopidogrel (P<0.05), but most of them was type Ⅰ non-fetal bleeding events.There was no difference in bleeding risk between the <60T group and the ≥75T group (P=0.392).Cox regression analysis revealed that blood glucose level (B=0.111, RR=1.117,95%CI:1.014-1.231, P=0.025), estimated glomerular filtration rate ( eGFR, B =-0.023, RR =0.977, 95%CI: 0.961 -0.993, P=0.005), and heart rate (B=0.040, RR=1.041, 95%CI:1.013 -1.070, P=0.004) were risk factors for MACE.Logistic regression analysis showed that different strategies of DAPT (B=3.527, OR=34.025, 95%CI:9.560-121.101, P<0.001) and sex (B=1.126, OR=3.085, 95%CI:1.083-8.788, P=0.035) were risk factors for bleeding events .Conclusion The clinical efficacy of aspirin+ticagrelor is not superior to that of aspirin +clopidogrel , and the former regimen is associated with higher risk of type Ⅰbleeding .No difference is observed in the bleeding risk in the patients treated with aspirin +ticagrelor at different age period .%目的 比较≥75岁老年急性冠脉综合征(ACS)患者与<60岁中年ACS患者"阿司匹林+替格瑞洛"与"阿司匹林+氯吡格雷"两种双联抗血小板治疗(DAPT)方案的疗效与出血风险.方法 连续入选2014年3月至2015年5月于解放军总医院心血管内科住院治疗的ACS患者、年龄<60岁及≥75岁,并进行血栓弹力图(TEG)检查的患者416例,分为:(1)年龄<60岁阿司匹林+氯吡格雷(<60C组),(2)年龄≥75岁阿司匹林+氯吡格雷(≥75C组),(3)年龄<60岁阿司匹林+替格瑞洛(<60T组),(4)年龄≥75岁阿司匹林+替格瑞洛(≥75T组),随访1年,比较各组主要不良心血管事件(MACE)及出血情况.结果 各组MACE事件发生率、TEG检测的最大振幅(MA)值、花生四烯酸抑制率(AA-IPA)差异均无统计学意义(P>0.05);相同年龄段"阿司匹林+替格瑞洛"患者二磷酸腺苷抑制率(ADP-IPA)高于"阿司匹林+氯吡格雷"(P<0.05),但"阿司匹林+替格瑞洛"在两个年龄段的ADP-IPA差异无统计学意义(P=0.828),≥75C组ADP-IPA较<60C组低(P=0.011);相同年龄段"阿司匹林+替格瑞洛"患者出血事件发生率高于"阿司匹林+氯吡格雷"患者(P<0.05),但多为Ⅰ型非致命性出血;"阿司匹林+替格瑞洛"在不同年龄段出血事件发生率差异无统计学意义(P=0.392).应用Cox回归分析MACE危险因素:血糖(B=0.111,RR=1.117,95%CI:1.014~1.231,P=0.025),eGFR(B=-0.023,RR=0.977,95%CI:0.961~0.993,P=0.005),心率(B=0.040,RR=1.041,95%CI:1.013~1.070,P=0.004).应用logistic回归分析出血事件危险因素:DAPT方案(B=3.527,OR=34.025,95%CI:9.560~121.101,P<0.001),性别(B=1.126,OR=3.085,95%CI:1.083~8.788,P=0.035).结论 在本研究中"阿司匹林+替格瑞洛"的临床疗效不优于"阿司匹林+氯吡格雷",且Ⅰ型出血风险增高;中、老年人口服"阿司匹林+替格瑞洛"的出血风险无差异.
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