低剂量替格瑞洛对老年急性冠脉综合征伴慢性肾功能不全患者的疗效

Efficacy of low-dose ticagrelor in the treatment of acute coronary syndrome in the elderly patients with chronic renal insufficiency

【摘要】目的 观察低剂量替格瑞洛治疗老年急性冠脉综合征(ACS)伴慢性肾功能不全(CRI)患者的疗效和安全性。方法 连续入选2016年10月至2017年2月解放军空军第986医院心血管内科住院治疗的≥75岁老年 ACS合并CRI患者148例,根据患者服用替格瑞洛剂量不同分为低剂量替格瑞洛组(45 mg/次, 2次/d, n=52)和标准剂量替格瑞洛组(90 mg/次,2次/d,n=96),口服药物3 d后行血栓弹力图(TEG)检测,比较2组患者腺苷二磷酸(ADP)诱导的血小板聚集抑制率(IPA)和随访12个月主要不良心脑血管事件(MACCE)和大出血事件的发生率。采用SPSS 19.0统计软件对数据进行分析。组间比较采用t检验或χ²检验。结果 标准剂量组患者ADP诱导的IPA高于低剂量替格瑞洛组患者[(83.4±2.5)% vs (67.3±4.7)%,P=0.043],但2组IPA<50%患者比例差异无统计学意义[13.5%(7/52) vs 5.2%(5/96),P=0.219]。2组患者12个月MACCE发生率差异无统计学意义[19.2%(10/52) vs 13.5(13/96),P=0.476]。低剂量替格瑞洛组大出血事件发生率显著低于标准剂量替格瑞洛组[9.6%(5/52)vs 24.0%(23/96), P=0.033]。结论 低剂量替格瑞洛与标准剂量替格瑞洛相比同样可发挥较好的抗血小板作用,且降低出血事件风险,可更好地平衡缺血与出血。

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【Abstract】Objective To investigate the efficacy and safety of low-dose ticagrelor in the treatment of acute coronary syndrome (ACS) in the elderly patients with chronic renal insufficiency (CRI). Methods A total of 148 consecutive inpatients (aged≥75 years) with ACS and CRI were enrolled in the study, who were admitted to the Department of Cardiology of the 986^th Hospital of the PLA Air Force from October 2016 to February 2017. Patients were divided into low-dose ticagrelor group (LD group; 45 mg/once, twice/d; n=52) and standard-dose ticagrelor group (SD group; 90 mg/once, twice/d; n=96). Thromboelastography (TEG) was performed 3 days after oral administration. The 2 groups were compared in the inhibition rate of platelet aggregation (IPA) induced by ADP, and the incidence of major adverse cardiac and cerebrovascular events (MACCE) and hemorrhage events during a follow-up of 12 months. The data were analyzed using SPSS statistics 19.0. Student′s t test or χ² test was performed for comparison. Results IPA induced by ADP in the SD group was higher than that in the LD group [(83.4±2.5)% vs (67.3±4.7)%, P＝0.043], but there was no significant difference with IPA was fewer than 50% between 2 groups[13.5%(7/52) vs 5.2%(5/96),P＝0.219]. No significant difference was found between the 2 groups in the incidence of MACCE at month 12 [19.2%(10/52) vs13.5(13/96),P=0.476]. The incidence of massive hemorrhage in the LD group was significantly lower than that in the SD group [9.6%(5/52) vs 24.0%(23/96), P＝0.033]. Conclusion Low dose of ticagrelor can be as effective as standard dose in antiplatelet action, reducing the risk of bleeding events and maintaining a balance between ischemia and hemorrhage.