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《国际心血管病杂志》[ISSN:1006-6977/CN:61-1281/TN]

期数:

2019年03期

页码:

164-169

栏目:

临床研究

出版日期:

2019-05-27

文章信息/Info

Title:

Minor bleeding in superficial tissue in patients undergonging dual antiplatelet therapy after percutaneous coronary intervention

作者:

王赛华 郇强 王温慧 赵志宏

201318 上海健康医学院附属周浦医院心内科

Author(s):

WANG Saihua;  HUAN Qiang;  WANG Wenhui;  ZHAO Zhihong

Department of Cardiology, Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China

关键词:

经皮冠状动脉介入术;  双联抗血小板治疗;  表浅轻微出血

Keywords:

Percutaneous coronary intervention;  Dual antiplatelet therapy;  Minor bleeding in superficial tissue

分类号:

-

DOI:

10.3969/j.issn.1673-6583.2019.03.009

文献标识码:

-

摘要:

目的:探讨冠状动脉粥样硬化性心脏病(冠心病)经皮冠状动脉介入术(PCI)后双联抗血小板治疗(DAPT)引起表浅轻微出血的病例特点及药物调整效果。方法:分析2016年6月至2017年12月于周浦医院行PCI的500例冠心病患者,所有患者均置入药物洗脱支架,术后常规服用阿司匹林100 mg/d,氯吡格雷75 mg/d。37例患者在PCI后出现表浅轻微出血,设为表浅轻微出血组; 另从500例患者中随机选取40例无表浅轻微出血患者作为对照组,分析两组患者的临床资料。对表浅轻微出血患者行血栓弹力图检查,计算花生四烯酸诱导的血小板抑制率(AA抑制率)和二磷酸腺苷诱导的血小板抑制率(ADP抑制率),记录表浅轻微出血患者DAPT剂量调整情况。结果:500例PCI患者中,37例出现表浅轻微出血,发生率为7.4%。与对照组相比,表浅轻微出血组患者平均年龄较大,体质量指数较低(P均< 0.05)。表浅轻微出血患者AA抑制率及ADP抑制率提示阿司匹林及氯吡格雷治疗有效。根据表浅轻微出血距PCI时间等调整DAPT方案,先减阿司匹林剂量,再减氯吡格雷剂量; 必要时可提前改为单一抗血小板药物,以氯吡格雷为主; 如仍有出血,氯吡格雷可由75 mg/d减为50 mg/d,极端病例可继续减量。DAPT方案调整后,患者均恢复正常,无相关心脑血管事件发生。结论:PCI后DAPT方案可导致患者表浅轻微出血,血栓弹力图检测的AA抑制率和ADP抑制率对指导DAPT方案剂量调整指导价值有限。可根据表浅轻微出血距PCI时间及病情调整DAPT方案。

Abstract:

Objective:Characterize the cases of minor bleeding in superficial tissue in patients with coronary heart disease(CHD)undergonging dual antiplatelet therapy(DAPT)after percutaneous coronary intervention(PCI)and evaluate the efficacy of drug adjustment.Methods:A total of 500 patients with CHD were recruited at Zhoupu hospital from June 2016 to December 2017. All the patients underwent drug-eluting stent implantation and standard DAPT therapy with 100 mg aspirin daily plus 75 mg ticagrelor daily. Among them minor bleeding events occurred in 37 patients(bleeding group). Forty patients with no bleeding events from the same cohort were assigned randomly to control group. We analysed clinical data of both group. In bleeding group, thrombelastogram was carried out to calculate the platelet inhibition rate induced by arachidonic acid(AA)and adenosine diphosphate(ADP)respectively, and adjustment of DAPT was recorded as well.Results:Of the 500 patients with PCI, 37(7.4%)had minor bleeding in superficial tissue. Compared with the control group, the average age and body mass index in bleeding group were higher(P<0.05). The inhibition rate of AA and ADP in bleeding group suggested that aspirin and clopidogrel were effective. According to the interval between PCI and bleeding events, reduced the dose of DAPT gradually with aspirin first. Switched from DAPT to clopidogrel alone in advance if necessary. If bleeding continued adjusted dose of clopidogrel from 75 mg daily to 50 mg daily even less. The patients returned to normal after drug adjustment with no cardiovascular and cerebrovascular events.Conclusions:DAPT could cause minor bleeding events in superficial tissue in patients undergonging PCI. Adjusting dose of aspirin and clopidogrel accrording to interval between PCI and bleeding events as well as patient's condition is effective, while the inhibition rate of AA and ADP have limited instructing value.

参考文献/References

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备注/Memo

备注/Memo:

基金项目:上海市浦东新区重点学科群建设基金(PWZxq2017-01)
通信作者:赵志宏,Email:zhihong_zhao@126.com

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更新日期/Last Update: 2019-05-27