双联抗血小板降阶治疗经皮冠状动脉介入治疗后血栓高危患者的有效性及安全性研究

背景 急性冠脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)后常应用阿司匹林、氯吡格雷进行双联抗血小板治疗,以降低术后血栓发生风险,但部分患者存在不耐受现象,可能导致冠状动脉缺血事件,因此双联抗血小板降阶治疗方案逐步应用于临床,但该治疗方案对PCI后血栓高危患者的治疗效果尚处于探索阶段.目的 探讨双联抗血小板降阶...

Efficacy and Safety of Duplex Antiplatelet Degradation Therapy in Patients with High-risk of Thrombosis after Percutaneous Coronary Intervention

Background The patients with acute coronary syndrome(ACS)are often treated with aspirin and clopidogrel after percutaneous coronary intervention(PCI),in order to reduce the incidence of postoperative thrombosis.However,there are some patients with intolerance,which may lead to the occurrence of coronary ischemia.Therefore,the duplex antiplatelet degradation therapy is gradually applied in clinic,but the therapeutic effect in the treatment of patients with highrisk of thrombosis after PCI is still in the exploratory stage.Objective To explore the efficacy and safety of duplex antiplatelet degradation therapy in patients with high-risk of thrombosis after PCI,in order to provide reference for the clinical treatment of the disease.Methods A total of 180 patients with ACS and high-risk of thrombosis after PCI treated in Beijing Aerospace General Hospital from January 2019 and September 2020 were enrolled as the research objects.According to random table number method,they were divided into study group and control group,with 90 cases in each group.Patients in the study group were treated with aspirin and ticagrelor for 6 months,then changed ticagrelor to clopidogrel and continued the treatment for another 6 months.Patients in the control group were treated with aspirin and ticagrelor for 12 months.The curative effect,hemorrhage classification and inflammatory factorshigh-sensitive C reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α)],cardiac function indexesleft ventricular end diastolic diameter(LVEDD),left ventricular ejection fractions(LVEF),E/A ratio],gastric mucosal injury markerspepinogenⅠ(PGⅠ),pepinogenⅡ(PGⅡ),gastrin 17(G-17)]before treatment and at 12 months after treatment were compared between the two groups,and the incidence of major cardiovascular events and adverse reactions during treatment were compared between the two groups.Results There was no significant difference in curative effect and hemorrhage classification between the two groups(P>0.05).At 12 months after treatment,serum levels of hs-CRP,IL-6,TNF-αwere lower than those of control group(P<0.05).In the two groups,serum levels of hs-CRP,IL-6,TNF-αat 12 months after treatment were lower than those before treatment,respectively(P<0.05).There was no significant difference in LVEDD,LVEF,E/A ratio before treatment and at 12 months after treatment between the two groups(P>0.05);in the two groups,LVEDD、E/A ratio at 12 months after treatment were less than those before treatment,respectively(P<0.05).At 12 months after treatment,serum levels of PGⅠ,PGⅡ,G-17 in the study group were higher than those of control group(P<0.05).In the two groups,serum levels of PGⅠ,PGⅡ,G-17 at 12 months after treatment were higher than those before treatment,respectively(P<0.05).Incidence of major cardiovascular events and adverse reactions during treatment in the study group were lower than those of control group(P<0.05).Conclusion Duplex antiplatelet degradation therapy can effectively reduce inflammatory reaction and gastric mucosal injury in patients with high-risk of thrombosis after PCI,reduce the incidence of major cardiovascular events and adverse reactions,and will not cause adverse effects on cardiac function of patients,and with high safety.