氯吡格雷与阿司匹林或单独阿司匹林预防动脉粥样硬化血栓事件观察

目的:观察氯吡格雷联合阿司匹林对心血管病人或有动脉粥样硬化高危因素病人血栓事件的疗效。方法:选择2007年1月～2010年12月在我院治疗的心血管疾病或有多种危险因素聚集的605例患者,随机分为:联合用药组(302例,给予氯吡格雷75mg/d加阿司匹林75mg/d),阿司匹林组(303例,单用阿司匹林75mg/d),观察两组3年内主要不良心血管事件(MACE,包括心肌梗死,心性死亡,缺血性脑卒中)及次要不良心血管事件(不稳定型心绞痛,一过性脑缺血等)发生情况。结果:MACE发生率:联合用药组为6.8%,阿司匹林组为7.3%,相对风险0.93,95%CI 0.83～1.05,P=0.22,无显著差异。次要不良心血管事件:联合用药组16.7%,阿司匹林组17.9%,相对风险0.92,95%CI 0.86～0.995,P=0.04联合用药组的次要事件显著少于阿司匹林组;严重出血事件率两组分别为1.7%和1.3%,P=0.08,无显著差异;少量出血事件率两组分别为2.5%和1.3%,P<0.01。结论:氯吡格雷联合阿司匹林与单用阿司匹林比较对于心血管病人或有动脉粥样硬化高危因素病人主要不良心血管事件效果相当,次要不良心血管事件显著减少,但少量出血事件显著增加。

Observation of preventing atherosclerotic thrombotic events by clopidogrel combined aspirin or single aspirin

Objective：To observe curative effect of clopidogrel combined aspirin on atherosclerotic thrombotic events in patents with cardiovascular diseases or persons with multiple risk factors.Methods：A total of 605patients with cardiovascular diseases or persons with multiple risk factors treated in our hospital from Jan 2007to Dec 2010were randomly divided into combined medication group（n=302,received clopidogrel 75mg/d and aspirin 75mg/d） and aspirin group（n=303,only received aspirin 75mg/d）.Incidence of major adverse cardiovascular events（MACE,including myocardial infraction,stroke and cardiovascular-cause death） and secondary adverse cardiovascular events（including unstable angina pectoris,transient cerebral ischemia） within three years were observed in two groups.Results：MACE incidence rates were 6.8% and 7.3%in combined medication group and aspirin group respectively（P=0.22）,no significant difference.Secondary adverse cardiovascular events of combined medication group（16.7%） was significantly lower than that of aspirin group（17.9%）,P=0.04;There were no significant difference in incidence rate of severe bleeding in combined medication group（1.7%） and aspirin group（1.3%）,P= 0.08;the small amounts bleeding of combined medication group（2.5%） significantly increased than that of aspirin group（1.3%）,P〈0.01.Conclusion：Compared with aspirin treatment,clopidogrel combined aspirin treatment possesses similar efficacy for MACE,but secondary adverse cardiovascular events significantly decrease and small amounts bleeding significantly increase in patents with cardiovascular diseases or persons with multiple risk factors.