急性冠脉综合征PCI术后患者双联抗血小板治疗相关不良反应特点及危险因素分析

目的 探讨急性冠脉综合征（ACS）患者接受经皮冠状动脉介入治疗（PCI）后服用替格瑞洛和阿司匹林双联抗血小板治疗出现不良反应的特点及危险因素。方法 前瞻性纳入2018年3月—2018年6月郑州市第七人民医院收治的PCI术后服用替格瑞洛和阿司匹林的ACS患者100例，采用VerifyNow-P2Y12系统检测患者血小板反应性并随访6个月，根据是否发生相关不良反应分为对照组和不良反应组，收集对比两组患者临床基线资料，采用单因素和多因素Logistic回归分析出血和呼吸困难的危险因素。结果 纳入研究的患者未出现不良反应的40例纳入对照组，出现不良反应的60例纳入不良反应组，双联抗血小板治疗相关不良反应发生率60.0%，84例（84.0%）患者存在低血小板反应性。两组患者在年龄、性别、合并疾病、血小板反应性等方面差异不具有统计学意义（P＞0.05），不良反应组吸烟患者占比明显高于对照组（51.7%vs27.5%，P=0.016）。不良反应主要临床表现为皮肤黏膜出血和轻中度呼吸困难，用药后1个月内出血和呼吸困难发生率显著高于用药后2～6个月（出血发生率：38.0%vs1.0%，P＜0.001；呼吸困难发生率：32.0%vs8.0%，P＜0.001）。多因素Logisitc回归分析显示老年、女性和贫血是双联抗血小板治疗相关出血的独立危险因素（P＜0.05），吸烟和出血事件是双联抗血小板治疗相关呼吸困难的独立危险因素（P＜0.05）。结论 ACS患者PCI术后双联抗血小板治疗早期出血和呼吸困难发生率高但程度较轻，对于合并危险因素的患者应提前评估、加强监测，最大限度地降低药品不良反应的发生。

Analysis of characteristics and risk factors of adverse reactions of dual therapy with aspirin and ticagrelor after PCI in patients with acute coronary syndrome

Objective To investigate the characteristics and risk factors of adverse reactions related to dual antiplatelet therapy of ticagrelor and aspirin in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods Prospectively included 100 patients with ACS who took ticagrelor and aspirin after PCI in Zhengzhou Seventh People''s Hospital from March 2018 to June 2018. The platelet reactivity of the patients was detected by VerifyNow-P2Y12 system and followed up for six months. The patients were divided into control group and adverse reaction group according to whether there was related adverse reaction. The clinical baseline data of the two groups were collected and compared. The risk factors of hemorrhage and dyspnea were analyzed by single factor and multiple factor Logistic regression.Results A total of 40 patients without adverse reactions were included in the control group, and 60 patients with adverse reactions were included in the adverse reaction group. The incidence of adverse reactions related to dual antiplatelet therapy was 60.0%, and 84 patients (84.0%) had low platelet reactivity. There was no significant difference between the two groups in terms of age, sex, comorbidity, platelet reactivity, etc (P > 0.05). The proportion of smokers in the adverse reaction group was significantly higher than that in the control group (51.7% vs 27.5%, P = 0.016). The main clinical manifestations of adverse reactions were skin mucosal hemorrhage and mild to moderate dyspnea. The incidence of bleeding and dyspnea within one month after administration was significantly higher than that of two to six months after administration(bleeding incidence: 38.0% vs 1.0%, P <0.001. Dyspnea incidence: 32.0% vs 8.0%, P <0.001). Multivariate Logisitc regression analysis showed that old age, women and anemia were independent risk factors for bleeding associated with dual antiplatelet therapy (P <0.05), and smoking and bleeding events were independent risk factors for dyspnea associated with dual antiplatelet therapy (P <0.05).Conclusion The incidence of early bleeding and dyspnea in ACS patients treated with dual antiplatelet therapy after PCI is high, but the degree is relatively low. Patients with risk factors should be evaluated in advance and monitored to minimize the occurrence of adverse drug reactions.