高龄急性冠脉综合征患者双联抗血小板治疗的疗效及安全性探讨

目前,双联抗血小板治疗(dual antiplatelet therapy,DAPT)仍然是急性冠脉综合征(ACS)的一线治疗方法。强化抗血小板治疗带来心血管获益的同时,由此引起的出血风险的增加也值得关注。文中通过回顾近些年来国内外几项大型临床试验,综述得出:高龄ACS患者给予DAPT有效且相对安全;对于有出血危险因素及需要长期应用阿司匹林(尤其是接受DAPT)者,可选择较低剂量阿司匹林(75～81 mg.d-1);年龄>75岁者,不推荐给予氯吡格雷负荷剂量(300 mg);服用阿司匹林和(或)氯吡格雷时,不推荐常规应用质子泵抑制剂预防胃肠道不良反应。

The efficacy and safety of dual antiplatelet therapy in elderly patients with acute coronary syndrome

At present,dual antiplatelet therapy(DAPT) is still the first-line therapy of acute coronary syndrome(ACS).Although intensive antiplatelet therapy can bring the cardiovascular benefit,increased risk of bleeding caused by which is also worthy of attention.In this paper,we reviewed several large clinical trials of recent years and got the conclusion that:DAPT is effective and relatively safe in the elderly patients with ACS.Patients with the risk factors of hemorrhage and the need for long-term application of aspirin(especially DAPT),can choose a low dose of aspirin(75~81 mg·d-1).Those with the age>75 years old,clopidogrel loading dose(300 mg) is not recommended.Proton pump inhibitors are not recommended for routine use to prevention of gastrointestinal adverse reaction in addition to Aspirin and(or) clopidogrel.