Clinical value of monitoring antiplatelet drug inhibition rate by thromboelastography in elderly patients with acute coronary syndrome
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摘要: 目的:应用血栓弹力图(TEG)监测老年急性冠脉综合征(ACS)患者不同抗血小板药物的血小板抑制率,评估药物疗效。方法:选取2018-01—2019-06住院的老年ACS患者(年龄≥60岁)234例,应用TEG监测并比较在不同诱导途径下抗血小板药物的抑制率,随访出院后6个月内患者出血及不良心血管事件(MACE)等发生情况。结果:2组发生四烯酸(AA)途径血小板抑制率比较,差异无统计学意义(t=1.274,P=0.078);A组较B组二磷酸腺苷(ADP)途径血小板抑制率高,药物抵抗的发生率低,差异有统计学意义(t=2.421,P=0.035)。2组抗血小板药物AA途径低反应性比较,差异无统计学意义(χ2=0.17,P=0.623);A组ADP途径低反应性明显低于B组,差异有统计学意义(χ2=9.15,P=0.004)。A组MACE发生率低于B组,差异有统计学意义(χ2=4.60,P=0.043);A组呼吸困难发生率高于B组,差异有统计学意义(χ2=8.98,P=0.005);2组出血事件发生率比较,差异无统计学意义(χ2=0.02,P=0.90)。结论:阿司匹林联合替格瑞洛双联抗血小板疗法疗效确切,可降低心血管事件的发生率;对存在血小板抵抗患者更换或加量抗血小板药物改善抗血小板药物的低反应性,取得良好效果且并不增加出血风险,有临床应用价值。Abstract: Objective:To monitor the platelet inhibition rate of different antiplatelet drug in elderly patients with acute coronary syndrome（ACS）by thromboelastography（TEG）and evaluate the efficacy of drugs. Method:From January 2018 to June 2019,234 elderly patients with ACS（age ≥60 years）were selected.The inhibition rate of antiplatelet drug was monitored by TEG,patients were followed up for 6 months after discharge for bleeding and adverse cardiovascular events. Result:There was no significant difference in the platelet inhibition rate of arachidonic acid（AA）pathway between two groups（t=1.274,P=0.078）;Group A had higher platelet inhibition rate and lower drug resistance rate than those in Group B by adenosine diphosphate（ADP）pathway（t=2.421,P=0.035）.There was no significant difference in AA pathway low reactivity between two groups(χ~2=20.17,P=0.623;ADP pathway low reactivity in Group A was significantly lower than that in Group B（χ~2=29.15,P=0.004）.The incidence of MACE in Group A was significantly lower than that in Group B（χ~2=24.60,P=0.043）,and the incidence of dyspnea in Group A was significantly higher than that in Group B（χ~2=28.98,P=0.005）.Conclusion:Aspirin combined with Tigrelo antiplatelet therapy is effective in reducing the incidence of cardiovascular events,and in improving the antiplatelet drug response to replacement or antiplatelet drug in patients with platelet resistance,it has good effect without increasing the risk of bleeding and has clinical application value.
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Key words:
- thromboelastogram /
- platelet inhibition rate /
- acute coronary syndrome
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