Lancet:70岁以上非ST升高急性冠状动脉综合征患者抗血小板药物选择

2020-04-27 MedSci原创 MedSci原创

对于70岁以上的非ST升高急性冠状动脉综合征,氯吡格雷的治疗受益要优于替卡格雷

目前指南建议,推荐急性冠状动脉综合征患者使用替卡格雷或普拉格雷抑制血小板,然而,关于老年患者最佳的血小板抑制方案尚不明确。 近日研究人员探讨了氯吡格雷、替卡格雷或普拉格雷在老年非ST升高急性冠状动脉综合征(NSTE-ACS)患者中的安全性和有效性。
 
POPular AGE研究在荷兰开展,70岁以上的NSTE-ACS患者参与,随机接受初始计量为300或600mg的氯吡格雷、180mg的替卡格雷或60mg的普拉格雷,随后12个月的维持治疗方案为:氯吡格雷75mg,每日1次;90mg替卡格雷每日2次;10mg普拉格雷,每日1次。研究的主要终点为,临床受益包括全因死亡、心肌梗死、中风,安全性终点包括主要及轻微出血事件。
 
1002名患者参与研究,其中氯吡格雷组500人、替卡格雷或普拉格雷组502人(475人接受替卡格雷)。替卡格雷组47%的患者以及氯吡格雷组22%的患者停止治疗。氯吡格雷组主要出血事件发生率显著提低替卡格雷组(88 vs 118例;18% vs 24%,HR=0.71)。组间临床治疗受益差异不显著(28% vs 32%),达到非劣性。停药的最主要因素包括出血、呼吸困难以及需抗凝治疗。
 
研究认为,对于70岁以上的非ST升高急性冠状动脉综合征,氯吡格雷的治疗受益要优于替卡格雷。
 
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    2020-06-17 howi
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    2020-04-27 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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