老年冠心病双联抗血小板治疗中出血事件的相关危险因素分析

Risk factors of bleeding in elderly patients with coronary heart disease on dual antiplatelet therapy

关键词:  老年冠心病  双联抗血小板  出血  危险因素

Key words:  eldly coronary heart disease  dual antiplatelet therapy  bleeding  risk factors

摘要:

目的　探讨氯吡格雷联合阿司匹林双重抗血小板治疗老年冠心病过程中出血事件的危险因素。方法　选取2013年1月至2015年12月邯郸市第一医院收治的218例老年冠心病患者作为研究对象，依据有无发生消化道出血和（或）泌尿系出血设为出血组和未出血组。回顾性分析患者的临床资料，记录年龄、性别、肾功能、负荷剂量、既往合并基础疾病及联合用药情况，分析出血事件的相关危险因素。结果　消化道出血组及未出血组在年龄、是否有既往胃病史、肾功能情况、给予剂量及是否应用PPI因素间比较，差异有显著性意义，均P<0.05。泌尿系出血组及未出血组在年龄、是否有既往高血压病史及糖尿病病史、肾功不全、给予剂量间比较，差异有显著性意义，均P<0.05。结论　老年患者应用双重抗血小板药物治疗冠心病过程中出血风险相对较高,年龄≥75岁，患有肾功能不全以及应用负荷剂量等会增加消化道出血及泌尿系出血风险，临床上应注意识别高危人群，减少抗血小板治疗出血事件的发生。

Abstract:

Objective　To investigate the risk factors of bleeding in elderly patients with coronary heart disease on dual antiplatelet therapy of clopidogrel and aspirin. Methods　From January 2013 to December 2015, 218 cases of elderly patients with coronary heart disease in the first hospital of Handan were selected as the research object. Based on the incidence of digestive tract bleeding and/or urinary bleeding, the patients were divided into bleeding group and non-bleeding group. The clinical data of patients were retrospectively analyzed, including age, gender, renal function, loading dose, history of basic diseases such as diabetes, hypertension, cardiovascular and cerebrovascular diseases, chronic stomach and renal insufficiency and the combined use of drugs such as proton pump inhibitor (PPI), and the related risk factors of bleeding were analyzed. Results　In comparison of digestive tract bleeding group with the non-bleeding group, there were significant differences (P<0.05) in age, history of gastric disease, renal insufficiency, the amount of double anti-load and combined application of PPI. In comparison of urinary bleeding group with the non-bleeding group, there were significant differences (P<0.05) in age, history of hypertension and diabetes, renal insufficiency, and the amount of double anti-load. Conclusion　The risk of bleeding in elderly patients with dual anti platelet drugs in the treatment of coronary heart disease is relatively high. Patients 75 years of age or older, suffering from renal insufficiency and the application of load dosage have increased risk of gastrointestinal bleeding and urinary tract bleeding. Clinicians should pay attention to the identification of high-risk groups, effective prevention and control of antiplatelet therapy for bleeding events.