Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Coron Artery Dis. 2020 Jan;31(1):66-72. doi: 10.1097/MCA.0000000000000787.
This study aims to determine frequency and reasons for prematurely discontinuing or switching antiplatelet therapy in elderly patients admitted with non-ST-elevation acute coronary syndrome (NSTE-ACS).
Patients of 75 years or older admitted with suspected NSTE-ACS were included between 2013 and 2016. Information was extracted from the patients' medical files.
A total of 544 patients were included, 17.3% discontinued aspirin within one year, predominantly (57%) within 30 days. The most common reason was the start of a (non-vitamin-K) oral anticoagulant [(N)OAC], either combined with a P2Y12-inhibitor (43%) or as monotherapy (16%). The P2Y12-inhibitor was discontinued in 31.2% of patients within one year, of which 46% within 30 days. The most common reason was undergoing coronary artery bypass grafting (CABG; 22%). Switching of clopidogrel seldom occurred; however, ticagrelor was switched in 50/179 patients mainly due to dyspnoea (42%). Independent predictors for prematurely discontinuing antiplatelet therapy were undergoing CABG [odds ratio (OR) 3.257 (95% confidence interval [CI] 1.836-5.779)], need for (N)OAC [OR 2.167 (95% CI 1.423-3.300)] and type II ACS as final diagnosis [OR 3.793 (95% CI 1.721-8.361)]. Undergoing percutaneous coronary intervention [OR 0.393 (95% CI 0.243-0.634)] and use of clopidogrel [OR 0.441(95% CI 0.293-0.662)] were independent predictors of continuing antiplatelet therapy.
In elderly patients of at least 75 years with NSTE-ACS, antiplatelet therapy is frequently discontinued prematurely, most often within 30 days. Main reasons for discontinuing are need for (N)OAC, undergoing CABG or type II ACS as final diagnosis and suffering from dyspnoea while on ticagrelor.
本研究旨在确定老年非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者中断或转换抗血小板治疗的频率和原因。
纳入 2013 年至 2016 年期间入院的年龄在 75 岁或以上的疑似 NSTE-ACS 患者。从患者的病历中提取信息。
共纳入 544 例患者，17.3%的患者在一年内停用阿司匹林，主要（57%）在 30 天内。最常见的原因是开始使用（非维生素 K）口服抗凝剂[（N）OAC]，联合使用 P2Y12 抑制剂（43%）或单独使用（16%）。一年内有 31.2%的患者停用 P2Y12 抑制剂，其中 46%在 30 天内。最常见的原因是行冠状动脉旁路移植术（CABG；22%）。氯吡格雷的转换很少发生，但 50/179 例患者改用替格瑞洛，主要因呼吸困难（42%）。过早停用抗血小板治疗的独立预测因素包括行 CABG[比值比（OR）3.257（95%置信区间[CI] 1.836-5.779]）、需要（N）OAC[OR 2.167（95%CI 1.423-3.300）]和最终诊断为 II 型 ACS[OR 3.793（95%CI 1.721-8.361）]。行经皮冠状动脉介入治疗[OR 0.393（95%CI 0.243-0.634）]和使用氯吡格雷[OR 0.441（95%CI 0.293-0.662）]是继续抗血小板治疗的独立预测因素。
在年龄至少 75 岁的 NSTE-ACS 老年患者中，抗血小板治疗经常过早中断，最常见于 30 天内。停药的主要原因是需要（N）OAC、行 CABG 或最终诊断为 II 型 ACS 以及使用替格瑞洛时出现呼吸困难。
