替格瑞洛和阿司匹林的血浆浓度对中国急性冠脉综合征患者双联抗血小板治疗出血并发症的预测作用：一项前瞻性观察研究。

The Plasma Concentration of Ticagrelor and Aspirin as a Predictor of Bleeding Complications in Chinese Acute Coronary Syndrome Patients With Dual Antiplatelet Therapy: A Prospective Observational Study.

机构信息

Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang City, China.

Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang City, China; and.

出版信息

J Cardiovasc Pharmacol. 2023 Aug 1;82(2):148-156. doi: 10.1097/FJC.0000000000001442.

DOI:10.1097/FJC.0000000000001442

PMID:37295072

Abstract

PURPOSE

This study evaluated the association among the plasma concentration of ticagrelor, ARC124910XX, aspirin, and salicylic acid with the risk of recent bleeding in patients with the acute coronary syndrome. To this end, we developed an accurate model to predict bleeding.

METHODS

A total of 84 patients included in this study cohort between May 2021 and November 2021. The risk factors were identified by univariate and multivariate analyses, and statistically significant risk factors identified in the multivariate analysis were included in the nomogram. We used the calibration curve and the receiver operating characteristic curve to verify the accuracy of the prediction model.

RESULTS

Multivariable logistic analysis showed that ticagrelor concentration (odds ratio [OR]: 2.47, 95% confidence interval [CI], 1.51-4.75, P = 0.002), ST-segment elevation acute myocardial infarction (OR: 32.2, 95% CI, 2.37-780, P = 0.016), and lipid-lowering drugs (OR: 11.52, 95% CI, 1.91-110, P = 0.015) were positively correlated with bleeding. However, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (OR: 0.04, 95% CI, 0.004-0.213, P < 0.001) was negatively correlated with bleeding. The receiver operating characteristic curve analysis showed that ticagrelor concentration and these factors together predict the occurrence of bleeding (area under receiver operating characteristic curve = 0.945, 95% CI, 0.896-0.994) and that ticagrelor concentration >694.90 ng/mL is the threshold of bleeding concentration (area under receiver operating characteristic curve = 0.696, 95% CI, 0.558-0.834).

CONCLUSION

In patients with acute coronary syndrome treated with dual antiplatelet therapy, ticagrelor concentration >694.90 ng/mL was an independent risk factor for bleeding (OR: 2.47, 95% CI, 1.51-4.75, P = 0.002), but ARC124910XX and salicylic acid concentration did not affect bleeding risk ( P > 0.05).

摘要

目的

本研究旨在评估急性冠状动脉综合征患者中替格瑞洛、ARC124910XX、阿司匹林和水杨酸的血浆浓度与近期出血风险之间的关系。为此，我们开发了一个准确的模型来预测出血。

方法

本研究共纳入 2021 年 5 月至 2021 年 11 月期间的 84 例患者。采用单因素和多因素分析确定危险因素，并将多因素分析中确定的统计学显著危险因素纳入列线图。我们使用校准曲线和接收者操作特征曲线来验证预测模型的准确性。

结果

多变量逻辑分析显示，替格瑞洛浓度（比值比 [OR]：2.47，95%置信区间 [CI]，1.51-4.75，P=0.002）、ST 段抬高型急性心肌梗死（OR：32.2，95%CI，2.37-780，P=0.016）和降脂药物（OR：11.52，95%CI，1.91-110，P=0.015）与出血呈正相关。然而，血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂（OR：0.04，95%CI，0.004-0.213，P<0.001）与出血呈负相关。接收者操作特征曲线分析显示，替格瑞洛浓度和这些因素共同预测出血的发生（接收者操作特征曲线下面积=0.945，95%CI，0.896-0.994），且替格瑞洛浓度>694.90ng/mL 是出血浓度的阈值（接收者操作特征曲线下面积=0.696，95%CI，0.558-0.834）。