培训课件-抗血小板药物 2.ppt

* 一项关于40,812 例心梗患者经抗栓治疗后出血风险的研究表明：联用抗凝药物和抗血小板药物的出血风险最大，单独使用阿司匹林发生出血事件的几率最低，仅2.6%。阿司匹林的出血风险明显低于其他抗栓药物。 Methods:?The authors used nationwide registries from Denmark to identify patients ages 30 years or older who had been admitted to the hospital with first-time myocardial infarction between 2000 and 2005. Prescription claims starting at hospital discharge were used to determine the regimen prescribed according to the following groups: monotherapy with aspirin, clopidogrel, or vitamin K antagonist; dual therapy with aspirin plus clopidogrel, aspirin plus vitamin K antagonist, or clopidogrel plus vitamin K antagonist; or triple therapy including all three drugs. Patients could be in only one group at a time, although they could change groups as medications were started or stopped. Risk of hospital admission for bleeding, recurrent myocardial infarction, and death were assessed by Cox proportional hazards models with the drug exposure groups as time-varying covariates. Use of this model implies that patients were only deemed at risk for each exposure group while taking the corresponding antithrombotic drug(s). Results:?The total cohort was comprised of 40,812 patients. During a mean follow-up of 476 days, 1,852 (4.5%) patients required hospitalization for a nonfatal bleeding event. The annual incidence of bleeding was 2.6% for the aspirin group, 4.6% for clopidogrel, 4.3% for vitamin K antagonist, 3.7% for aspirin plus clopidogrel, 5.1% for aspirin plus vitamin K antagonist, 12.3% for clopidogrel plus vitamin K antagonist, and 12.0% for triple therapy. After adjusting for baseline differences, and using the aspirin group as a reference, adjusted hazard ratios for bleeding were 1.33 (95% confidence interval [CI], 1.11-1.59) for clopidogrel, 1.23 (95% CI, 0.94-1.61) for vitamin K antagonist, 1.47 (95% CI, 1.28-1.69) for aspirin plus clopidogrel, 1.84 (95% CI, 1.51-2.23) for aspirin plus vitamin K antagonist, 3.52 (95% CI, 2.42-5.11) for clopidogrel plus vitamin K antagon