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A Comparative Study in the Very Old Patients Treated with Different Antiplatelet Agents

Author: LiKaiLiang
Tutor: SiQuanJin
School: PLA Postgraduate Medical School
Course: Elderly cardiovascular medicine
Keywords: Advanced age Aspirin Clopidogrel Resistance Adverse reactions
CLC: R541.4
Type: Master's thesis
Year: 2011
Downloads: 72
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Abstract


Background: the elderly, especially the oldest old is a high-risk population of ischemic cardiovascular and cerebrovascular disease, the current evidence-based medical research shows that the reasonable application of anti-platelet drugs can significantly reduce the incidence of cardiac events in elderly, therefore antiplatelet The drug has become a cornerstone of cardio-cerebral vascular disease prevention indispensable and alternative. Aspirin and clopidogrel in the primary and secondary prevention of coronary heart disease, is the most widely used two antiplatelet drugs in the general population, there are many large-scale clinical trials show that the use of aspirin and clopidogrel is necessary reasonable application dose and adverse reactions, but for Senile antiplatelet therapy, clinical evidence based medicine is not yet too much. Senile due to their special physiological and metabolic state, more prone to adverse drug reactions or difficult to achieve the desired drug efficacy, so that the crowd choose a safe and effective antiplatelet regimen is very important. Objective: A Comparative Study of Advanced Age in patients with coronary heart disease the application of different types of anti-platelet drug efficacy, adverse reactions and drug interactions between to explore best suitable for the crowd antiplatelet drug treatment programs and reduce the incidence of adverse reactions of possible measures for the The clinical use of drugs to provide evidence based medicine. Methods: 263 cases of senior citizens over the age of 75 elderly patients with coronary heart disease, eliminate blood diseases, liver function abnormalities in patients with active peptic ulcer, acute trauma and a history of bleeding within two weeks, no previous relevant experimental drug allergy history. The subjects were randomly divided into Aspirin group (Aspirin 100mg / d), gastric mucosal protective agent group (Aspirin 100mg / d marzulene 0.67 g / d) in Aspirin, Plavix group (clopidogrel 75mg / d) Techno group (Taijia 50 mg / d), Aspirin Plavix group (Aspirin 100mg / d clopidogrel the dimension 75mg / d), and the clopidogrel-dimensional proton pump inhibitor group and the control group (Compound Danshen the dripping pills 270mg3 / d). Experimental medication time for more than 16 weeks, the subjects before the experiment and 2 weeks after the start of the experiment blood pumping blood routine, arachidonic acid and ADP as an inducer of platelet aggregation rate (PAG) detecting, clotting five check indicators before the experiment, and 16 weeks after the start of the experimental line electronic gastroscopy for gastric mucosal damage. Results: ① baseline age, sex distribution, underlying diseases, such as comparable among the experimental group. Compared with the control group, each observation group for all types of anti-platelet drugs have the exact inhibition of platelet aggregation (P lt; 0.05). The ③ antiplatelet effect analysis showed that Plavix, Aspirin combined treatment group was superior to the rest of the group, however, and the aspirin alone group or single Plavix group showed no significant difference. ④ with the control group and the aspirin gastric mucosal protective agent group, the incidence of gastric mucosal injury in the aspirin group tended to increase, but the statistical analysis no significant differences between the groups. ⑤ dimensional proton pump inhibitors clopidogrel group platelet inhibition compared with Plavix group no significant difference. ⑥ all observed group before and after treatment, the clotting five and routine blood there was no significant difference. ⑦ All patients had not to appear the platelets significantly reduce the phenomenon. Conclusion: ① in elderly elderly population, alone, aspirin, clopidogrel, or their combination have the exact role of anti-platelet aggregation, and the use is safe and effective in the crowd. The ② aspirin and Plavix drug combination can inhibit platelet aggregation from different sources, comprehensive, and adverse reactions does not increase than aspirin alone. ③ 50mg the Taijia and 75mg Plavix can obtain similar antiplatelet efficacy, safety. (4) in the oldest-old group, Aspirin and gastric mucosal protective agents to reduce gastric mucosal injury needs further study. Similarly, clopidogrel dimensional proton pump inhibitor group security is good in Taijia group or Plavix group also remains to be seen . (5) proton pump inhibitors does not diminish the efficacy of antiplatelet Plavix. ⑥ aspirin and clopidogrel did not occur to the number of elderly patients with platelet significant impact. The ⑦ elderly elderly patients with aspirin resistance and clopidogrel resistance similar incidence with domestic and foreign literature.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Coronary arteries ( atherosclerosis ),heart disease (CHD)
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