A Study Of The Standardized Treatment Status And Influences Of Antiplatelet Drugs In The Elderly Patients

BackgroundIschemic cardiac-cerebral vascular diseases (CCVD), especially coronary heart disease and ischemic stroke, are one of the leading causes of death among the elderly patients worldwide. While thrombosis formation serves as the crucial part in the onset and development of CCVD, antiplatelet agents, which could inhibit platelet activation and restrain thrombosis, are the cornerstone of prevention and treatment of coronary heart disease and other ischemic diseases. Although antiplatelet treatment has been proven to be beneficial in most researches, the incidences of cardiovascular disease associated with thrombosis remain high. Besides, improved efficacy could be offset by an increased potential risk of bleeding, sometimes fatal bleeding. Thus, it is imperative to have a detailed investigation and to standardize the application of antiplatelet therapy in order to get optimal therapeutic outcomes practically.ObjectiveThe objectives of this study were to describe the application status of antiplatelet drugs among the elderly patients in our hospital, evaluate the standardized treatment status, and to identify the influences of antiplatelet drugs.Methods2771 patients were enrolled in this retrospective study. All cases were hospitalized in the geriatric departments in Chinese PLA General Hospital from January 2014 to April 2016. The information involving general conditions, diseases, laboratory examinations and pharmacotherapy were collected. The participants were firstly divided into four groups based on the type of antiplatelet agents administered and then were divided into two groups according to the status of standardization.Results1. (1) A total of 2221 patients were under aspirin treatment, accounting for 80.2% of 2771 patients. Of which, there were 648 cases, accounting for 23.4%, using aspirin alone. (2) Utilization rate of aspirin in patients with coronary heart disease and ischemic cerebrovascular disease were 83.3%.67.6% respectively. (3) Patients with smoking or drinking history,obesity, diagnosed as coronary heart disease, ischemic stroke, vertebrobasilar insufficiency, hypertension, hyperlipidemia, were prone to receive aspirin treatment. While patients over 75 years old, acomplicated with peptic ulcer, chronic kidney disease, anemia, were not prone to receive aspirin treatment.2. (1) A total of 1965 patients were under clopidogrel treatment, accounting for 70.9% of 2771 patients. Of which, there were 407 cases, accounting for 14.7%, using clopidogrel alone. (2) Utilization rate of clopidogrel in patients with coronary heart disease and ischemic cerebrovascular disease were 78.5%,43.5% respectively. (3) Patients with smoking history, or diagnosed with coronary heart disease, hypertension, hyperlipidemia, chronic kidney disease, were also likely to receive clopidogrel treatment. While patients over 75 years old, alcohol drinking history, diagnosed as ischemic stroke, vertebrobasilar insufficiency, complicated with peptic ulcer, anemia were not.3. (1) A total of 1030 patients were under dual antiplatelet therapy (aspirin combined with clopidogrel), accounting for 76.7% of the patients with acute cardiac-cerebral vascular disease. (2) Utilization rate of dual antiplatelet therapy in patients with coronary heart disease and ischemic cerebrovascular disease were 82.6%,53.1% respectively. (3) Patients during acute period, diagnosed as coronary heart disease, hyperlipidemia, undertaken arterial interventional treatment, were more likely to receive dual antiplatelet therapy. While elderly patients, female, alcohol drinking, diagnosed as stable angina, ischemic stroke, peptic ulcer, serious bleeding tendency were not.4. (1) A total of 2305 patients were under standardized antiplatelet therapy, accounting for 83.2% of 2771 patients. While, there were 466 cases, accounting for 16.8%, were under unstandardized antiplatelet treatments. (2) Patients with smoking history, diagnosed as coronary heart disease, diabetes were inclined to receive regular standardized antiplatelet treatment. However, patients over 75 years old, diagnosed as peripheral atherosclerosis, undertaken arterial interventional treatment, were overlooked in standardized antiplatelet therapy.Conclusions1. The overall ratio of antiplatelet therapy was higher among the elderly patients hospitalized in PLA General Hospital. Aspirin and clopidogrel remained the dominating agents of antiplatelet therapy. It was slightly lower of the ratio than that in previous researches.2. The utilization rate of aspirin (including single and dual use) was higher than clopidogrel in patients with Coronary heart diseases or ischemic cerebrovascular diseases.3. Acute coronary syndrome, post-PCI and acute ischemic cerebrovascular diseases were the main reasons of application of dual antiplatelet therapy. Patients with acute cardiovascular disease were more likely to receive dual antiplatelet drugs than patients with acute ischemic cerebrovascular disease.4. There were 83.2% of elderly patients hospitalized in PLA General Hospital had gotten standardized antiplatelet therapy, while 16.8% hadn't.5. Lots of factors influenced the standardized application of antiplatelet agents among elderly patients. Advanced age, digestive diseases, chronic kidney diseases, interventional therapy, and bleeding risk were the most common ones among them.