Clinic Value Of Different Antiplatelet Therapy Policies In Preventing And Treating Cardiovascular Events In Elderly Patients With Coronary Heart Disease

Objective To analyze the clinic value of different antiplatelet therapy policies in preventing and treating main cardiovascular events(MACE) and bleeding events in elderly patients with coronary heart disease(CHD).Methods The patients were chosen from April 1,2010 to June 30,2014 with 3579 cases. According to inclusion criteria, exclusion criteria and follow-up time, 1023 cases of elderly patients with coronary heart disease were divided into three groups, including clopidogrel combined aspirin therapy group(group A, n=703, men 470,women 233, average age 67.1±8.7 yrs), clopidogrel group(group B, n=211,men 109,women 102,average age68.6±8.7 yrs) and aspirin group(group C, n=109,men 68,women 41,average age66.9±8.4 yrs). Each group received the corresponding antiplatelet therapy for 1 year follow-up period, the MACE rates and bleeding events wereaa analyzed at 1 month, 6 months and 1 year follow-up time. Meanwhile the relationships between MACE and medication condition, age, hypertension, diabetes, severity of disease were analyzed.Results A total of 1023 patients were successfully followed up one year time. The CHD patients receiving dual antiplatelet therapy, clopidogrel therapy and aspirin therapy accounted for 68.7%, 20.6%and 10.7% respectively. Compared to clopidogrel or aspirin therapy group, the incidence rate of MACE was reduced significantly in patients with dual antiplatelet therapy in 1 month,6 months and 1 year( 1 month :9.1%,14.6%,16.5% P<0.05;6 months:16.6%,25.5%,29.4% P<0.05;1 year:28.4%,37.9%,34.0% P<0.05). The incidence rate of MACE in clopidogrel therapy group was lower than that in the aspirin group at 1 month and 6 months follow up but without significant difference(P>0.05). At 1 year follow up, the incidence rate of MACE in clopidogrel therapy group was higher than that in the aspirin group, but the difference was not statistically significant(P>0.05).There were no significant differences in total incidence of deaths,the recurrence rate of myocardial infarction and stent restenosis rate among the three groups(P>0.05). The incidence of angina in the dual antiplatelet group was lower significantly than that in the clopidogrel or aspirin therapy group(P<0.05),but When the treatment time was extended to 1 year, there was no significant difference in the incidence of angina among the three groups( P > 0.05). The incidence of gastrointestinal bleeding in the dual antiplatelet group was slightly higher than that in the clopidogrel and aspirin group followed up time to 1 year(4.3%, 2.4%, 3.6%), but the difference was not statistically significant(P>0.05).Conclusions In the CHD patients receiving aspirin and clopidogrel dual antiplatelet therapy, the incidence of MACE was lower than that in patients with aspirin or clopidogrel treatment alone, especially a reduction in the incidence of angina, and without increase of the risks in the gastrointestinal bleeding events, but the advantages above waning as treatment time extended to 1 year.