Analysis Of The Related Factors Of Bleeding In The Application Of Triple Antiplatelet Drugs On Patients With Acute St-segment Elevation Myocardial Infarction

OBJECTIVE:The cornerstone of STEMI treatment is a prompt and effective antithrombotic therapy,and the improvement of the immediate reperfusion therapy is the key for the prognosis and for reducing the mortality of the STEMI patients.Primary percutaneous coronary intervention(PPCI)is the preferred and most effective reperfusion therapy for patients with STEMI.With the aim of reducing the thrombus burden of infarction related artery(IRA)and preventing or mitigating the effects of no-reflow,platelet glycoprotein IIb / IIIa(GPIIb / IIIa)receptor antagonist is often needed on the basis of dual antiplatelet drug therapy.Currently,most study are concentrated on the efficacy of different combination with triple antiplatelet drugs,major adverse cardiovascular events(MACE)and prognosis of patients,while researches on the risk factor of bleeding events are less,which are mostly on related factors of bleeding events occur during the aspirin,clopidogrel,tirofiban combined triple antiplatelet therapy.And there are comparatively less researches on the bleeding event incidence of aspirin,ticagrelor,tirofiban combine in the triple antiplatelet drugs treatment.This study are focus on bleeding risk factors analysis in the patients treated with triple antiplatelet drugs combination with ticagrelor,to help clinical drug selection.Methods: This study reviewed the clinical data of 84 patients with acute ST-segment elevation myocardial infarction undergoing emergency PCI and treated with triple antiplatelet drugs,enrolled in Hebei Province People’s Hospital from September 2016 to February 2018.All patients were divided into hemorrhage group 30 cases and non-hemorrhage group 54 cases.The general conditions,coronary angiography,PCI operation,auxiliary examination and medication of patients were compared between two groups to analyze the risk bleeding factors.Multivariate logistic regression analysis was used to show the independent risk factors for the possible influencing factors of P <0.05 included in the univariate analysis.All data were analyzed by using SPSS 21.0 software,P <0.05 statistically significant difference.Result:1.The comparison of two groups of clinical data showed significant statistical differences in platelet count,alanine aminotransferase,fibrinogen,troponin T > 2000 ng / L,the use of angiotensin inhibitor or angiotensin receptor inhibitor(ACEI / ARB).2.Multivariate Logistic regression analysis showed that troponin T> 2000 ng / L(OR = 4.666;95% CI: 1.122-19.404;P <0.05).fibrinogen(OR = 2.117;95% CI: 1.091-4.108;P <0.05)was an independent risk factor for bleeding in patients with acute ST-segment elevation myocardial infarction treated with triple antiplatelet agents.Conclusion:1.During the hospitalization period STEMI of patients,The application of aspirin,ticagrelor,tirofiban triple antiplatelet drugs treatment is relatively safety.2.During the hospitalization period STEMI of patients,the occurrence of bleeding events are mostly mild bleeding,fatal bleeding events occured in low incidence.3.Fibrinogen,Troponin T > 2000 ng / L are the independent risk factors of bleeding events for STEMI patients who taking aspirin,ticagrelor,tirofiban triple antiplatelet drugs.