| Objective:After percutaneous coronary intervention,aspirin combined with P2Y12 receptor inhibitor is the standard method to prevent in stent thrombosis.However,antiplatelet drugs are a double-edged sword,which can inhibit platelet activation and prevent thrombosis while increasing the risk of bleeding,the most common of which is gastrointestinal bleeding.In recent years,with the continuous development of stent technology and antiplatelet drugs,in order to reduce the adverse effects caused by the risk of bleeding,a number of "step-down treatment" studies have been successfully carried out in clinical practice,including shortening the course of dual anti platelet therapy,reducing the dose,single drug therapy,etc.,which provides a new direction for antiplatelet therapy.A number of clinical trials have confirmed that stopping aspirin as soon as possible after short-term dual antibody(1-3 months)is an effective and safe treatment strategy.However,these clinical trials have not specifically studied the best antiplatelet medication scheme for the high bleeding risk population with peptic ulcer.Currently,antiplatelet therapy combined with proton pump inhibitors is recommended in the guidelines for high-risk patients with gastrointestinal injury.The purpose of this study is to compare the efficacy and safety of different duration of dual antibody in patients with peptic ulcer undergoing percutaneous coronary intervention,and to explore whether shortening the duration of dual antibody is better than the traditional treatment without increasing the risk of ischemia,so as to provide the basis for individualized medication.Methods:Patients with NSTE-ACS who underwent PCI in Liaoning Provincial People’s hospital from September 2018 to February 2020 were selected.All patients were diagnosed as peptic ulcer by gastroscopy within 2 years.At present,there is no active gastrointestinal bleeding(fecal occult blood test is negative).They were randomly divided into experimental group and control group.The patients were given aspirin 300 mg and ticagrelor 180 mg loading dose before operation.The patients in the experimental group were given aspirin(100mg,once a day)combined with ticagrelor(90mg,twice a day)dual antibody treatment after operation.After 3 months,the patients in the control group were given aspirin(100mg,once a day)combined with ticagrelor(90mg,twice a day)Rilol(90mg,twice a day)was given conventional double antibody treatment for 12 months.Both groups were treated with rabeprazole for 12 months.The inhibition rate of platelet aggregation induced by AA and ADP in the two groups before discharge and 12 months after operation was compared;the incidence of bleeding events defined by TIMI in the two groups during hospitalization and 12 months after operation was compared;the incidence of major cardiovascular adverse events(including all-cause death,recurrent angina pectoris,acute myocardial infarction and ischemic stroke)in the two groups during hospitalization and 12 months after operation was compared;The incidence of upper gastrointestinal adverse reactions(including nausea or vomiting,abdominal distension or pain,acid regurgitation,heartburn,Hiccup)and ulcer healing were compared between the two groups 12 months after operation.Results:In this study,192 patients(33-75 years old,mean age 61.19±8.17,male 141)were selected,95 patients in the experimental group and 97 patients in the control group.The results showed that: 1.There was no significant difference in the baseline data between the two groups,including gender,age,BMI,smoking history,hypertension history,diabetes history,hyperlipidemia history,hemoglobin,left ventricular ejection fraction,target lesion type,number of stents,and the proportion of intraoperative antithrombotic drugs(heparin,bivalirudin or tirofiban).2.There was no significant difference in the proportion of patients with TIMI grade 3 blood flow between the two groups(94.7% in the experimental group and 96.9% in the control group,P = 0.495).3.There was no significant difference in the inhibition rate of platelet aggregation induced by AA and ADP between the two groups(AA: 83.73 ± 12.51% vs.84.15 ± 11.74%,P = 0.813;ADP: 65.76 ± 19.25% vs.69.33 ± 19.36%,P = 0.202);There was no significant difference in the inhibition rate of platelet aggregation induced by AA and ADP between the experimental group and the control group at 12 months after operation(AA: 83.39 ± 12.34% vs.85.98 ± 9.43%,P = 0.104;ADP: 75.45 ± 14.75% vs.77.75 ± 15.27%,P = 0.290).4.There were two cases of slight bleeding defined by TIMI in the two groups during hospitalization(2.1% in the experimental group and 2.1% in the control group,P = 1.000),there was no significant difference;the incidence of bleeding events defined by TIMI in the experimental group and the control group was5.3% and 9.3%,P = 0.285,respectively,12 months after operation,there was no significant difference.5.There was no significant difference in the incidence of mace events between the two groups during hospitalization(1.1% vs.1.0%,P = 1.000),including 1 case of recurrent angina pectoris in the experimental group and 1 case of ischemic stroke in the control group;there was no significant difference in the incidence of major cardiovascular adverse events between the two groups 12 months after operation(8.4% in the experimental group and 5.2% in the control group,P =0.368).6.The incidence of upper gastrointestinal adverse reactions in the two groups12 months after operation was significantly lower in the short-term double antibody group than in the conventional double antibody group(12.6% in the experimental group and 24.7% in the control group,P = 0.032).7.A total of 85 patients were reexamined 12 months after operation,including 39 patients in the experimental group and 46 patients in the control group(41.1% vs.47.4%,P = 0.374).In endoscopic staging of ulcer,the proportion of patients in active phase in the experimental group was significantly lower than that in the control group(15.4% vs.34.8%,P = 0.042),the difference was statistically significant;there was no significant difference in the proportion of patients in healing phase between the two groups;the proportion of patients in scar phase in the experimental group was significantly higher than that in the control group(71.8% vs.50.0%,P = 0.041),the difference was statistically significant.Conclusion: 1.Compared with conventional 12-month dapt,the inhibition rates of platelet aggregation induced by AA and ADP were similar before discharge and 12 months after operation.2.The incidence of TIMI defined bleeding events in short course dapt group was lower than that in conventional double antibody group,but it did not reach statistical significance.3.There was no significant difference in the incidence of major adverse cardiovascular events between short course dapt group and conventional dapt group.4.The incidence of adverse reactions of upper digestive tract in dapt group was lower,which was more conducive to ulcer healing. |
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