目的:抗血小板治疗用于急性冠脉综合征(ACS)等血栓性疾病的一级和二级预防。这些患者更容易受到感染,因此,需要采取策略来减轻这些风险。
方法:我们使用TriNetX进行了一项回顾性队列研究,一个全球联合健康研究网络,包括来自世界各地卫生保健组织的住院和门诊电子病历。患者≥18岁,ACS之后,将服用阿司匹林和替格瑞洛的患者与服用阿司匹林和氯吡格雷或普拉格雷的患者进行比较.使用国际疾病和相关健康问题统计分类术语代码识别患者。在倾向得分匹配(1:1)后,每个队列中共有239,358例患者.研究的主要结果是(1)急性和亚急性感染性心内膜炎的发生率,(2)不明原因的脓毒症,(3)葡萄球菌关节炎,(4)蜂窝织炎和急性淋巴管炎,(5)金黄色葡萄球菌菌血症,和(6)开始治疗后的葡萄球菌肺炎。结果在1年、3年和5年进行分析。
结果:在5年,阿司匹林和替格瑞洛的组合,与阿司匹林和氯吡格雷或普拉格雷的组合相比,与(1)急性和亚急性心内膜炎(危险比[HR]加95%CI)的发生率显着降低相关(HR=0.85;0.77-0.945;P=0.030),(2)不明原因脓毒症(HR=0.89;95%CI,0.86-0.91;P<0.0001),(3)蜂窝织炎和急性淋巴管炎(HR=0.89;95%CI,0.87-0.92;P<0.0001;(4)金黄色葡萄球菌菌血症(HR=0.72;95%CI,0.61-0.85;P=0.0007)。然而,阿司匹林和氯吡格雷联合用药可降低葡萄球菌肺炎的风险(HR=1.04;95%CI,1.01-1.062;P<0.0001).
结论:阿司匹林和替格瑞洛的联合用药与较低的多种细菌感染率相关。这种组合值得在体外研究中进行进一步研究,以梳理机制,并通过在患有ACS且感染风险高的人群中进行临床随机试验。
OBJECTIVE: Antiplatelet therapy is used for the primary and secondary prevention of thrombotic diseases such as acute coronary syndrome (ACS). These patients are more vulnerable to infections, as such, strategies are required to mitigate these risks.
METHODS: We conducted a retrospective cohort
study using TriNetX, a global federated health research network that includes both inpatient and outpatient electronic medical records from health care organizations worldwide. Patients ≥18 years old, after ACS, who were placed on aspirin and
ticagrelor were compared with patients placed on aspirin and clopidogrel or prasugrel. Patients were identified using International Statistical Classification of Diseases and Related Health Problems terminology codes. After propensity score matching (1:1), a total of 239,358 patients were identified in each cohort. The primary outcomes of interest investigated were rates of (1) acute and subacute infective endocarditis, (2) sepsis of unknown origin, (3) staphylococcus arthritis, (4) cellulitis and acute lymphangitis, (5) Staphylococcus aureus bacteremia, and (6) staphylococcal pneumonia after initiation of treatment. Outcomes were analyzed at 1, 3, and 5 years.
RESULTS: At 5 years, a combination of aspirin and
ticagrelor, compared with a combination of aspirin and clopidogrel or prasugrel, was associated with significantly reduced rates of (1) acute and subacute endocarditis (hazard ratio [HR] plus 95% CI) (HR = 0.85; 0.77-0.945; P = 0.030), (2) sepsis of unknown origin (HR = 0.89; 95% CI, 0.86-0.91; P < 0.0001), (3) cellulitis and acute lymphangitis (HR = 0.89; 95% CI, 0.87-0.92; P < 0.0001, and (4) Staphylococcus aureus bacteremia (HR = 0.72; 95% CI, 0.61-0.85; P = 0.0007). However, a combination of aspirin and clopidogrel was associated with a marinally lower risk of staphylococcal pneumonia (HR = 1.04; 95% CI, 1.01-1.062; P < 0.0001).
CONCLUSIONS: A combination of aspirin and
ticagrelor is associated with a lower rate of a variety of bacterial infections. This combination warrants further investigation in in-vitro studies to tease out mechanisms and through clinical randomized trials in groups who have ACS and are at high infection risk.