摘要
目的探讨药物洗脱支架（DES）置入术后非急性血栓的防治，以减少DES置入术后急性心肌梗死（AMI）等事件的发生。方法选择2005年1月到2008年9月在本院置入DES的手术患者，按入院顺序随机将患者分为两组进行不同方案的抗血栓治疗。对照组患者术后应用阿司匹林联合氯吡格雷抗血小板治疗（双抗治疗）；试验组患者术后在双抗治疗基础上应用替罗非班和华法林，华法林疗程为6个月，将国际标准化比值（INR）维持在1．5～2．0。两组患者术后1。3个月随访1次，至2012年10月为止。按照美国学术联合会对支架血栓的定义判定支架血栓形成，主要终点指标为主要不良心脑血管事件（MACCE），次要终点指标为出血及不良反应。结果共入选505例患者，试验组245例，对照组260例。试验组术后1—48个月MACCE均显著低于对照组（1个月：0．41％比3．08％，2～6个月：0比231％，7～12个月：0．82％比4．23％，13—24个月：1．22％比8．85％，25～48个月：2．04％比12．31％，均P〈0．05），其中试验组心源性死亡（13～24个月：0．41％比3．08％，25～48个月：0．82％比4．23％）、与靶血管无关的非致死性AMI（25～48个月：0．41％比3．08％）、靶血管的血运重建（13～24个月：0．41％比3．08％，25～48个月：0．82％比4．23％）均较对照组明显减少（均P〈0．05）。试验组术后亚急性支架血栓形成、晚期支架血栓形成、极晚期支架血栓形成的发生率显著低于对照组（O比2．31％，0．82％比4．23％，1．63％比8．46％，均P〈0．05）。试验组轻微出血发生率略高于对照组（3．27％1：t1．54％，P=0．167），无严重出血发生。全部患者也无其他严重不良反应发生。结论DES置入术后在应用阿司匹林和氯吡格雷双抗治疗基础上，联合替罗非班及华法林，可预防支架血栓形成，降低MACCE和严重�
Objective To decrease acute myocardial infarction （AMI） and incidence of other cardiovascular event after drng-eluting stent （DES） implantation, so as to prevent non-acute stent thrombosis. Methods Patients who had undergone percutaneous coronary intervention with DES from January 2005 to September 2008 were enrolled. All patients were randomly assigned into two groups with different treatment protocols for anti-thrombosis. The patients in control group were treated with aspirin and clopidogrel for anti-thrombosis （double anti-treatment）, while those in observation group were treated with tirofiban and warfarin on top of basic treatment with double anti-thromotic drugs. The latter group of patients received warfarin in addition for 6 months, with the international normalized ratio （INR） maintained at 1.5-2.0. The patients in both groups were followed up at 1-3 months after the treatment, and the deadline was October 2012. Stent thrombosis was assessed by the definition of Dublin for Academic Research Consortium. The main ending point indexes were main adverse cardiac and cerebral events （MACCE）, and the secondary ending point indexes were incidence of bleeding and other adverse events. Results A total of 505 consecutive patients treated with DES implantation were enrolled, 245 in the observation group while 260 in the control. The rates of MACCE at 1- 48 months after operation in observational group were significantly lower than those in control group （ 1 month： 0.41% vs. 3.08%, 2-6 months： 0 vs. 2.31%, 7-12 months： 0.82% vs. 4.23%, 13-24 months： 1.22% vs. g.85%, 25- 48 months： 2.04% vs. 12.31%, all P〈0.05）. Cardiac death （13-24 months： 0.41% vs. 3.08%, 25-48 months： 0.82% vs. 4.23% ）, non-lethal acute myocardial infarction unrelated with target vessels （25-48 months： 0.41% vs. 3.08% ）, and rates of revascularization of target vessels （ 13-24 months： 0.41% vs. 3.08%, 25-48 months： 0.82% vs. 4.23%） in observation group were significantly lower than those in
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第5期285-289,共5页
Chinese Critical Care Medicine
基金
河南省郑州市技术研究与发展项目（074SGYS33201）
全国临床重点专科建设项目（2012-649）
关键词
非急性支架血栓
华法林
药物洗脱支架
不良心脑血管事件
Non-acute stent thrombosis
Warfarin
Drug-eluting stents
Main adverse cardiac and cerebral event
