主页 > 医学前沿 >
冠脉支架安置术后抗凝药物的使用
美国明尼苏达罗切斯特梅欧医院的James L. Orford博士指出，安放支架的经皮冠状动脉介入治疗干预（percutaneous coronary intervention，PCI）术后使用阿司匹林、氯吡格雷的双重抗血小板药物疗法目前已代替了阿司匹林和系统抗凝剂如华法林，被认为是更好的抗凝疗法。但许多病人却需要3种药联合应用。
为此，研究人员研究了放置支架的PCI术后病人在服用阿司匹林、氯吡格雷的同时应用系统抗凝剂华法林会引起什么类型和多严重的出血并发症。
研咳嗽?!-作者>对梅欧医院的PCI资料库进行了回顾性分析，确定了66名2000年1月～2002年8月连续在院内接受PCI术后离院，出院后接受双重抗血小板疗法（阿司匹林和氯吡格雷）和系统抗凝的联合治疗，来确定治疗期间出血和其他临床事件的发生率。
结果发现，6名病人有出血情况（9.2%; 95% CI, 3.5至19.0），2名病人需要输血，没有病人出现心梗或支架栓塞。
Orford博士认为，安放支架的PCI术后早期使用阿司匹林、噻吩并吡啶和华法林会增加出血的危险。
Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anticoagulation
Background
Dual antiplatelet therapy with aspirin and clopidogrel has replaced aspirin and systemic anticoagulation with warfarin as the preferred antithrombotic therapy after percutaneous coronary intervention (PCI) with stent placement. However, a number of patients have indications for all 3 drugs. We sought to determine the frequency and type of hemorrhagic complications in patients who undergo systemic anticoagulation with warfarin while receiving aspirin and clopidogrel after a PCI with stent placement.
Methods
We performed a retrospective analysis of the Mayo Clinic PCI database and identified 66 consecutive patients who were discharged from hospital after PCI between January 2000 and August 2002 (inclusive) receiving a combination of dual antiplatelet therapy (aspirin and clopidogrel) and systemic anticoagulation (warfarin) to determine the incidence of bleeding and other clinical events during the treatment period.
Results
Six patients (9.2%; 95% CI, 3.5–19.0) reported a bleeding event; 2 patients required a blood transfusion. No patient died or sustained a myocardial infarction or stent thrombosis.
Conclusions
The risk of bleeding may be increased in patients treated with aspirin, a thienopyridine, and warfarin early after PCI with stent placement.
American Heart Journal 2004, 147(3): 463-467 [标签:content1][标签:content2]
阅读本文的人还阅读：
作者:admin@医学,生命科学 2011-06-09 16:07
医学,生命科学网