联合应用阿司匹林、抵克力得和肝素预防亚急性冠状动脉支架血栓形成Combination of Aspirin,Ticlopidine and Heparin in the Prevention of Subacute Stent Tbrombosis
颜红兵,马长生,王勇,柯元南
摘要(Abstract)：
目的观察阿司匹林、抵克力得和肝素预防亚急性冠状动脉支架血栓形成（SST）的有效性。方法21个月期间在50例冠心病病人成功植入53个支架。男42例，女8例，平均52．04岁。A型病变17处，B1型20处，B。型9处，C型7处。前28例于术前4小时口服阿司匹林300mg和抵克力得250mg，术当晚再服抵克力得250mg。后22例改为术前72小时，开始口眼阿司匹林300mg，每日一次和抵克力得250mg日二次。穿刺动脉成功后注射肝素1万U。注射肝素后4小时退出动脉鞘，1小时后开始静滴肝素（800～1000U／h）3天。术次日始口服抵克力得（250mg日二次）3个月和阿司匹林（300mg日一次）6个月。4例口服华法令（3mg日一次）替代抵克力得。结果2周随访期间，所有病人均无胸痛加重，且ECG缺血性改变均改善。硝酸甘油耗量明显降低。未见SST及严重出血并发症。结论联合应用阿司匹林、抵克力得和肝素抗凝对预防SST可能是一种安全和有效的方法。
关键词(KeyWords)： 血栓;冠状动脉支架;抗凝
基金项目(Foundation):
作者(Author): 颜红兵,马长生,王勇,柯元南
参考文献(References)：
- 1 Eeckhout E, Kappenberger L, GoyJ-J. Stents for intracoronary placement: current status and future directions. J AmColl Cardiol, 1996, 27: 757.
- 2 Pepine CJ, Holems DR Jr, Bfork PC, et al. Coronary arterystents. J Am Coll Cardiol, 1996, 28: 782.
- 3 Ryan TJ, Faxon DP,Gunnar RM,et al. Guidelines for percutaneous transluminal coronary angioplasty. Circuletion,1988, 78: 486.
- 4 Baim DS,Carrozza JP Jr. Stent thrombosis: closing in on thebest prevention treatment. Circulation, 1997, 95: 1098.
- 5 Moussa I, In Mario C, Reimers B, et al. Subacute stentthrombosis in the era of intravascular ultrasound-guidedcoronary stenting without anticoagulation: frequency, predictors and clinical outcome. J Am Coll Cardiol, 1997, 29: 6.
- 6 Gregorini L, Marco J, Fajadet J, et al. Ticlopidine and aspirin pretreatment reduces coagulation and platelet activation during coronary dilation proceduries. J Am con cardiol, 1997, 29: 13.
- 7 Albiero R, Hall P, Itoch A, et al. Results of a conaseutive series of patients receiving only antiplatelet therapy after optimized stent impfantation:comparison of aspirin alone versuscornbined ticlopidine and aspirin therapy. Circufation, 1997,95: 1145.
- 8 Holems DR Jr, Faxon DP. Current antiplatelet and antithrombotic medications for interventional procedures. InEllis SG, Holems DR Jr. Strategic Approaches in CoronaryIntervention. Baltimore: WiIliams & Wilkins, 1996: 663