脑血管介入围手术期抗栓处理的实验室监测

Laboratory monitoring on anti-thrombotic treatment for periprocedural cerebral intervention

目的探讨脑血管介入围手术期合理抗栓用药,评价实验室监测在指导抗栓治疗中的价值。方法前瞻性地将2006年至2008年6月本中心脑血管介入手术患者随机分为A、B两个治疗组;A组患者采取围手术期经验性抗栓处理,B组患者在经验性抗栓用药过程中实验室监测活化部分凝血活酶时间(APTT)、活化凝血时间(ACT)、出血时间(BT)及血小板集聚率(PAgR),并根据监测结果调整用药。比较两组患者术前3d至术后1周内血管性并发症的发生率。结果 30个月内颈动脉支架成形术、颅内动脉支架成形术、椎动脉颅外段支架成形术、颅内宽颈动脉瘤支架辅助成形栓塞术共4种手术156例患者纳入本试验;A组86例(男63例,女23例,平均年龄55.4岁);B组70例(男46例,女24例,平均年龄59.0岁);两组患者血栓性和出血性并发症分别为A[6(6.9%);16(18.6%)]和B[4(5.7%);10(14.2%)]。结论脑血管介入围手术期经验性抗栓处理对于部分患者是不适宜的,实验室监测下的个体化抗栓用药可以使这部分患者获益。

Objective To pursue a more suitable anti-thrombotic method for periprocedural patients undergoing cerebral intervention, and evaluate the role of laboratory monitoring in anti-thrombotic treatment. Methods Patients underwent cerebral interventional procedure from January 2006 to June 2008 were ran- domly divided into group A and B respectiyely. Routine anti-platelet and anti-coagulation were administered during periprocedure to patients of group A. Laboratory monitoring including APTF, ACT, BT and PAgR were conducted and adjusted anti-thrombotic agents according laboratory data on the basis of routine treatment. Vascular complications were observed and analyzed occurred from 3 days pre and 1 week post-procedure. Results A total of 156 cases underwent carotid artery stenting（CAS） ,extra-cranial vertebral artery stenting （ ECVS）, intra-cranial artey stenting（ICAS） and intra-cranial aneurysm stent-assisted embolization（ICASE） in past 30 months were devided into group A of 86 cases （63 males and 23 females with mean age 55.4 years ） and group B of 70 cases （46 males and 24 femaley with mean age 59.0 years）. The rates of thrombot- ic and hemorrhagic complication were 6 （6.9 % ）, 16 （ 18.6% ） in group A, and 4 （5.7 % ）, 10 （ 14.2% ） in group B respectively. Conclusions Current periprocedural anti-thrombotic method seems not to be valid for all cerebral intervention cases. Setection of patients for anti-thrombotic treatment should be guided by laboratory monitoring with considering patient＇ s individual conditions.