替罗非班应用在药物涂层支架植入术后老年患者实行非心脏手术的可行性和安全性

A preliminary feasibility and safety study of Tirofiban application of drug-eluting stent implantation in patients with non-cardiac surgery

目的:明确替罗非班是否可以在药物涂层支架植入老年患者实行非心脏手术围手术期替代口服双联抗血小板药物而发挥预防支架内血栓的作用,同时不增加外科手术的出血。方法:入选入院前1年内曾因冠心病植入药物涂层支架服用双联抗血小板药物而后无缺血性胸痛症状,因外科疾病保守治疗无效需手术治疗的12例患者配对分组,手术前5d停用口服双联抗血小板药物,治疗组6例患者应用替罗非班0.1μg/(kg·min)持续静脉微量泵泵入,对照组6例患者应用低分子肝素依诺肝素1mg/kg皮下注射(每天2次),手术结束后在重症监护室中继续术前应用方法,根据外科情况允许,停用替罗非班及低分子肝素,尽早恢复口服双联抗血小板药物使用,分析围手术期两组新发心血管事件以及严重出血事件。结果:两组患者围手术期均未发生缺血性室性恶性心律失常、心绞痛、心肌梗死、心源性猝死,未发生大量出血而导致输血或需二次手术止血等出血事件。结论:替罗非班应用在药物涂层支架植入术后患者实行非心脏手术替代口服双联抗血小板药物预防围手术期支架内血栓的治疗作用不亚于低分子肝素,没有严重的出血并发症,而且有半衰期短的特点,其优势需要大样本随机对照试验以进一步证实。

Objective To identify whether tirofiban in the implementation of drug-eluting stent implantation in older patients with non-cardiac surgery perioperative alternative to oral anti-platelet drugs double play a preventive role of stent thrombosis, without increasing surgical bleeding. Methods Selected 12 patients within 1 year before admission who have drug-eluting stent implantation in coronary heart disease taking dual antiplatelet drugs without ischemic chest pain, and require surgical treatment due to failure of conservative treatment, 5 days before surgery stop oral dual antiplatelet drugs, 6 patients treated with tirofiban 0.1μg/（kg-min） continuous intravenous infusion micro pump, in the control group 6 patients with low molecular weight heparin enoxaparin lmg/kg IH Q12H, preoperative method continue after surgery in the intensive care unit , according to surgical conditions stop using tirofiban and low molecular weight heparin,, and take oral dual antiplatelet drug use as early as possible, Analysis of new perioperative cardiovascular events, and serious bleeding. Results Two groups of patients in the perioperative period did not occur neither malignant ischemic ventricular arrhythmia, angina peetoris, myocardial infarction, sudden cardiac death, nor massive bleeding requiring blood transfusion or secondary surgery to stop bleeding. Conclusion tirofiban used in the drug-eluting stent implantation in patients with non-cardiac surgery, an alternative implementation of dual oral antiplatelet drugs to prevent perioperative stent thrombosis has the same effect as much as the treatment of low molecular weight heparin with no serious bleeding complications and short half-life, and its advantages need a large randomized controlled trials to further confirm.