冠脉内支架安置术后抗凝与抗血小板治疗的探讨

Anticoagulatic and antiplatelet therapy after PTCA and stenting

我院从 1995年 1月～ 1998年 4月共为 70例冠心病病人安置冠脉支架 (PTCA基础上 ) 94个。男性 6 2例 ,女性 8例 ,年龄 5 4 2岁 (37～ 72岁 )。诊断 :急性心肌梗死 15例 (梗后 3～ 4周安置 ) ,亚急性心肌梗死 9例 ,陈旧性心肌梗死 11例 ,伴不稳定性心绞痛 31例 ,稳定性心绞痛 11例。术前心前区剧痛者 18例 ,中度痛者 38例 ,轻痛者 8例 ,胸闷不适 6例。支架安放的冠脉LAD 5 7支 ,RCA 2 8支 ,LCX 9支。支架种类 :Cordis 17个 ,Cook 16个 ,Nil 11个 ,Wirktor 11个 ,Crooflex 10个 ,J&J 8个 ,GR Ⅱ 7个 ,Pongrogh 6个 ,Bestent 4个 ,其他 4个。术前口服阿司匹林、术后除口服阿司匹林2 5 0mg 2次 /d ,静滴或皮下注射肝素 10 0～ 2 0 0mg外 ,1995年10月以前服华法林 2～ 3mg/d ,1995年 10月后服力抗栓2 5 0mg 2次 /d 1～ 2月。术前后观测心电图与凝血时间、出血时间均无特殊变化。术后疼痛消失 45例 (6 4 3% ) ,减轻2 0例 (2 8 5 % ) ,无变化 4例 (5 7% ) ,死亡 (术中导管穿孔、心包填塞 ) 1例。心电图缺血恢复正常 33例 (4 7 1% ) ,改善 2 5例 (35 7% ) ,无变化 11例 (15 8% ) ,心电机械分离 1例(1 4% )。术后出血并发症 6例 (8 6 % ) ,用华法林组 2 / 13例(15 4% ) ,主要为穿刺点血肿、淤斑 。

Objective To evaluate the safety and efficacy of anticoagulatic and antiplatelet therapy after PTCA and stenting. Methods 94 stents had been plauted in 70 cases underwent PTCA. After operation, the patient in early group was treated with Aspirine 250 mg Bid and wafarine 2～3 mg QD; The patient in late group was treated with Aspirine 250 mg Bid and Ticlopidine 250 mg Bid.Results During 3 year follow up, 7 cases had neappeared angina pectoris and their coronary angiography demonstrated artery stenosis with 70%～99%, 1 case was in wafarine group, other 6 cases was in Ticlopidine group. Post PTCA hemorrage complications were observed in 6 cases, 2 cases (2/13, 15.4%) were in wafarine group and 4 cases (4/57,7%) in Ticlopidine group.Conclusion The hemorrage complication in Ticlopidine after PTCA and stenting was less than in wafarine.