冠心病支架术后行非心脏手术围手术期的抗栓治疗

Antithrombotic treatment for patients during perioperative period of non-cardiac surgery after intracoronary stent implantation

目的探讨冠心病药物涂层支架置入患者行非心脏手术围手术期的抗栓治疗策略。方法选择2010年1月至2013年6月,因冠心病置入药物涂层支架服用双联抗血小板药物期间因外科疾病需手术治疗的16例患者,术前3～5 d停用双联抗血小板药物,应用替罗非班0.1μg/(kg.min)持续泵入,术前8 h停用替罗非班,外科手术后若无明显出血情况,在术后24～48 h恢复氯吡格雷、阿司匹林双联抗血小板治疗。观察围手术期及3个月随访期主要心血管事件以及出血事件的发生情况。结果 16例患者围手术期未发生心血管事件,未发生大出血事件,发生轻微出血2例。结论药物涂层支架置入术后近期行非心脏手术患者围手术期应用血小板表面糖蛋白Ⅱb/Ⅲa受体拮抗剂替代双联抗血小板药物是有效和安全的。但本研究的例数偏少。

Objective To discuss the antithrombotic therapeutic strategy for patients during perioperative period of non-cardiac surgery after drug-eluting stent implantation. Methods The patients （n=16） with drug-iluting stent implantation due to coronary heart disease and needed surgery because external diseases during the period of taking dual antiplatelet drugs were chosen from Jan. 2010 to Jun. 2013. Before the surgery for 3 to 5 d, dual antiplatelet drugs were substituted by tirofiban （0.1μg/kg·min） continuously, and 8 h before surgery, tirofiban was stopped. When there was no severe bleeding after the surgery, the dual antiplatelet treatment with tirofiban and aspirin was used again 24 h to 48 h after the surgery. The incidence of major adverse cardiovascular events （MACE） and bleeding events were observed during perioperative period and 3-month follow-up period. Results All 16 patients had no MACE and massive bleeding events, and only 2 had mild bleeding. Conclusion It is effective and safe that platelet receptor antagonists IIb/IIIa instead of dual antiplatelet drugs in the patients during perioperative period of non-cardiac surgery after drug-eluting stent implantation. Because of the cases are less in this study, more large-scale randomized controlled studies are required.