摘要
目的:评价需长期抗凝治疗的患者接受冠状动脉支架置入后的抗血栓形成治疗。方法和结果:回顾性分析了2003—2004年在6家医院接受经皮冠状动脉介入术(PCI)的所有长期华法林治疗患者(n=239,平均年龄70岁,男性74%)。在研究期间选择年龄及性别相匹配且有相似临床表现(不稳定性或稳定性症状)的对照组。主要终点事件定义为12个月内的死亡、心肌梗死、靶血管血运重建或支架血栓形成。
Aim: The aim of this study was to evaluate the antithrombotic treatment adopted after coronary stenting in patients requiring long-term anticoagulation. Methods and results: We analysed retrospectively all consecutive patients on warfarin therapy(n=239, mean age 70 years, men 74% ) who underwent percutaneous coronary intervention(PCI) in 2003- 04 in six hospitals. An age- and sex-matched control group with similar disease presentation(unstable or stable symptoms) was selected from the study period. Primary endpoint was defined as the occurrence of death, myocardial infarction, target vessel revascularization, or stent thrombosis at 12 months. Warfarin treatment was an independent predictor of both primary endpoint(OR 1.7, 95% CI 1.0- 3.0, P=0.05) and major bleeding(OR 3.4, 95% CI 1.2- 9.3, P=0.02). Triple therapy with aspirin and clopidogrel was the most common(48% ) option in stented patients in warfarin group, and there was a significant(P=0.004) difference between the drug combinations in stent thrombosis with the highest(15.2% ) incidence in patients receiving warfarin plus aspirin combination. Conclusion: Our study shows that the prognosis is unsatisfactory in warfarin-treated patients irrespective of the drug combination used. Aspirin plus warfarin combination seems to be inadequate to prevent stent thrombosis.
