静脉应用替罗非班与术前顿服负荷剂量氯吡格雷在急性期破裂动脉瘤支架辅助栓塞中的安全性和有效性

Safety and efficacy of intravenous tirofiban and loading dose of clopidogrel in stent-assisted embolization of acute ruptured aneurysms

目的评估静脉应用替罗非班与鼻饲负荷剂量氯吡格雷在急性期破裂动脉瘤支架辅助弹簧圈栓塞的安全性和有效性。方法回顾性分析2012年1月至2018年10月连续性治疗的颅内动脉瘤破裂出血病人,均急性期应用支架辅助弹簧圈栓塞动脉瘤。替罗非班组支架释放前15分钟应用替罗非班,氯吡格雷组术前2小时顿服负荷剂量氯吡格雷(300 mg)。观察分析2种抗血小板聚集药物出血和血栓栓塞事件。结果替罗非班组36例病人的38个破裂动脉瘤接受治疗。术中血栓形成2例(5.6%);术后急性脑梗塞3例(8.3%);术中动脉瘤破裂2例(5.6%);脑室钻孔引流穿刺道后期出血2例。血小板计数降低无统计学意义(P=0.136)。GOS评分≥4分30例。氯吡格雷组37例病人41个破裂动脉瘤接受治疗,术后急性脑梗塞2例(4.9%);术中动脉瘤破裂2例(4.9%),术后破裂3例(7.3%);脑室钻孔引流后期穿刺道出血1例。血小板计数明显降低(P=0.000)。GOS评分≥4分26例。结论静脉应用替罗非班在急性期破裂动脉瘤支架辅助弹簧圈栓塞过程中显示出较低的缺血及出血事件,可溶解术中新产生的血栓,可作为围手术期抗血小板聚集的替代药物。

Objective To evaluate the safety and efficacy of intravenous tirofiban and loading dose of clopidogrel in stent-assisted coil embolization of acute ruptured aneurysms.Methods A retrospective analysis was made of the patients with ruptured intracranial aneurysms treated continuously from January 2012 to October 2018.All patients were treated with stent-assisted coil embolization in acute stage.Tirofiban was injected intravenously 15 minutes before stent release in tirofiban group,and clopidogrel was given a load dose of clopidogrel(300 mg)2 hours before stent release in clopidogrel group.The hemorrhage and thromboembolism events of two kinds of antiplatelet aggregation drugs were observed and analyzed.Results Thirty-eight ruptured aneurysms of 36 patients in tirofiban group were treated.Two patients(5.6%)had new thrombosis during operation,three patients(8.3%)had acute cerebral infarction after operation,two patients'(5.6%)aneurysms had ruptured during operation,and two patients had late hemorrhage after ventricular drilling and drainage.There was no significant difference in platelet count(P=0.136).Thirty cases with GOS score(≥4).In clopidogrel group,41 ruptured aneurysms were treated in 37 patients,2 patients(4.9%)had acute cerebral infarction after operation,2 patients'(4.9%)aneurysms had ruptured during operation,3 patients'(7.3%)aneurysms had ruptured after operation,and 1 patient had puncture bleeding after ventricular drilling and drainage.Platelet count decreased significantly(P=0.000).26 cases with GOS score(≥4).Conclusion Intravenous application of tirofiban during stent-assisted coil embolization of ruptured aneurysms in acute phase showed lower ischemia and hemorrhage events.In particular,tirofiban can dissolve newly generated thrombus during operation,and can be used as an alternative drug for anti-platelet aggregation in perioperative period.