髂静脉受压综合征患者支架植入术后抗血小板与抗凝治疗效果比较

Comparison of antiplatelet and anticoagulant therapy in patients with iliac vein compression syndrome after stent implantation

目的比较抗血小板治疗与抗凝治疗对髂静脉受压综合征(IVCS)患者支架植入术后预防血栓形成的效果。方法选取2015年1月至2018年12月浙江省台州医院收治的因IVCS行支架植入术的患者326例。其中145例患者术后采用抗凝药物预防血栓(抗凝组),181例患者采用抗血小板药物预防血栓(抗血小板组)。抗血小板组患者术后口服阿司匹林联合氯吡格雷治疗,抗凝组患者术后口服华法林治疗。比较两组患者手术前及术后1、3、6个月血常规、血生化等指标,以及术后出血、支架内血栓形成情况。结果两组患者手术前及术后1、3、6个月ALT、AST、RBC、红细胞压积、Hb、白蛋白比较差异均无统计学意义(均P>0.05)。两组患者术后出血发生率、支架内血栓形成发生率比较差异均无统计学意义(7.18%比5.52%、2.75%比2.76%,均P>0.05)。但抗凝组患者术后1、3、6个月服用华法林国际标准化比值(INR)达标率分别为25.5%(37/145)、39.3%(57/145)、45.5%(65/145),术后INR达标率较低,出血或支架内血栓形成的风险较大,不容忽视。结论IVCS患者支架植入术后采用抗血小板治疗预防血栓可以达到与抗凝治疗相当的效果,且不增加患者的出血风险。

Objective To compare the effect of antiplatelet therapy and anticoagulant therapy on prevention of thrombosis in patients with iliac vein compression syndrome(IVCS)after stent implantation.Methods From January 2015 to December 2018,326 patients with IVCS undergoing stent implantation in Taizhou Hospital of Zhejiang Province were enrolled,including 145 patients treated with anticoagulant drugs(anticoagulant group),and 181 patients treated with antiplatelet drugs(antiplatelet group)to prevent thrombosis.The patients in the antiplatelet group were treated with aspirin combined with clopidogrel,and the patients in the anticoagulant group were treated with warfarin.The blood routine,blood biochemical indexes,postoperative bleeding and stent thrombosis were compared between the two groups at 1,3 and 6 months after operation.The related indexes of the two groups before and after operation were analyzed.Results There were no significant differences in alanine aminotransferase,aspartate aminotransferase,erythrocyte,hematocrit,hemoglobin and albumin between the two groups at 1,3 and 6 months after operation(all P>0.05).There was no significant difference in the incidence of postoperative bleeding and stent thrombosis between the two groups(7.18%vs.5.52%,2.75%vs.2.76%,P>0.05).But in anticoagulant group,the INR compliance rate of warfarin was 25.5%(37/145),39.3%(57/145)and 45.5%(65/145)at 1,3 and 6 months after operation,respectively.Conclusion Antiplatelet therapy in IVCS patients after stent implantation can achieve the same effect as anticoagulant therapy,and does not increase the risk of bleeding.