Clinical characteristics of patients readmitted for stroke with double anti-platelet therapy after percutaneous coronary intervention

Background The clinical characteristics of stroke patients treated with double anti-platelet therapy （DAPT） after percutaneous coronary intervention （PCI） is not clear. Methods In total, 2675 patients under- went PCI and DAPT in Guangdong General Hospital, and 68 out of them were hospitalized due to suspected stroke, of whom 23 were diagnosed as having stroke. Data of the 23 stroke patients were collected and tradi- tional risk factors associated with stroke were analyzed retrospectively. Results The mean age of these pa- tients was 75.6± 8.7 years, and 20 （87.0%） were males. Notably, 19 patients were complicated with hyper- tension, 7 with diabetes mellitus, 7 with previous history of stroke, none with atrial fibrillation （AF） or patent foramen ovale （PFO）. Specifically, 22 patients were diagnosed with ischemic stroke, and 1 patient with hemorrhagic stroke. Conclusion Stroke in patients treated with DAPT after PCI was correlated with ad- vanced age, gender, hypertension, diabetes mellitus, stroke history. Long term electrocardiography （ECG） may be needed for the diagnosis of AF, while trans-esophageal echocardiography （TEE） may be needed for PFO.

冠脉介入术患者经双联抗血小板治疗发生消化道出血返院治疗的临床特点

目的探讨经皮冠脉介入术患者使用双联抗血小板治疗后因消化道出血返院诊治的临床特点。方法选取2011-2013年在广东省人民医院心内科行冠脉介入术长期双联抗血小板治疗后再次住院的患者2 675例,收集了其中28例疑似消化道出血患者的临床资料,对于其中21例确诊为消化道出血的患者使用CRUSADE出血评分系统进行出血风险危险分层,分析该21例患者消化道出血诊治的相关临床特点。结果 21例确诊消化道出血患者中,高龄患者(>60岁)14例(66.7%),男性16例(76.2%),吸烟史患者5例(23.8%),消化性溃疡病史5例(23.8%),消化道出血病史2例(9.5%),肾功能不全病史17例(81%),心功能衰竭病史18例(85.7%),幽门螺杆菌感染7例(33.3%)。使用CRUSADE出血评分系统进行出血风险评分并行危险分层,其中出血风险极高危者7例(33.3%),高危者5例(23.8%),中危者6例(28.6%)。消化道出血前曾预防性口服质子泵抑制剂6例,消化道出血后所有患者均使用质子泵抑制剂治疗。本组患者有一半以上(61.9%)在消化道出血后停用了所有抗血小板治疗药物,消化道出血控制后,约一半(52.4%)患者使用氯吡格雷继续抗血小板治疗。结论 CRUSADE评分系统可以用于经皮冠脉介入术后双联抗血小板治疗患者消化道出血风险的早期评估。抗血小板药物的停用与重新使用应根据消化道出血的严重程度、支架血栓形成的风险等综合评估。