冠状动脉介入治疗术后抗血小板药物治疗的现况分析

目的了解经皮冠状动脉介入治疗(PCI)术后抗血小板药物的应用是否规范,并对其可能的原因进行分析。方法对2001-07-01—2002-06-30与2003-07-01—2004-06-30两个时间段内,于首都医科大学附属北京安贞医院心内科行PCI治疗的注册研究患者进行回顾分析,研究其术后抗血小板治疗药物的种类、联合用药、药物剂量及服用时间。结果1728例患者接受了PCI治疗,其中1006例患者置入药物洗脱支架(DES组),518例置入普通金属支架(BMS组),192例患者同时置入了DES与BMS,12例患者单纯球囊扩张。术后有70例患者未继续使用任何抗血小板治疗药物。其余1658例患者使用1种或1种以上抗血小板治疗药物。进一步分析BMS组与DES组术后抗血小板药物的使用情况,术后未使用任何抗血小板药物(BMS组52例,DES组18例,P<0.001),只使用阿司匹林一种抗血小板药物(BMS组236例,DES组180例,P<0.001),只使用噻吩并吡啶类药物(BMS组45例,DSE组39例,P>0.05),使用阿司匹林加噻吩并吡啶类药物双重抗血小板治疗(BMS组350例,DES组808例,P<0.001)。结论冠状动脉介入治疗术后的抗血小板治疗有待进一步加强,提高抗血小板药物的依从性,降低PCI术后并发症的发生。

Current status of antiplatelet therapy after percutaneous coronary intervention

Objective To evaluate whether antiplatelet therapeutics after percutaneous coronary intervention(PCI)followed the recommendation of current guidelines.Methods Variety of antiplatelet drugs,duration of the antiplatelet therapeutics and combination of different variety antiplatelet drugs after PCI were collected retrospectively.Results Among 1 728 patients undergoing PCI in two intervals(July 1,2001 to June 30,2002 and July 1,2003 to June 30,2004),1 006 patients were implanted one or more drug eluting stents(DES group),and 518 patients were implanted bare metal stents(BMS group).Seventy patients did not take any antiplatelet drugs after PCI.1 658 patients took one or more than one type of antiplatelet drugs after procedures.A quarter of study administration aspirin alone,5 percent of patients with Thienopyridines(Clopidogrel or ticlopidine)only,69.8 percent of patients took combined Aspirin and Thienopyridines.There were 52 patients who didn't take any antiplatelet drug in BMS group,18 patients in DES group(P<0.001);236 patients in BMS group had Aspirin as the only antiplatelet drug while 180 patients in DES group(P<0.001),45 patients in BMS group had Thienopyridines as the only antiplatelet drug while as 39 patients in DES group(P>0.05).Combined aspirin and thienopyridines were taken in 350 patients in BMS group and 808 patients in DES group(P<0.001).Although most of patients were administrated aspirin and thienopyridines after PCI,there were about one fourth patients with aspirin only,and furthermore,there were 4 percent of patients who didn't take any antiplatelet drugs.Conclusion Antiplatelet therapy as guidelines recommended should be emphasized further after PCI.