复杂冠状动脉病变介入治疗后应用替罗非班预防急性支架血栓的疗效及安全性

目的观察替罗非班预防复杂冠状动脉病变患者介入治疗后急性、亚急性支架血栓的疗效,以及评价其安全性。方法将2008年1月至2012年12月在高州市人民医院住院的200例冠状动脉粥样硬化性心脏病(冠心病)复杂冠状动脉病变介入治疗后患者按随机数字表法随机分为2组:治疗组100例,在阿司匹林、氯吡格雷常规基础上予替罗非班负荷量,后维持量24 h;对照组100例,在阿司匹林、氯吡格雷常规基础上,术后用低分子肝素抗凝治疗3 d。观察两组支架血栓及出血并发症。结果治疗组冠状动脉病变中B2、C型病变分别为63例、37例,对照组为70例、30例。治疗组与对照组植入支架的数量及植入支架的总长度比较,差异均无统计学意义(3.1±1.3)枚vs.(2.9±1.2)枚,P>0.05;(32.4±13.8)mm vs.(33.2±12.7)mm,P>0.05]。治疗组急性支架血栓形成低于对照组,差异有统计学了意义2%(2/100)vs.7%(7/100),χ2=45.82,P<0.05]。两组出血并发症的发生率比较,差异无统计学意义12%(12/100)vs.9%(9/100),χ2=5.18,P>0.05]。结论复杂冠状动脉病变患者PCI治疗后使用替罗非班是安全的,且降低了支架内急性、亚急性血栓发生率。

Efficacy and safety of tirofiban on prevention of acute stent thrombosis in patients with complex coronary lesions after intervention treatment

Objectives To evaluate the efficacy of tirofiban on prevention of acute and subacute stent thrombosis in patients with complex coronary heart disease after intervention treatment, as well as evaluating its safety. Methods Totally 200 patients with complex coronary lesions after intervention treatment from January 2008 to December 2012 in Gaozhou City Hospital were randomly divided into 2 groups： treatment group （100 cases ） and control group （100 cases）. Patients in treatment group were given tirofiban （class load） on the regular basis of applying aspirin and elopidogrel. After that, patients were given a maintenance dose of tirofiban for 24 hours. Patients in control group were given low-molecular- weight heparin for 3 days after intervention on the regular basis of applying aspirin and elopidogrel. Stent thrombosis and bleeding complications of the two groups were observed. Results Type B2 and C coronary lesions in treatment group were 63 cases and 37 cases ; 70 cases and 30 cases in control group. Implanted stent numbers and total length of stents between the two groups had no significant differences （3.1±1.3） vs. （2.9±1.2） ,P〉0.05; （32.4±13.8） mm vs. （33.2± 12.7） mm, P〉0.05 ]. Incidence of acute stent thrombosis in treatment group was significantly lower than that in control group 2% （ 2/100 ） vs. 7 % （7/100）, x2=45.82, P〈0.05 ]. Incidence of bleeding complications between the two groups had no significant differences 12% （12/100） vs. 9% （9/100）, x2=5.18,P〉0.05]. Conclusions It is safe to apply tirofiban after PCI in patients with complex coronary lesions, and it also reduces incidence of acute and subacute thrombosis.