Neumann F J, Schömig A
Deutsches Herzzentrum, München, Germany.
Semin Interv Cardiol. 1998 Jun;3(2):81-90.
GP IIb/IIIa blockade for stenting offers almost complete inhibition of platelet aggregation and can bridge the delayed onset of action of ticlopidine. In the EPISTENT trial, GP IIb/IIIa blockade with abciximab reduced the 30-day cardiac event rate after stenting by more than 50% compared to placebo. Economic constraints may demand to restrict the use of GP IIb/IIIa blockade to subgroups that benefit most. Bail-out stenting constitutes one of these subgroups. Another group are patients with acute myocardial infarction. Moreover, the exquisitely high risk of residual dissection after stenting suggests to always employ GP IIb/IIIa blockade in this instance.
用于支架置入术的糖蛋白IIb/IIIa受体阻滞剂几乎能完全抑制血小板聚集，并且可以弥补噻氯匹定起效延迟的问题。在EPISTENT试验中，与安慰剂相比，使用阿昔单抗进行糖蛋白IIb/IIIa受体阻滞使支架置入术后30天心脏事件发生率降低了50%以上。经济限制可能要求将糖蛋白IIb/IIIa受体阻滞剂的使用限制在获益最大的亚组。补救性支架置入术患者即属于这些亚组之一。另一组是急性心肌梗死患者。此外，支架置入术后残余夹层的极高风险提示在这种情况下应始终使用糖蛋白IIb/IIIa受体阻滞剂。
