Marco J, Ariëns R A, Fajadet J, Bossi I M, Marco I, Bernies M, Romano S M, Donatelli F, Brambilla G M, Somalvico F, Mari D, Gregorini L
Clinique Pasteur, Toulouse, France.
Am J Cardiol. 2000 Mar 1;85(5):527-31. doi: 10.1016/s0002-9149(99)00805-x.
Patients with unstable angina have an increased activation of the coagulation system. Aspirin and ticlopidine given in combination may potentiate each other by the combination of different action mechanisms and may reduce the risk of coronary occlusion and clinical instability. Plasma tissue factor (TF) levels collected into the stenotic coronary artery may be an index of TF expression within the vasculature. In 160 patients undergoing angioplasty for a 81+/-5% coronary lesion, we measured TF in blood samples collected from a vein and from the coronary ostium. Immediately after and 10 minutes after the dilation procedures the samples were withdrawn also beyond the lesion. Heparin 150 U/kg was given as an anticoagulant. All patients were pretreated with 250 mg/day of aspirin. One hundred twenty patients were randomly assigned to receive 24, 48, or 72 hours of ticlopidine treatment (250 mg/twice daily). TF levels did not increase during angioplasty but there was a significantly higher TF expression in unstable than in stable patients, irrespective of the invasiveness of debulking procedures. When ticlopidine was given for 72 hours, TF levels were similar to normal laboratory values both in stable and unstable patients. This combined antiplatelet pretreatment may be of benefit in unstable angina patients, with a favorable cost/benefit ratio.
不稳定型心绞痛患者的凝血系统激活增强。联合使用阿司匹林和噻氯匹定可能通过不同作用机制的联合而相互增效，并可能降低冠状动脉阻塞和临床不稳定的风险。收集到狭窄冠状动脉内的血浆组织因子（TF）水平可能是脉管系统内TF表达的一个指标。在160例因81±5%冠状动脉病变接受血管成形术的患者中，我们测量了从静脉和冠状动脉口采集的血样中的TF。在扩张操作后立即以及10分钟后，也在病变远端采集样本。给予150 U/kg肝素作为抗凝剂。所有患者均预先接受每日250 mg阿司匹林治疗。120例患者被随机分配接受24、48或72小时的噻氯匹定治疗（每日两次，每次250 mg）。血管成形术期间TF水平没有升高，但不稳定型患者的TF表达明显高于稳定型患者，与减容操作的侵入性无关。当给予噻氯匹定72小时时，稳定型和不稳定型患者的TF水平均与正常实验室值相似。这种联合抗血小板预处理可能对不稳定型心绞痛患者有益，且成本效益比良好。
