Khurram Zakaria, Chou Eric, Minutello Robert, Bergman Geoffrey, Parikh Manish, Naidu Srihari, Wong S Chiu, Hong Mun K
Lenox Hill Hospital, New York, New York, USA.
J Invasive Cardiol. 2006 Apr;18(4):162-4.
Dual antiplatelet therapy of aspirin and a thienopyridine is the standard of care following coronary stenting. Patients who are on chronic warfarin therapy and receive a coronary stent need to be treated with the triple therapy of aspirin, clopidogrel and warfarin; however, the bleeding risk in these patients is unknown. To evaluate the bleeding risk in patients requiring chronic warfarin therapy and undergoing stent implantation, we compared 107 consecutive patients on chronic warfarin therapy who underwent coronary stenting and were discharged on aspirin, clopidogrel and warfarin to 107 contemporary patients who were treated with aspirin and clopidogrel. We evaluated their bleeding history before and after coronary stenting. Major bleeding was defined as bleeding that was significantly disabling, intraocular or requiring at least 2 units of blood transfusion. Minor bleeding was defined as other bleeding that led to interruption of the medications. Patients on triple therapy were younger and more likely to have hypertension. This group had significantly higher major bleeding (6.6% vs. 0%; p = 0.03) and minor bleeding (14.9% vs. 3.8%; p = 0.01) compared with the dual antiplatelet therapy group. In the triple therapy group, the international normalized ratio or aspirin dosage did not influence the bleeding risk. In patients requiring warfarin therapy, the addition of dual antiplatelet therapy is associated with an approximately 7% major bleeding risk. Thus, novel regimens are needed to reduce the bleeding risk.
阿司匹林与噻吩并吡啶的双联抗血小板治疗是冠状动脉支架置入术后的标准治疗方案。正在接受慢性华法林治疗且植入冠状动脉支架的患者需要接受阿司匹林、氯吡格雷和华法林的三联治疗；然而，这些患者的出血风险尚不清楚。为了评估需要慢性华法林治疗并接受支架植入的患者的出血风险，我们将107例连续接受慢性华法林治疗、接受冠状动脉支架置入术并在出院时服用阿司匹林、氯吡格雷和华法林的患者与107例接受阿司匹林和氯吡格雷治疗的当代患者进行了比较。我们评估了他们在冠状动脉支架置入术前和术后的出血史。大出血定义为明显致残、眼内出血或至少需要输注2单位血液的出血。小出血定义为导致药物治疗中断的其他出血。接受三联治疗的患者更年轻，更有可能患有高血压。与双联抗血小板治疗组相比，该组的大出血（6.6%对0%；p = 0.03）和小出血（14.9%对3.8%；p = 0.01）明显更高。在三联治疗组中，国际标准化比值或阿司匹林剂量不影响出血风险。在需要华法林治疗的患者中，添加双联抗血小板治疗会带来约7%的大出血风险。因此，需要新的治疗方案来降低出血风险。
