Roy Probal, Bonello Laurent, Torguson Rebecca, de Labriolle Axel, Lemesle Gilles, Slottow Tina L Pinto, Steinberg Daniel H, Kaneshige Kimberly, Xue Zhenyi, Satler Lowell F, Kent Kenneth M, Suddath William O, Pichard Augusto D, Lindsay Joseph, Waksman Ron
Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
Am J Cardiol. 2008 Dec 15;102(12):1614-7. doi: 10.1016/j.amjcard.2008.07.063. Epub 2008 Sep 27.
Premature cessation of clopidogrel is a strong risk factor for drug-eluting stent thrombosis in patients undergoing percutaneous coronary intervention. The impact that superficial or "nuisance" bleeding may have on clopidogrel compliance has not been described. The study population consisted of 2,360 unselected patients undergoing successful drug-eluting stent implantation. Nuisance bleeding, defined as easy bruising, bleeding from small cuts, petechia, and ecchymosis, was assessed during routine clinical follow-up. Internal and alarming bleeding was recorded. Cessation of clopidogrel as a consequence of such bleeding was then assessed. Study population characteristics were 66.1% men, mean age 64.5 +/- 11.8 years, diabetes mellitus in 31.1%, smoking in 18.5%, systemic hypertension in 81.8%, dyslipidemia in 87.9%, history of coronary artery disease in 49.1%, chronic renal insufficiency in 8.7%, and acute myocardial infarction in 10.8%. A total of 837 patients reported bleeding events (incidence 32.4%) of which 85.7% were nuisance, 13.6% were internal, and 0.7% were alarming. Rate of clopidogrel discontinuation as a result of bleeding in the nuisance bleeding group was 11.1%. In conclusion, superficial or nuisance bleeding is common in patients taking dual antiplatelet therapy after percutaneous coronary intervention. Overall, 11.1% of patients with nuisance bleeding discontinued clopidogrel. Greater education and follow-up in this patient subset may lead to improved compliance with clopidogrel therapy.
对于接受经皮冠状动脉介入治疗的患者，氯吡格雷过早停用是药物洗脱支架血栓形成的一个重要危险因素。目前尚未有研究描述轻微或“烦扰性”出血对氯吡格雷依从性的影响。本研究纳入了2360例成功植入药物洗脱支架的未经过筛选的患者。在常规临床随访期间，对烦扰性出血进行评估，烦扰性出血定义为容易出现瘀斑、小伤口出血、瘀点和瘀斑。记录严重出血和危及生命的出血情况。然后评估因这类出血导致的氯吡格雷停药情况。研究人群特征为：男性占66.1%，平均年龄64.5±11.8岁，糖尿病患者占31.1%，吸烟者占18.5%，系统性高血压患者占81.8%，血脂异常患者占87.9%，有冠状动脉疾病史者占49.1%，慢性肾功能不全者占8.7%，急性心肌梗死患者占10.8%。共有837例患者报告了出血事件（发生率32.4%），其中85.7%为烦扰性出血，13.6%为严重出血，0.7%为危及生命的出血。烦扰性出血组中因出血而停用氯吡格雷的比例为11.1%。总之，在接受经皮冠状动脉介入治疗后服用双联抗血小板治疗的患者中，轻微或烦扰性出血很常见。总体而言，11.1%的烦扰性出血患者停用了氯吡格雷。对这一患者亚组加强教育和随访可能会提高氯吡格雷治疗的依从性。
