Dean Jia, Yujie Zhou, Yingxin Zhao, Yuyang Liu, Yonghe Guo, Wanjun Cheng, Zheng Cao
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Clin Cardiol. 2009 Mar;32(3):164-8. doi: 10.1002/clc.20307.
Although a science advisory recommending 12 months of dual antiplatelet therapy after drug-eluting stents implantation was published recently, the optimal duration of dual antiplatelet therapy has not yet been precisely determined.
Prolonged dual antiplatelet therapy can improve clinical outcomes in high-risk patients implanted with sirolimus-eluting stents.
The patients implanted with sirolimus-eluting stents were assigned into standard clopidogrel therapy group (clopidogrel 75 mg/d for 12 mo) and prolonged clopidogrel therapy group (clopidogrel 75 mg/d for 18 mo). Long-term aspirin (100 mg/d) therapy was adopted in both groups. The primary endpoint was very late stent thrombosis.
After 12 months, 24 patients were excluded because of major adverse cardiovascular events (MACEs). Three hundred and thirty six patients surviving without MACEs were further followed up for 6 months. Between 12 and 18 months, in 160 patients with standard clopidogrel therapy, 5.6% had very late stent thrombosis. In contrast, in 176 patients with prolonged clopidogrel therapy, 1.1% had very late stent thrombosis (p<0.01, versus standard clopidogrel therapy group).
Prolonged dual antiplatelet therapy may be beneficial to prevent very late stent thrombosis after sirolimus-eluting stents implantation in high-risk patients.
尽管最近发布了一项科学建议，推荐在药物洗脱支架植入后进行12个月的双重抗血小板治疗，但双重抗血小板治疗的最佳持续时间尚未精确确定。
延长双重抗血小板治疗可改善植入西罗莫司洗脱支架的高危患者的临床结局。
将植入西罗莫司洗脱支架的患者分为标准氯吡格雷治疗组（氯吡格雷75毫克/天，持续12个月）和延长氯吡格雷治疗组（氯吡格雷75毫克/天，持续18个月）。两组均采用长期阿司匹林（100毫克/天）治疗。主要终点是极晚期支架血栓形成。
12个月后，24例患者因发生重大心血管不良事件（MACE）而被排除。对336例未发生MACE的存活患者进行了6个月的进一步随访。在12至18个月期间，160例接受标准氯吡格雷治疗的患者中，5.6%发生了极晚期支架血栓形成。相比之下，在176例接受延长氯吡格雷治疗的患者中，1.1%发生了极晚期支架血栓形成（与标准氯吡格雷治疗组相比，p<0.01）。
延长双重抗血小板治疗可能有利于预防高危患者植入西罗莫司洗脱支架后发生极晚期支架血栓形成。
