Dai Xuming, Makaryus Amgad N, Makaryus John N, Jauhar Rajiv
Division of Cardiology, North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA.
Rev Cardiovasc Med. 2009 Winter;10(1):14-24.
The evolution of drug-eluting stents (DES), effective periprocedural antithrombotic therapy, and advanced interventional techniques have fueled the surge of percutaneous coronary interventions. Stent thrombosis remains a serious complication of coronary artery stent implantation. Long-term antiplatelet therapy is required to prevent stent thrombosis, especially following DES implantation. Discontinuation of antiplatelet therapy (particularly clopidogrel) is the strongest independent risk factor for the development of stent thrombosis. Bleeding complications, most of which arise from the upper gastrointestinal (GI) tract, are the major limiting factors for antiplatelet therapy. The association of aspirin with the increased risk of upper GI bleeding has been well established. Peptic ulcer bleeding and Helicobacter pylori infection are the 2 most important risk factors for aspirin-associated GI bleeding complications. Endoscopy (for both surveillance and potential intervention), performed either emergently or semi-electively, is the primary tool for definitive management of GI bleeding. Considering the increase in GI bleeding risk seen with prolonged antiplatelet therapy, adjunctive proton pump inhibitor therapy and/or eradication of H. pylori infection might be beneficial for DES patients on long-term antiplatelet therapy.
药物洗脱支架（DES）的发展、有效的围手术期抗栓治疗以及先进的介入技术推动了经皮冠状动脉介入治疗的迅猛发展。支架血栓形成仍然是冠状动脉支架植入的严重并发症。需要长期抗血小板治疗以预防支架血栓形成，尤其是在植入DES之后。停用抗血小板治疗（特别是氯吡格雷）是发生支架血栓形成的最强独立危险因素。出血并发症是抗血小板治疗的主要限制因素，其中大多数源于上消化道（GI）。阿司匹林与上消化道出血风险增加之间的关联已得到充分证实。消化性溃疡出血和幽门螺杆菌感染是阿司匹林相关胃肠道出血并发症的两个最重要危险因素。急诊或半择期进行的内镜检查（用于监测和潜在干预）是胃肠道出血明确管理的主要工具。考虑到长期抗血小板治疗会增加胃肠道出血风险，辅助使用质子泵抑制剂治疗和/或根除幽门螺杆菌感染可能对接受长期抗血小板治疗的DES患者有益。
