Gilard Martine, Blanchard Didier, Helft Gérard, Carrier Didier, Eltchaninoff Helene, Belle Loic, Finet Gérard, Le Breton Hervé, Boschat Jacques
Department of Cardiology, University Hospital of Brest, Brest, France.
Am J Cardiol. 2009 Aug 1;104(3):338-42. doi: 10.1016/j.amjcard.2009.03.053. Epub 2009 Jun 6.
We evaluated the safety and efficacy of dual antiplatelet therapy, in association with oral anticoagulant (OAC) therapy, in patients undergoing percutaneous coronary intervention (PCI). The use of this triple therapy increases the rate of adverse outcomes, as shown by retrospective studies. In this first prospective multicenter registry STENTIng and oral antiCOagulation (STENTICO), all patients with OAC therapy undergoing PCI were included and followed up at 2 and 12 months. A total of 359 patients were included from 40 French centers. In 234 (65.2%; group 1) of these 359 patients, OAC therapy was discontinued (22 +/- 31 days). In 125 patients (34.8%; group 2), triple therapy was continued. The baseline characteristics were similar in the 2 groups. In group 2, a radial approach was more often used (65.6% vs 43.8%, p = 0.003), fewer drug-eluting stents were implanted (33.3% vs 24.8%, p = 0.06), and fewer anti-glycoprotein IIb/IIIa antagonists were prescribed (5.6% vs 8.5%, p = 0.02). The stroke rate did not differ significantly, at 3.0% (95% confidence interval 0.8% to 5.2%) for group 1 versus 0.8% (95% confidence interval -0.8% to 2.4%) in group 2. Severe and moderate bleeding, according to the Global Use of Strategies to Open Coronary Arteries (GUSTO) criteria, occurred in 2.1% and 6.4% of groups 1 and 2, respectively (p = 0.04). A significant difference in bleeding risk was found between the femoral and radial approaches (10.3% vs 3.8%, respectively; p = 0.01). In conclusion, adding dual antiplatelet therapy to pre-existing OAC therapy increases the post-PCI bleeding risk. Temporary discontinuation decreased this bleeding risk but tended to increase the risk of stroke. A radial approach for PCI could be a good alternative to the conventional femoral route to avoid bleeding.
我们评估了双联抗血小板治疗联合口服抗凝药（OAC）治疗在接受经皮冠状动脉介入治疗（PCI）患者中的安全性和有效性。回顾性研究表明，使用这种三联疗法会增加不良事件发生率。在这项首个前瞻性多中心注册研究“支架置入与口服抗凝治疗（STENTICO）”中，纳入了所有接受OAC治疗且正在接受PCI的患者，并在2个月和12个月时进行随访。共有来自40个法国中心的359例患者被纳入研究。在这359例患者中的234例（65.2%；第1组）中，OAC治疗被停用（22±31天）。在125例患者（34.8%；第2组）中，三联疗法继续进行。两组的基线特征相似。在第2组中，更常采用桡动脉入路（65.6%对43.8%，p = 0.003），植入的药物洗脱支架较少（33.3%对24.8%，p = 0.06），并且开具的抗糖蛋白IIb/IIIa拮抗剂较少（5.6%对8.5%，p = 0.02）。第1组的卒中发生率为3.0%（95%置信区间0.8%至5.2%），第2组为0.8%（95%置信区间 -0.8%至2.4%），两组之间无显著差异。根据全球冠状动脉开通策略（GUSTO）标准，严重和中度出血在第1组和第2组中分别发生率为2.1%和6.4%（p = 0.04）。在股动脉和桡动脉入路之间发现出血风险存在显著差异（分别为10.3%对3.8%；p = 0.01）。总之，在已有的OAC治疗基础上加用双联抗血小板治疗会增加PCI术后出血风险。暂时停用可降低这种出血风险，但往往会增加卒中风险。PCI采用桡动脉入路可能是避免出血的传统股动脉途径的一个良好替代方案。
