Division of Cardiology, Weill Medical College of Cornell University, 520 East 70th Street, Starr 4 Pavilion, Box 108, New York, NY 10021, USA.
Catheter Cardiovasc Interv. 2009 Dec 1;74(7):1047-54. doi: 10.1002/ccd.22167.
Drug-eluting stents (DES) have several advantages over bare-metal stents (BMS), including significantly lower target vessel revascularization. However, DES is associated with a higher incidence of late stent thrombosis (ST). Although late ST after DES placement is uncommon (approximately 0.4-0.6%/year), it is catastrophic clinical consequences make it a concern. Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is the standard of care for prevention of ST, and DAT discontinuation is associated with a marked increase in ST risk. These guidelines recommend continuing DAT for > or = 12 months after DES implantation in patients not at high risk for bleeding. Premature DAT discontinuation is common in clinical practice. Therefore, it is imperative that physicians be aware of factors contributing to discontinuation, including cost, patient education, and actual bleeding events, so as to educate their patients about the risks and benefits of continued DAT. This review highlights the risks of premature DAT discontinuation, discusses common reasons for discontinuation, and offers potential solutions to improve adherence.
药物洗脱支架（DES）相对于裸金属支架（BMS）具有多种优势，包括靶血管血运重建的发生率显著降低。然而，DES 与更高的晚期支架血栓形成（ST）发生率相关。尽管 DES 置入后晚期 ST 并不常见（约 0.4-0.6%/年），但其灾难性的临床后果使其成为关注的焦点。双联抗血小板治疗（DAT）联合阿司匹林和氯吡格雷是预防 ST 的标准治疗方法，DAT 停药与 ST 风险的显著增加相关。这些指南建议在无出血高风险的患者中，DES 植入后继续 DAT >或= 12 个月。在临床实践中，DAT 的过早停药很常见。因此，医生必须了解导致停药的因素，包括费用、患者教育和实际出血事件，以便就 DAT 的风险和获益对患者进行教育。本综述强调了过早 DAT 停药的风险，讨论了停药的常见原因，并提出了改善依从性的潜在解决方案。
