口服抗凝剂治疗的患者在接受冠状动脉支架置入术时联合使用氯吡格雷和华法林的早期和晚期疗效

Early and late outcomes of clopidogrel and coumadin combination for patients on oral anticoagulants undergoing coronary stenting.

作者信息

Ait Mokhtar Omar, Bonello Laurent, Armero Sebastien, Sbragia Pascal, Paganelli Frank

机构信息

Department of Cardiology, Centre Hospitalo-Universitaire Nord, Chemin des Bourrelys, 13015 Marseille, France.

出版信息

Cardiovasc Revasc Med. 2010 Jul-Sep;11(3):159-62. doi: 10.1016/j.carrev.2009.05.002.

DOI:10.1016/j.carrev.2009.05.002

PMID:20599166

Abstract

BACKGROUND

In patients under oral anticoagulant requiring percutaneous coronary intervention (PCI) with stent implantation, the optimal association between aspirin, clopidogrel and oral anticoagulant (OAC) remains cumberstome. Triple therapy and dual therapy using aspirin and OAC have been evaluated and are associated with a high frequency of major bleedings. The combination of clopidogrel and OAC has never been evaluated.

OBJECTIVE

We aimed to investigate the safety and efficacy of clopidogrel and OAC in patients requiring OAC undergoing PCI for acute coronary syndrome.

METHODS

A monocenter retrospective study was undertaken between 2000 and 2006 and included all patients undergoing PCI with stent implantation on OAC. On discharge dual therapy with clopidogrel and OAC was prescribed. The primary end-point was the frequency of major TIMI bleedings. Secondary end-points were major cardiovascular event (MACE). Results are reported as rate of events with 95% confidence intervals (CI).

RESULTS

Two hundreds and nine patients were followed for 71 +/- 22 months. The indication for oral anticoagulation was atrial fibrillation in 80% of patients, a valvular prothesis in 18% and a history of pulmonary embolism in 5%. The rate (95%CI) of major bleeding was 2.4% (0.9%-5.8%) 2.87% (1.17%-6.44%) and 3.8% (1.79%-7.68%) at 1 month, 12 months and 71 months respectively, which represent 8 events among which 2 were fatal. The MACE rate (95%CI) was low: 0% at one month, 3.8% (1.79%-7.68%) at 12 months and 24.4% (19.07%-30.65%) at 71 months of follow up. Only one stent thrombosis was recorded at the ninth month. The overall rate of death was 9.5% (6.28%-14.32%) among which 2.87% (1.17%-6.44%) were of cardiovascular origin.

CONCLUSION

The use of clopidogrel and OAC combination in patients on OAC undergoing coronary stenting is safe and efficient at the short-term. At the long-term, this combination is probably not safe, with a relatively high incidence of fatal stroke.

摘要

背景

在接受口服抗凝治疗且需要经皮冠状动脉介入治疗（PCI）并植入支架的患者中，阿司匹林、氯吡格雷与口服抗凝剂（OAC）之间的最佳联合用药方案仍很复杂。已对三联疗法以及使用阿司匹林和OAC的双联疗法进行了评估，这些疗法与高频率的严重出血相关。氯吡格雷与OAC联合使用的情况从未被评估过。

目的

我们旨在研究氯吡格雷与OAC联合使用对于因急性冠状动脉综合征而接受PCI且需要OAC治疗的患者的安全性和有效性。

方法

于2000年至2006年开展了一项单中心回顾性研究，纳入了所有在接受OAC治疗时接受PCI并植入支架的患者。出院时开具了氯吡格雷与OAC的双联疗法处方。主要终点是TIMI严重出血的发生率。次要终点是主要心血管事件（MACE）。结果以事件发生率及95%置信区间（CI）报告。

结果

209例患者接受了71±22个月的随访。口服抗凝治疗的适应证为：80%的患者是房颤，18%的患者是人工瓣膜置换，5%的患者有肺栓塞病史。主要出血发生率（95%CI）在1个月时为2.4%（0.9%-5.8%），12个月时为2.87%（1.17%-6.44%），71个月时为3.8%（1.79%-7.68%），共发生8起事件，其中2起是致命的。MACE发生率（95%CI）较低：1个月时为0%，12个月时为3.8%（1.79%-7.68%），随访71个月时为24.4%（19.07%-30.65%）。仅在第9个月记录到1例支架血栓形成。总体死亡率为9.5%（6.28%-14.32%），其中2.87%（1.17%-6.44%）是心血管源性的。