Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, 42283 Wuppertal, Germany.
Cardiovasc Intervent Radiol. 2012 Feb;35(1):30-42. doi: 10.1007/s00270-011-0204-0. Epub 2011 Jun 23.
In treating peripheral arterial disease, a profound knowledge of antiplatelet and anticoagulative drug therapy is helpful to assure a positive clinical outcome and to anticipate and avoid complications. Side effects and drug interactions may have fatal consequences for the patient, so interventionalists should be aware of these risks and able to control them. Aspirin remains the first-line agent for antiplatelet monotherapy, with clopidogrel added where dual antiplatelet therapy is required. In case of suspected antiplatelet drug resistance, the dose of clopidogrel may be doubled; prasugrel or ticagrelor may be used alternatively. Glycoprotein IIb/IIIa inhibitors (abciximab or eptifibatide) may help in cases of hypercoagulability or acute embolic complications. Desmopressin, tranexamic acid, or platelet infusions may be used to decrease antiplatelet drug effects in case of bleeding. Intraprocedurally, anticoagulant therapy treatment with unfractionated heparin (UFH) still is the means of choice, although low molecular-weight heparins (LMWH) are suitable, particularly for postinterventional treatment. Adaption of LMWH dose is often required in renal insufficiency, which is frequently found in elderly patients. Protamine sulphate is an effective antagonist for UFH; however, this effect is less for LMWH. Newer antithrombotic drugs, such as direct thrombin inhibitors or factor X inhibitors, have limited importance in periprocedural treatment, with the exception of treating patients with heparin-induced thrombocytopenia (HIT). Nevertheless, knowing pharmacologic properties of the newer drugs facilitate correct bridging of patients treated with such drugs. This article provides a comprehensive overview of antiplatelet and anticoagulant drugs for use before, during, and after interventional radiological procedures.
在治疗外周动脉疾病时，深入了解抗血小板和抗凝药物治疗有助于确保良好的临床效果，并预测和避免并发症。副作用和药物相互作用可能对患者产生致命后果，因此介入医生应该了解这些风险并能够控制它们。阿司匹林仍然是抗血小板单药治疗的首选药物，在需要双重抗血小板治疗的情况下，加用氯吡格雷。如果怀疑存在抗血小板药物抵抗，可以将氯吡格雷的剂量加倍；也可以选择使用普拉格雷或替格瑞洛。在存在高凝状态或急性栓塞性并发症的情况下，糖蛋白 IIb/IIIa 抑制剂（阿昔单抗或依替巴肽）可能有助于治疗。如果发生出血，可使用去氨加压素、氨甲环酸或血小板输注来降低抗血小板药物的作用。在介入过程中，虽然低分子肝素（LMWH）也适用，但未分级肝素（UFH）仍然是抗凝治疗的首选方法。在肾功能不全的情况下，通常在老年患者中发现，需要调整 LMWH 的剂量。硫酸鱼精蛋白是 UFH 的有效拮抗剂；然而，对于 LMWH，这种作用较弱。新型抗血栓形成药物，如直接凝血酶抑制剂或因子 X 抑制剂，在介入治疗中仅具有有限的重要性，除了治疗肝素诱导的血小板减少症（HIT）的患者。然而，了解新型药物的药理学特性有助于正确桥接接受此类药物治疗的患者。本文全面概述了介入放射学治疗前后使用的抗血小板和抗凝药物。
