Division of Cardiology, Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA.
Eur Heart J. 2011 Oct;32(19):2358-64. doi: 10.1093/eurheartj/ehr141. Epub 2011 Jul 30.
The optimal length of clopidogrel therapy in patients with acute coronary syndromes or in those who have undergone percutaneous coronary intervention (PCI) remains controversial. We therefore sought to determine the risk of both perioperative and premature discontinuation of clopidogrel. PubMed and EMBASE databases were searched January 2000 through March 2010 for articles written in English and reporting adverse clinical events following discontinuation of clopidogrel. Studies of perioperative clopidogrel cessation are mostly observational, but do suggest a hazard for adverse cardiac events. This appears to be especially high in the first month after PCI, but it is unclear whether there is a 'safe' window. Studies of 'premature' clopidogrel discontinuation, although mostly retrospective and statistically flawed, suggest that the first 6 months after stenting are highest risk; discontinuation with drug-eluting stents (DESs) is probably higher risk than with bare metal stents, but most studies are of DESs alone. There are no randomized trials sufficient to determine the optimal length of clopidogrel therapy; future randomized clinical trials may provide more clarity.
氯吡格雷治疗急性冠脉综合征或经皮冠状动脉介入治疗（PCI）患者的最佳疗程仍存在争议。因此，我们试图确定氯吡格雷围手术期和过早停药的风险。检索 2000 年 1 月至 2010 年 3 月发表的英文文献，报道氯吡格雷停药后不良临床事件的 PubMed 和 EMBASE 数据库。围手术期氯吡格雷停药的研究主要是观察性的，但确实表明存在心脏不良事件的危险。这在 PCI 后第一个月似乎特别高，但尚不清楚是否存在“安全”窗口。“过早”氯吡格雷停药的研究，尽管大多是回顾性的和存在统计学缺陷的，表明支架置入后 6 个月内风险最高；药物洗脱支架（DES）与裸金属支架相比，停药的风险可能更高，但大多数研究仅涉及 DES。目前尚无足够的随机临床试验来确定氯吡格雷治疗的最佳疗程；未来的随机临床试验可能会提供更明确的信息。
