Department of Cardiology, Shenyang Northern Hospital, Liaoning, China.
PLoS One. 2012;7(10):e48520. doi: 10.1371/journal.pone.0048520. Epub 2012 Oct 31.
Until now there has been scarce evidence regarding an optimal antiplatelet strategy and clinical outcomes for patients who had suffered from stent thrombosis (ST).
140 patients who suffered from stent thrombosis were prospectively registered. Patients received dual (aspirin and 150 mg clopidogrel, N = 66) or triple (additional cilostazol, N = 74) antiplatelet therapy at the physician's discretion. Thereafter platelet reactivity and one year clinical outcomes were analyzed. The primary outcome included the composite of cardiac death, non-fatal myocardial infarction (MI) or stroke at one year,which developed in 41 (29.3%) patients, consisting of 31 (22.1%) cardiac death, 9 (6.4%) non-fatal MI and 1 (1.4%) stroke. Recurrent definite and probable ST according to ARC definition was observed in 8 (5.7%) and 14 (10.0%) patients, respectively. Triple therapy was associated with significantly lower platelet reactivities (50.2 ± 17.8, % vs. 59.6 ± 17.2, %, P = 0.002) compared to high dose dual antiplatelet therapy. However, the incidence of primary events (24.3% vs. 34.8%, P = 0.172) did not differ between triple and dual antiplatelet therapies. High on-treatment platelet reactivity (HR: 8.35, 95% CI: 2.234∼30.867, P = 0.002) and diabetes (HR: 3.732, 95% CI: 1.353∼10.298, P = 0.011) were independent predictors of primary events.
Patients who suffered from stent thrombosis have a poor prognosis even after revascularization with intensive antiplatelet therapy. Triple antiplatelet therapy was more effective in reducing on-treatment platelet reactivity, compared to high dose dual antiplatelet therapy.
目前，关于支架血栓形成（ST）患者的最佳抗血小板治疗策略和临床结局，仅有少量证据。
前瞻性登记了 140 例支架血栓形成患者。根据医生的判断，患者接受双重（阿司匹林和氯吡格雷 150mg，N=66）或三重（加用西洛他唑，N=74）抗血小板治疗。此后，分析血小板反应性和一年临床结局。主要结局包括一年时发生的心脏死亡、非致死性心肌梗死（MI）或卒中的复合终点，共有 41 例（29.3%）患者发生该终点事件，包括 31 例（22.1%）心脏死亡、9 例（6.4%）非致死性 MI 和 1 例（1.4%）卒中。根据 ARC 定义，复发性明确和可能 ST 分别在 8 例（5.7%）和 14 例（10.0%）患者中观察到。与高剂量双联抗血小板治疗相比，三联抗血小板治疗显著降低了血小板反应性（50.2±17.8%比 59.6±17.2%，P=0.002）。然而，三联和双联抗血小板治疗之间主要终点事件的发生率（24.3%比 34.8%，P=0.172）没有差异。高治疗时血小板反应性（HR：8.35，95%CI：2.234∼30.867，P=0.002）和糖尿病（HR：3.732，95%CI：1.353∼10.298，P=0.011）是主要终点事件的独立预测因素。
即使在强化抗血小板治疗再血管化后，支架血栓形成患者的预后仍然较差。与高剂量双联抗血小板治疗相比，三联抗血小板治疗更能有效降低治疗时的血小板反应性。
