Lechleitner P, Genser N, Dienstl F
Medizinischen Universitätsklinik Innsbruck.
Wien Med Wochenschr. 1990 Jun 15;140(10-11):277-8, 281.
Antiplatelet therapy to prevent occlusion of coronary bypass grafts is widely used. Though the value of this therapy after bypass surgery is not yet settled, some favourable results have been achieved. Many physicians continue to use the Mayo Clinic recommendations (peri- and postoperative administration of aspirin and dipyridamole) while others used dipyridamole and aspirin after surgery, and others use aspirin alone. It is now well established that pretreatment with platelet inhibitors is effective in lowering the incidence of acute vessel closure after angioplasty: Numerous drugs, including warfarin, aspirin and dipyridamole, aspirin and heparin, nifedipine, diltiazem and the experimental antiplatelet agent ticlopidine have proved ineffective in reducing the rate of restenosis after coronary angioplasty. Only high dose administration of an omega-3 fatty acid dietary supplement for 1 week before angioplasty lowers patients' risk for restenosis, but this therapy does not appear effective if begun the night before the procedure or done with somewhat lower dose. Until additional results are available, clinicians must treat patients on extrapolation from the published trials. Low-dose aspirin should be used for several weeks after the procedure. Careful attention to risk factor modification, especially smoking, lipid profile and diabetes control, seems essential in any long-term plan of management in the patient with coronary disease.
预防冠状动脉搭桥移植血管闭塞的抗血小板治疗被广泛应用。尽管这种治疗在搭桥手术后的价值尚未确定，但已取得了一些有利结果。许多医生继续采用梅奥诊所的建议（围手术期及术后给予阿司匹林和双嘧达莫），而其他医生在术后使用双嘧达莫和阿司匹林，还有些医生仅使用阿司匹林。现已明确，血小板抑制剂预处理可有效降低血管成形术后急性血管闭塞的发生率：包括华法林、阿司匹林和双嘧达莫、阿司匹林和肝素、硝苯地平、地尔硫䓬以及实验性抗血小板药物噻氯匹定在内的众多药物，在降低冠状动脉血管成形术后再狭窄发生率方面均未显示出效果。只有在血管成形术前1周给予高剂量的ω-3脂肪酸膳食补充剂可降低患者再狭窄风险，但如果在手术前一晚开始使用或使用较低剂量，则该治疗似乎无效。在获得更多结果之前，临床医生必须根据已发表的试验结果对患者进行治疗。术后应使用低剂量阿司匹林数周。在冠心病患者的任何长期管理计划中，密切关注危险因素的改善，尤其是吸烟、血脂状况和糖尿病控制，似乎至关重要。
