Urban P, Buller N, Fox K, Shapiro L, Bayliss J, Rickards A
National Heart Hospital, London.
Br Heart J. 1988 Dec;60(6):485-8. doi: 10.1136/hrt.60.6.485.
Between September 1985 and April 1987, 110 consecutive patients who had successful coronary angioplasty were included in a randomised prospective controlled evaluation of the effects of warfarin on restenosis. The warfarin (n = 56) and the control (n = 54) groups were not different in terms of age, sex, previous coronary bypass surgery or coronary balloon angioplasty, severity of symptoms, and frequency of multivessel disease or of total coronary occlusions. Warfarin was started on the day of the procedure and the dosage was adjusted to maintain the thromboplastin international normalised ratio greater than or equal to 2.5. One hundred and five (96%) of the patients were given verapamil and other antianginal drugs were prescribed as needed. Low molecular weight dextran and heparin were given during the procedure and heparin was continued for 24 hours in all patients. One hundred and eight (98%) of patients were followed up clinically after a median of five months (range 1-20). Eighty five (77%) had follow up angiography at five months. In the warfarin group symptoms improved in 46 (85%) patients by at least 1 angina class and 31 (57%) were symptom free; the exercise test remained positive in 20 (36%) patients and the angiographic restenosis rate was 25% per lesion and 29% per patient. There were no major bleeding complications. In the control group 46 (85%) patients were improved by at least 1 angina class and 31 (57%) were symptom free; the exercise test was positive in 11 (21%) patients and the angiographic restenosis rate was 33% per lesion and 37% per patient. Although the incidence of angiographic restenosis tended to be lower with warfarin, none of these differences was significant. These data suggest that the combination of verapamil and warfarin, in the absence of aspirin, is not significantly better than verapamil alone in preventing symptom recurrence or angiographic restenosis after coronary angioplasty.
在1985年9月至1987年4月期间，110例连续成功接受冠状动脉成形术的患者被纳入一项关于华法林对再狭窄影响的随机前瞻性对照评估。华法林组（n = 56）和对照组（n = 54）在年龄、性别、既往冠状动脉搭桥手术或冠状动脉球囊成形术、症状严重程度以及多支血管病变或冠状动脉完全闭塞的频率方面无差异。华法林在手术当天开始使用，剂量进行调整以维持凝血活酶国际标准化比值大于或等于2.5。105例（96%）患者使用维拉帕米，并根据需要开具其他抗心绞痛药物。术中给予低分子右旋糖酐和肝素，所有患者肝素持续使用24小时。108例（98%）患者在中位时间为5个月（范围1 - 20个月）后进行了临床随访。85例（77%）患者在5个月时进行了随访血管造影。在华法林组中，46例（85%）患者症状改善至少1个心绞痛级别，31例（57%）无症状；运动试验在20例（36%）患者中仍为阳性，血管造影再狭窄率为每个病变25%，每位患者29%。无严重出血并发症。在对照组中，46例（85%）患者症状改善至少1个心绞痛级别，31例（57%）无症状；运动试验在11例（21%）患者中为阳性，血管造影再狭窄率为每个病变33%，每位患者37%。尽管使用华法林时血管造影再狭窄的发生率有降低趋势，但这些差异均无统计学意义。这些数据表明，在没有阿司匹林的情况下，维拉帕米与华法林联合使用在预防冠状动脉成形术后症状复发或血管造影再狭窄方面并不比单独使用维拉帕米显著更好。
