Torii Sho, Yamamoto Tadashi, Nakamura Norihito, Ijichi Takeshi, Yoshikawa Ayako, Ito Yusuke, Sugidachi Atsuhiro, Ikari Yuji, Nakazawa Gaku
Department of Cardiology, Tokai University School of Medicine Isehara Japan.
Department of Major in Integrative Bioscience and Biomedical Engineering, Waseda University Graduate School of Science and Engineering Tokyo Japan.
Circ Rep. 2021 Aug 7;3(9):504-510. doi: 10.1253/circrep.CR-21-0084. eCollection 2021 Sep 10.
Antiplatelet therapy following stent implantation in patients requiring oral anticoagulation (OAC) is controversial because triple therapy (i.e., dual antiplatelet therapy [DAPT] with OAC) is associated with a high risk of bleeding. In this study, 21 rabbits were divided into 5 groups: prasugrel and warfarin (Prasugrel+OAC group); aspirin and warfarin (Aspirin+OAC group); prasugrel, aspirin, and warfarin group (Triple group); prasugrel and aspirin (Conventional DAPT group); and no medication (Control group). The treated groups were administered medication for 1 week. An arteriovenous shunt loop was established from the rabbit carotid artery to the jugular vein and 2 bare metal stents were deployed in a silicone tube. After 1 h of circulation, the volume of thrombi was evaluated quantitatively by measuring the amount of protein. Bleeding time was measured at the same time. The volume of the thrombus (amount of protein) around stent struts was lowest in the Triple group, followed by the Prasugrel+OAC and Conventional DAPT groups, and was highest in the Control group. Bleeding time was the longest in the Triple group, followed by the Aspirin+OAC, Prasugrel+OAC, Conventional DAPT, and Control groups. This study suggests that prasugrel with OAC may be a feasible antithrombotic regimen following stent implantation in patients who require OAC therapy.
对于需要口服抗凝药（OAC）的患者，支架植入术后的抗血小板治疗存在争议，因为三联疗法（即双重抗血小板治疗[DAPT]联合OAC）会带来较高的出血风险。在本研究中，21只兔子被分为5组：普拉格雷与华法林组（普拉格雷+OAC组）；阿司匹林与华法林组（阿司匹林+OAC组）；普拉格雷、阿司匹林与华法林组（三联组）；普拉格雷与阿司匹林组（传统DAPT组）；以及未用药组（对照组）。治疗组用药1周。建立从兔颈动脉到颈静脉的动静脉分流环，并在硅胶管中植入2个裸金属支架。循环1小时后，通过测量蛋白质含量定量评估血栓体积。同时测量出血时间。支架支柱周围血栓的体积（蛋白质含量）在三联组中最低，其次是普拉格雷+OAC组和传统DAPT组，在对照组中最高。出血时间在三联组中最长，其次是阿司匹林+OAC组、普拉格雷+OAC组、传统DAPT组和对照组。本研究表明，对于需要OAC治疗的患者，普拉格雷联合OAC可能是支架植入术后一种可行的抗栓方案。
