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冠状动脉搭桥术后一年,各种抗血栓治疗方案(阿司匹林、阿司匹林加双嘧达莫、抗凝剂)对患者及移植物功能状态的影响。

Effect of various antithrombotic regimens (aspirin, aspirin plus dipyridamole, anticoagulants) on the functional status of patients and grafts one year after coronary artery bypass grafting.

作者信息

Mulder B J, van der Doef R M, van der Wall E E, Tijssen J G, Piek J J, van der Meer J, Dunning A J

机构信息

Department of Cardiology, Academic Medical Centre Amsterdam, The Netherlands.

出版信息

Eur Heart J. 1994 Aug;15(8):1129-34. doi: 10.1093/oxfordjournals.eurheartj.a060639.

Abstract

From 1987 until 1991 a large prospective randomized multicentre study was performed in The Netherlands, Germany and Switzerland entitled CABADAS (Prevention of Coronary Artery Bypass graft occlusion by Aspirin, Dipyridamole, and Acenocoumarol/Phenprocoumon Study). The aim of CABADAS was to evaluate the relative efficacy of (1) aspirin, (2) aspirin plus dipyridamole, and (3) oral anticoagulants in the prevention of vein graft occlusion during the first year after aortocoronary bypass surgery. No significant difference was observed in the incidence of graft occlusion among the three treatment groups. In a subgroup of 127 CABADAS patients, studied in the Academic Medical Centre in Amsterdam, the relationship between treatment and clinical status (i.e. symptoms of angina pectoris and exercise capacity) was assessed, and the relationship between treatment and functional status of the vein grafts was determined by means of thallium-201 exercise scintigraphy. There were no differences in symptoms among the three treatment groups in the 127 patients studied. There were no significant differences either among the treatment groups, as regards exercise capacity and the number or intensity of perfusion defects, in the 81 patients who underwent thallium-201 exercise scintigraphy. The three antithrombotic treatment regimens had a similar effect on the clinical status of patients and on the functional status of venous bypass grafts one year after coronary bypass surgery. This finding underscores the CABADAS results in that aspirin may be the preferred treatment option in patients following venous bypass surgery.

摘要

1987年至1991年期间,在荷兰、德国和瑞士开展了一项大型前瞻性随机多中心研究,名为CABADAS(阿司匹林、双嘧达莫和醋硝香豆素/苯丙香豆素预防冠状动脉搭桥移植血管闭塞研究)。CABADAS的目的是评估(1)阿司匹林、(2)阿司匹林加双嘧达莫和(3)口服抗凝剂在预防主动脉冠状动脉搭桥手术后第一年静脉移植血管闭塞方面的相对疗效。三个治疗组之间在移植血管闭塞发生率上未观察到显著差异。在阿姆斯特丹学术医学中心研究的127名CABADAS患者亚组中,评估了治疗与临床状况(即心绞痛症状和运动能力)之间的关系,并通过铊-201运动闪烁扫描确定了治疗与静脉移植血管功能状态之间的关系。在研究的127名患者中,三个治疗组之间在症状方面没有差异。在接受铊-201运动闪烁扫描的81名患者中,治疗组之间在运动能力以及灌注缺损的数量或强度方面也没有显著差异。三种抗血栓治疗方案对冠状动脉搭桥手术后一年患者的临床状况和静脉搭桥移植血管的功能状态具有相似的效果。这一发现强调了CABADAS的结果,即阿司匹林可能是静脉搭桥手术后患者的首选治疗方案。

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