Zemour G, Morice M C, Benveniste E, Biron Y, Lienhart Y, Valeix B, Louvard Y, Glatt B, Lefevre T, Guérin Y
Service de cardiologie, centre hospitalier Victor-Durouy, Argenteuil.
Arch Mal Coeur Vaiss. 1996 Mar;89(3):291-7.
This paper reports experience with a new antithrombotic agent prescribed to reduce the incidence of subacute occlusions during the first month after coronary stenting. Therefore, a powerful association of platelet antiaggregant agents was tested. From December 1992 to October 1994, coronary stenting was successfully achieved in 1,294 patients (1,118 men, average age 60.5 +/- 10 years) who were then treated with the association of ticlopidine 0.25 g/day and aspirin 0.10 g/day for one month. This was covered with anticoagulation with a low molecular weight heparin for a variable period (one month, two weeks, then one week), according to the different phases of the study protocol. In all, 1487 stents were successfully implanted (1,330 Palmaz Schatz; 63 Cook; 80 Wictor; 13 AVE and 1 Strecker) in 1,326 vessels (520 left anterior descending, 208 left circumflex, 475 right coronary, 16 left main coronary arteries and 107 venous grafts) using balloon catheters of 2.5 mm to 5 mm diameter for average 3.45 +/- 0.4 mm). Major complications in the first month included 9 deaths (0.7%), 22 occlusions (1.7%): 14 myocardial infarcts (1%) and 11 aorto-coronary bypass procedures (0.85%). There were 136 local haematomas or false aneurysms (10.5%), 42 of which (3.25%) required blood transfusion or surgical repair. This multicenter trial of a protocol associating platelet antiaggregant agents and low molecular weight heparin for one month showed a low incidence of subocclusion after coronary stenting (1.7 +/= 2.5%) and should enable interventional cardiologists to widen the indications for coronary stenting.
本文报告了一种新型抗血栓形成药物的应用经验，该药物用于降低冠状动脉支架置入术后第一个月内亚急性闭塞的发生率。因此，对一种强效的血小板抗聚集药物联合疗法进行了试验。1992年12月至1994年10月，1294例患者（1118例男性，平均年龄60.5±10岁）成功进行了冠状动脉支架置入术，术后接受噻氯匹定0.25g/天和阿司匹林0.10g/天联合治疗1个月。根据研究方案的不同阶段，用低分子量肝素进行不同时间段（1个月、2周、然后1周）的抗凝治疗。总共在1326条血管（520条左前降支、208条左旋支、475条右冠状动脉、16条左冠状动脉主干和107条静脉移植物）中成功植入了1487个支架（1330个帕尔马兹·沙茨支架；63个库克支架；80个维克托支架；13个AVE支架和1个斯特雷克支架），使用直径2.5mm至5mm的球囊导管（平均3.45±0.4mm）。第一个月的主要并发症包括9例死亡（0.7%），22例闭塞（1.7%）：14例心肌梗死（1%）和11例主动脉冠状动脉搭桥手术（0.85%）。有136例局部血肿或假性动脉瘤（10.5%），其中42例（3.25%）需要输血或手术修复。这项将血小板抗聚集药物与低分子量肝素联合应用1个月的多中心试验表明，冠状动脉支架置入术后亚闭塞发生率较低（1.7±2.5%），这应该能使介入心脏病学家扩大冠状动脉支架置入术的适应证。
