Tomaru T, Fujimori Y, Morita T, Aoki N, Sakamoto Y, Nakamura F, Omata M, Uchida Y
Second Department of Internal Medicine, University of Tokyo, Japan.
Jpn Circ J. 1996 Dec;60(12):981-92. doi: 10.1253/jcj.60.981.
We investigated the ability of various antithrombotic drugs, delivered locally, to prevent restenosis after angioplasty in hypercholesterolemic rabbits. After dilating atherosclerotic iliac stenoses by balloon angioplasty, a low dose of heparin or a new antithrombotic drug, such as low molecular weight heparin (fragmin), argatroban, or batroxobin, was delivered locally using the balloon double-occlusion technique. In 1 group, high-dose heparin was administered intravenously. Animals that received no drugs served as a control group. After angioplasty, the stenotic segment was dilated and the mean percentage luminal stenosis fell from 89% to 9% in the group that received locally delivered heparin, from 88% to 7% in the group that received locally delivered argatroban, from 87% to 11% in the group that received locally delivered fragmin, from 88% to 15% in the group that received locally delivered batroxobin, from 82% to 18% in the group that received i.v. heparin (p < 0.0001 compared with before angioplasty in each case), and from 84% to 17% in the control group (p < 0.005 compared with before angioplasty). Twenty-eight days after angioplasty, the percentage luminal stenosis remained at 14% in the group that received locally delivered argatroban, 15% in the group that received locally delivered fragmin, and 28% in the group that received locally delivered batroxobin, whereas it increased to 45% in the group that received i.v. heparin, 30% in the group that received locally delivered heparin and 72% in the control group (p < 0.05 compared with after angioplasty in each case). Thus, local delivery low doses of new antithrombotic drugs prevents restenosis after angioplasty without affecting systemic coagulability; heparin, whether administered locally or intravenously, was less effective than the new drugs in preventing restenosis.
我们研究了多种局部给药的抗血栓药物预防高胆固醇血症兔血管成形术后再狭窄的能力。通过球囊血管成形术扩张动脉粥样硬化性髂动脉狭窄后，采用球囊双闭塞技术局部给予低剂量肝素或一种新的抗血栓药物，如低分子量肝素（速避凝）、阿加曲班或巴曲酶。在一组中，静脉给予高剂量肝素。未接受药物治疗的动物作为对照组。血管成形术后，狭窄段扩张，接受局部给予肝素的组平均管腔狭窄百分比从89%降至9%，接受局部给予阿加曲班的组从88%降至7%，接受局部给予速避凝的组从87%降至11%，接受局部给予巴曲酶的组从88%降至15%，接受静脉给予肝素的组从82%降至18%（与血管成形术前相比，每种情况p<0.0001），对照组从84%降至17%（与血管成形术前相比p<0.005）。血管成形术后28天，接受局部给予阿加曲班的组管腔狭窄百分比仍为14%，接受局部给予速避凝的组为15%，接受局部给予巴曲酶的组为28%，而接受静脉给予肝素的组增加至45%，接受局部给予肝素的组为30%，对照组为72%（与血管成形术后相比，每种情况p<0.05）。因此，局部给予低剂量新抗血栓药物可预防血管成形术后再狭窄且不影响全身凝血功能；肝素无论是局部给药还是静脉给药，在预防再狭窄方面均不如新药有效。
