Zanini R, Bonandi L, Curello S, Bersatti F, Giovannini G, Metra M, Dei Cas L
Divisione e Cattedra di Cardiologia, Università degli Studi, Brescia.
Cardiologia. 1997 Aug;42(8):837-43.
Implantation of intracoronary stents has been rapidly increasing in the last few years, especially after a reduction of restenosis has been shown. The main limitation in the use of coronary endoprosthesis is still represented by acute and subacute thrombosis. In order to limit this dangerous complication a very strong coagulant regimen, which has been improved since 1993-94, was initially recommended. We report our experience with patients who underwent a stent implantation comparing two therapeutic regimens with or without oral coagulants associated with antiplatelet agents. During 700 consecutive coronary angioplasties 128 Palamatz-Schatz and Wiktor stents have been implanted in 118 patents (16.9%). After stent implantation, 33 patients underwent a traditional anticoagulant therapy with heparin followed by oral anticoagulants for 3 months. They were also treated with ticlopidine 250 mg/die started 2 days before the procedure and then kept at least one month (group A). Eighty-five patients were treated only with antiplatelet therapy (ticlopidine 500 mg/die) started 2 days before implantation (group B). These two groups of patients were similar in age, sex, type and number of treated vessels and in diameter of the vessel with stent implantation. Subacute thrombosis rate was not significantly different between groups (3 vs 2.3%, NS). The predictive factors of thrombosis were acute myocardial infarction and implantation of multiple stents. No significant differences were found between thrombosis of the stents implanted in bail-out conditions compared to the elective ones. Ticlopidine started 2 days before stent implantation seems to be sufficient to limit thrombosis rate; moreover it allows a reduction of the hemorrhagic complications and hospitalization period.
在过去几年中，冠状动脉内支架植入术迅速增加，尤其是在显示出再狭窄率降低之后。冠状动脉内假体使用的主要限制仍然是急性和亚急性血栓形成。为了限制这种危险的并发症，最初推荐了一种自1993 - 1994年以来得到改进的非常强效的抗凝方案。我们报告了对接受支架植入术的患者的经验，比较了两种治疗方案，一种联合口服抗凝剂与抗血小板药物，另一种不联合。在连续700例冠状动脉血管成形术中，118例患者（16.9%）植入了128个Palamatz - Schatz和Wiktor支架。支架植入后，33例患者接受了传统的肝素抗凝治疗，随后口服抗凝剂3个月。他们还在手术前2天开始服用噻氯匹定250mg/天，然后至少持续1个月（A组）。85例患者仅在植入前2天开始接受抗血小板治疗（噻氯匹定500mg/天）（B组）。这两组患者在年龄、性别、治疗血管的类型和数量以及植入支架的血管直径方面相似。两组的亚急性血栓形成率无显著差异（3%对2.3%，无统计学意义）。血栓形成的预测因素是急性心肌梗死和多个支架植入。与择期植入的支架相比，在紧急情况下植入的支架血栓形成方面未发现显著差异。在支架植入前2天开始使用噻氯匹定似乎足以限制血栓形成率；此外，它还能减少出血并发症和住院时间。
