Mizgala H F, Counsell J
Can Med Assoc J. 1976 Jun 19;114(12):1123-6.
Abrupt cessation of oral propranolol therapy was followed by 15 acute coronary events in 14 patients with severe angina who had been receiving propranolol in daily doses of 80 to 400 mg for periods of 7 days to 6 years. Propranolol had been stopped 1 to 14 days before each acute event because of angiographic study (seven patients), increasing symptoms (three), acute coronary insufficiency (one), asymptomatic bradycardia (one), elective surgery (one) and unknown reasons (two). Before abrupt cessation of propranolol treatment anginal symptoms had been stable in six instances but had increased in the other nine. Cessation was followed by rapid progression of symptoms prior to 11 of the 15 acute events. There were six acute transmural myocardial infarctions with three deaths, three intramural myocardial infarctions, one with ventricular fibrillation, and six episodes of acute coronary insufficiency, Unstable angina followed nine of the events and responded to propranolol therapy (160 to 320 mg/d) in eight instances. Three other patients underwent aortocoronary bypass surgery; perioperative acute myocardial infarction occurred in two. These data suggest that in a minority of patients abrupt cessation of propranolol may be hazardous, particularly in severe or unstable disease. Cessation or propranolol therapy in such patients should be gradual and closely observed. Recurrent symptoms respond to reinstitution of propranolol therapy.
在14例严重心绞痛患者中，他们曾接受每日80至400毫克的普萘洛尔治疗7天至6年，突然停用口服普萘洛尔治疗后，发生了15起急性冠状动脉事件。在每次急性事件发生前1至14天停用普萘洛尔，原因包括血管造影研究（7例）、症状加重（3例）、急性冠状动脉供血不足（1例）、无症状心动过缓（1例）、择期手术（1例）及不明原因（2例）。在突然停用普萘洛尔治疗前，6例患者的心绞痛症状稳定，另外9例症状加重。在15起急性事件中的11起之前，停用普萘洛尔后症状迅速进展。有6例急性透壁性心肌梗死，其中3例死亡；3例壁内心肌梗死，1例伴有心室颤动；6例急性冠状动脉供血不足。9起事件后出现不稳定型心绞痛，8例对普萘洛尔治疗（160至320毫克/天）有反应。另外3例患者接受了主动脉冠状动脉搭桥手术，2例发生围手术期急性心肌梗死。这些数据表明，少数患者突然停用普萘洛尔可能有危险，尤其是在病情严重或不稳定时。在此类患者中停用普萘洛尔治疗应逐渐进行并密切观察。复发性症状对重新使用普萘洛尔治疗有反应。
