van de Loo A, Nauck M, Noory E, Just H, Wollschläger H
Universitätsklinik Freiburg, Medizinische Klinik III, Kardiologie und Angiologie, Freiburg, Germany.
Eur Heart J. 1998 Jan;19(1):96-102. doi: 10.1053/euhj.1997.0740.
In many patients today, elective percutaneous transluminal coronary angioplasty is followed by implantation of coronary stents to achieve optimal results. The current medical strategy to prevent early reocclusion is the inhibition of platelet aggregation by administration of ticlopidine, in addition to aspirin, immediately after the procedure. In order to inhibit platelet aggregation as early as possible, many centres begin to treat patients with additional ticlopidine the day before elective coronary intervention. The aim of this study was to determine the effect of this strategy on platelet aggregation before angioplasty.
Fifty-two consecutive patients admitted to hospital for elective balloon angioplasty were prospectively randomized to receive either standard oral aspirin 100 mg per day or standard therapy plus 250 mg ticlopidine at the time of admission and the morning before angioplasty. Adenosine diphosphate-, collagen- and epinephrine-induced platelet aggregation was measured immediately before the procedure by an investigator who was blinded concerning the arm of therapy.
The two groups of patients were comparable in terms of age, sex, body mass index, anginal state, time interval between application of study drug and coronary intervention. Patients on aspirin and ticlopidine had a mean maximal platelet aggregation of 36 +/- 12% with adenosine diphosphate as agonist. For the control group, 54 +/- 12% was measured (P < 0.001). Myocardial infarction or emergency coronary bypass grafting did not occur in either group. Local haemorrhagic complications at the arterial access site occurred in five (aspirin) and six (aspirin and ticlopidine) patients (P = ns) none of them requiring blood transfusion.
The additional application of ticlopidine to chronic aspirin therapy the day before elective coronary balloon angioplasty leads to a significantly higher inhibition of platelet aggregation at the time of the intervention. It seems to be safe compared to the standard procedure.
如今，许多患者在接受选择性经皮腔内冠状动脉成形术后会植入冠状动脉支架以获得最佳效果。目前预防早期再闭塞的医学策略是在术后立即除服用阿司匹林外，还给予噻氯匹定以抑制血小板聚集。为了尽早抑制血小板聚集，许多中心开始在选择性冠状动脉介入治疗前一天用额外的噻氯匹定治疗患者。本研究的目的是确定该策略对血管成形术前血小板聚集的影响。
连续52例因选择性球囊血管成形术入院的患者被前瞻性随机分为两组，一组每天接受标准口服阿司匹林100毫克，另一组在入院时及血管成形术前早晨接受标准治疗加250毫克噻氯匹定。在手术前，由一位对治疗分组不知情的研究者立即测量二磷酸腺苷、胶原和肾上腺素诱导的血小板聚集情况。
两组患者在年龄、性别、体重指数、心绞痛状态、应用研究药物与冠状动脉介入治疗之间的时间间隔方面具有可比性。以二磷酸腺苷为激动剂时，服用阿司匹林和噻氯匹定的患者平均最大血小板聚集率为36±12%。对照组测量值为54±12%（P<0.001）。两组均未发生心肌梗死或急诊冠状动脉搭桥术。动脉穿刺部位局部出血并发症在阿司匹林组有5例，阿司匹林和噻氯匹定组有6例（P=无显著性差异），均无需输血。
在选择性冠状动脉球囊血管成形术前一天，在慢性阿司匹林治疗基础上加用噻氯匹定可在干预时显著提高对血小板聚集的抑制作用。与标准治疗相比，似乎是安全的。
