外周动脉支架成形术后抗血小板药物预防再狭窄的临床观察  

A clinical trial of using antiplatelet therapy to prevent restenosis following peripheral artery angioplasty and stenting

作　　者：谭晋韵[1] 史伟浩[1] 何勍[1] 朱磊[1] 王铁平[1] 余波[1] 

机构地区：[1]复旦大学附属华山医院外科,上海200040

出　　处：《中华医学杂志》2008年第12期812-815,共4页National Medical Journal of China

摘　　要：目的研究抗血小板药物在外周动脉支架成形术后预防再狭窄的疗效。方法将2003年1月至2006年7月在复旦大学附属华山医院血管外科行外周动脉支架植入术后且符合入组条件的动脉硬化闭塞症病人103例分为治疗组（56例）及对照组（47例）。治疗组每日口服氯吡格雷（75mg／d）＋拜阿司匹林（100mg／d）；对照组术后每日皮下注射低分子肝素1周，并从术后第3天起口服华法令。主要终点事件为支架内闭塞、再狭窄以及临床出血率，次要终点事件为心血管事件、死亡以及药物不良反应等。结果两组病人基线特征比较差异无统计学意义（P〉0．05）。治疗组和对照组急性支架内血栓形成的发生率分别为1例（1．8％）和0例（0％），18个月的再闭塞率分别是3例（5．4％）和5例（10．6％），支架内再狭窄率分别是8例（14．3％）和12例（25．5％，P〉0．05）。治疗组在出血并发症方面显著低于对照组（1．8％VS19．1％，P〈0．01）。两组的心血管事件发生率和病死率无统计学意义。结论氯吡格雷联合阿司匹林可以预防外周动脉支架成形术后的再狭窄。Objective To evaluate the clinical effect and restenosis rate of antiplatelet therapy following peripheral artery angioplasty and stenting. Methods After successful placement of peripheral artery stents to 103 patients with peripheral arterial occlusive disease （PAOD） in were randomized assigned to 2 groups： antiplatelet therapy group receiving clopidogrel 75 mg plus aspirin 100 mg （n = 56） and control group （n = 47） receiving anticoagulation therapy low molecular weight heparin （LWMH） for 7 d plus longterm warfarin. The patients were followed up 1 day, and 1, 6, 12, and 18 months after the operation to undergo color Doppler uhrasonography, and examinations of blood routine, bleeding time, coagulation time, and ankle-brachial Index. The primary endpoint events included major bleeding rate, and composite rate of restenosis and reocclusion. The secondary endpoint events included cardiovascular events, death, and adverse drug reaction. Results There were no significant differences in the baseline data between these two groups. The thrombotic occlusion rate was 1.8% in the antipIatelet group and 0% in control group, and the restenosis rate was 14.3% in the antiplatelet group and 25.5% in control group （ both P 〉 0. 05 ）. The bleeding complication rate of the antiplatelet group was 1.8%, significantly lower than that of the anticoagulation group （19. 1%, P 〈 0. 01 ）. There were not significant differences in cardiovascular event rate and mortality 18 months after operation between these two groups. Conclusion Antiplatelet therapy combined with clopidogrel plus aspirin is effective and safe in preventing restenosis following peripheral artery angioplasty and stenting.

关 键 词：支架 导管插入术 外周 血栓形成 

分 类 号：R686[医药卫生—骨科学]