新型口服抗凝剂联合抗血小板治疗下肢动脉术后支架再狭窄的临床研究  

Clinical study of new oral anticoagulant combined with antiplatelet on in-stent stenosis after lower extremity artery angioplasty

作　　者：杨永久[1] 丁旭[1] 满新贺 李力宏 YANG Yongjiu;DING Xu;MAN Xinhe;LI Lihong(Department of Vascular Surgery,Beijing Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京市垂杨柳医院血管外科,100020

出　　处：《心肺血管病杂志》2020年第7期831-834,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:观察新型口服抗凝剂(NOACs)联合抗血小板治疗下肢动脉支架内再狭窄的安全性和临床疗效。方法:选取我院收治89例下肢动脉术后支架内再狭窄患者,分别进行再次腔内介入治疗或抗凝和扩血管保守治疗,出院后均采用NOACs联合抗血小板治疗,随访检测血小板、凝血功能、肝肾功能等指标,观察患者出血事件、过敏反应及下肢动脉超声、踝肱指数(ABI)和下肢缺血症状改变等情况。结果:所有89例患者治疗后下肢症状明显缓解出院,随访期间2例出现便血,无严重脏器出血并发症;无严重肝肾功能损害、过敏反应并发症;11例足溃疡患者创面换药后均愈合;治疗组30例随访1年后发现5例支架内再狭窄,无下肢缺血症状,ABI值和治疗前相比显著升高,差异具有统计学意义;保守组59例随访期内再次症状加重者7例,经扩血管治疗症状缓解,ABI值和治疗前相比有升高,但差异无统计学意义。结论:NOACs联合抗血小板治疗安全性高,可有效缓解支架内再狭窄引起的下肢缺血症状。Objective:To investigate clinical effica cy and safety of new oral anticoagulant(NOACs)combined with antiplatelet on in-stent stenosis in patients with lower extremity arteriosclerosis obliterans.Methods:89 patients with in-stent stenosis after lower extremity artery angioplasty were treated by intervention therapy or anticoagulant with vasodilator respectively.NOACs combined with antiplatelet therapy were used after discharge.PLT,coagulation,liver and kidney function,bleeding events,allergic reactions were followed up after 6 months,12 months and 24 months respectively.Arterial ischemia of lower extremity were assesmented by doppler ultrasound and ABI.Results:Symptoms of all 89 patients was relieved after treatment.During the follow-up period,mild gastrointestinal bleeding found in 2 cases;no complications of serious organ bleeding observed,liver and kidney function damage and allergic reaction;11 cases with foot ulcer healed after treatment;5 cases in the treatment group were found in-stent stenosis without ischemia symptoms one year later;and the ABI value was significantly higher than that before treatment.The ABI value of the conservative group was higher than that before treatment,but there was no statistical difference.Conclusions:NOACs combined with antiplatelet is a safe and effective treatment in-stent stenosis in lower extremity arteriosclerosis obliterans.

关 键 词：新型口服抗凝剂 抗血小板治疗 支架内再狭窄 下肢动脉 动脉粥样硬化闭塞症 

分 类 号：R54[医药卫生—心血管疾病]