不同抗血栓方案预防下肢动脉硬化闭塞症支架植入后再狭窄的临床研究  

Clinical study of different antithrombotic regimens in preventing restenosis after stent implantation in lower extremity arteriosclerosis obliterans

作　　者：银林 李荣荣 任素仪 王贵明[1] Yin Lin;Li Rongrong;Ren Suyi;Wang Guiming(Department of Vascular Surgery,First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China)

机构地区：[1]山西医科大学第一医院血管外科,山西太原030001

出　　处：《血管与腔内血管外科杂志》2023年第12期1480-1483,共4页Journal of Vascular and Endovascular Surgery

基　　金：山西省科技厅自然科学基金面上项目(201701D121175)。

摘　　要：目的探讨不同抗血栓方案预防下肢动脉硬化闭塞症(ASO)支架植入后再狭窄的安全性及疗效。方法收集2017年1月至2021年5月于山西医科大学第一医院行腔内支架植入治疗的106例ASO患者,根据术后抗血栓方案不同将其分为利伐沙班组(n=48)和对照组(n=58),两组患者术前均给予低分子肝素抗凝治疗1周,腔内支架植入术后,对照组口服阿司匹林肠溶片+硫酸氯吡格雷片,利伐沙班组口服阿司匹林肠溶片+利伐沙班片,比较两组患者的临床疗效和安全性。结果术后6、12个月,利伐沙班组患者一期通畅率均高于对照组患者,差异均有统计学意义(P﹤0.05)。两组患者动脉栓塞发生率、截肢率比较,差异均无统计学意义(P﹥0.05)。术后3个月,利伐沙班组患者APTT长于对照组患者,差异有统计学意义(P﹤0.05)。两组患者出血率比较,差异无统计学意义(P﹥0.05)。结论ASO腔内支架植入术患者采用低分子肝素+利伐沙班+阿司匹林能够有效提升术后一期通畅率,预防术后急性动脉栓塞及大截肢事件,且不增加出血风险,安全性较好。Objective To investigate the safety and efficacy of different antithrombotic regimens in preventing restenosis after stent implantation in lower extremity arteriosclerosis obliterans(ASO).Method A total of 106 ASO patients who underwent intraluminal stent implantation in the First Hospital of Shanxi Medical University from January 2017 to May 2021 were collected.They were divided into rivaroxaban group(n=48)and control group(n=58)according to different postoperative antithrombotic regimens.Both groups were given anticoagulant treatment with low molecular weight heparin for one week before the surgery,after intraluminal stent implantation,the control group took aspirin enteric-coated tablets+clopidogrel sulfate tablets orally,and the rivaroxaban group took aspirin entericcoated tablets+rivaroxaban tablets orally.The clinical efficacy and safety of the two groups of patients were compared.Result At six and twelve months after the surgery,the primary patency rate in the rivaroxaban group was higher than that of the control group,the differences were statistically significant(P<0.05).There were no statistically significant differences in the incidence rate of arterial embolism and amputation rate between the two groups of patients(P>0.05).Three months after the surgery,the activated partial thromboplastin time(APTT)of the rivaroxaban group was longer than that of the control group,the difference was statistically significant(P<0.05).There was no statistically significant difference in the bleeding rates between the two groups(P>0.05).Conclusion The use of low molecular weight heparin+rivaroxaban+aspirin in patients undergoing ASO intracavitary stent implantation can effectively improve the postoperative primary patency rate,prevent postoperative acute arterial embolism and major amputation events,and do not increase the risk of bleeding,with good safety.

关 键 词：下肢动脉硬化闭塞症 抗血栓方案 腔内治疗 

分 类 号：R543[医药卫生—心血管疾病]