与噻氯匹定相比,冠状动脉支架置入术后服用氯吡格雷使患者的远期支架内血栓形成发生率及死亡率升高

作     者：Wolak A. Amit G. Cafri C. D. Zahger 杜媛 

作者机构：Department of Cardiology Soroka University Medical Center Ben Gurion University of the Negev PO Box 151 Beer Sheva 84101 Israel 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第1期

页      面：58-59页

学科分类：0831[工学-生物医学工程（可授工学、理学、医学学位）] 1002[医学-临床医学] 08[工学] 10[医学] 

主　　题：支架内血栓形成 冠状动脉支架 噻氯匹定 氯吡格雷 置入术后 死亡率 患者 升高 发生率 服用 

摘      要：Background: Clopidogrel has largely replaced ticlopidine following coronary stent implantation. Recently, concern has been raised regarding the possibility of excess long term mortality in patients given clopidogrel rather than ticlopidine following coronary stenting. Methods: We studied 1519 consecutive patients who underwent 2020 stent implantations and were discharged on dual antiplatelet regimens of either aspirin and ticlopidine or aspirin and clopidogrel given for up to 4 weeks. Thrombotic stent occlusion(TSO) was defined as ST elevation myocardial infarction in the stented artery territory associated with angiographic demonstration of complete stent occlusion. Mortality follow up was obtained for all patients by linkage to the Population Register. Follow up duration was 12 months. Results: TSO occurred in 37 stents at a median of 29 days post procedure. Of these cases, six occurred in the ticlopidine group(0.7%) and 31 in the clopidogrel group(2.8%)(p 0.01). The median time to TSO was 34 days and 28 days in ticlopidine and clopidogrel treated patients, respectively(p 0.01). After controlling for multiple demographic, clinical and angiographic variables clopidogrel(vs. ticlopidine) treatment remained the sole predictor of TSO(OR: 5.4,95%CI=1.2-24.1, p=0.028). Of even more concern, clopidogrel treatment was associated with an increased risk of 1 year mortality(OR: 1.8, 95%CI=1.2-2.8). Conclusions: Long term follow up after stent implantation in patients receiving the traditional 2-4 weeks course of dual antiplatelet therapy reveals increased rates of TSO and mortality in patients given clopidogrel as opposed to ticlopidine. Whether longer treatment with clopidogrel will change these observations deserves further study.