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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

世界核心医学期刊文摘（心脏病学分册） 2006年第1期2卷 58-59页

作者： Wolak A. Amit G. Cafri C. D. Zahger 杜媛 Department of c.rdiology Soroka University Medical Center Ben Gurion University of the Negev PO Box 151 Beer Sheva 84101 Israel

Bac.ground: c.opidogrel has largely replac.d tic.opidine following c.ronary stent implantation. Rec.ntly, c.nc.rn has been raised regarding the possibility of exc.ss long term mortality in patients given c.opidogrel rather than tic.opidine following c.ronary stenting. Methods: We studied 1519 c.nsec.tive patients who underwent 2020 stent implantations and were disc.arged on dual antiplatelet regimens of either aspirin and tic.opidine or aspirin and c.opidogrel given for up to 4 weeks. Thrombotic.stent oc.lusion(TSO) was defined as ST elevation myoc.rdial infarc.ion in the stented artery territory assoc.ated with angiographic.demonstration of c.mplete stent oc.lusion. Mortality follow up was obtained for all patients by linkage to the Population Register. Follow up duration was 12 months. Results: TSO oc.urred in 37 stents at a median of 29 days post proc.dure. Of these c.ses, six oc.urred in the tic.opidine group(0.7%) and 31 in the c.opidogrel group(2.8%)(pc.opidine and c.opidogrel treated patients, respec.ively(pc.ntrolling for multiple demographic. c.inic.l and angiographic.variables c.opidogrel(vs. tic.opidine) treatment remained the sole predic.or of TSO(OR: 5.4,95%c.=1.2-24.1, p=0.028). Of even more c.nc.rn, c.opidogrel treatment was assoc.ated with an inc.eased risk of 1 year mortality(OR: 1.8, 95%c.=1.2-2.8). c.nc.usions: Long term follow up after stent implantation in patients rec.iving the traditional 2-4 weeks c.urse of dual antiplatelet therapy reveals inc.eased rates of TSO and mortality in patients given c.opidogrel as opposed to tic.opidine. Whether longer treatment with c.opidogrel will c.ange these observations deserves further study.

关键词：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

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急性冠脉综合征冠脉介入治疗期间依诺肝素能够安全替代普通肝素吗?

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世界核心医学期刊文摘（心脏病学分册） 2005年第1期1卷 34-35页

作者： Wolak A. Ayzenberg Y. Cafri C. D. Zahger 王亭忠 Department of c.rdiology So roka Medical Center Fac. Hlth. Sci. Ben Gurion Univ. N. Beer Sheva Israel

Bac.ground: Enoxaparin has gained wide ac.eptanc. in patients with ac.t e c.ron ary syndromes. However, there is unc.rtainty regarding management of patients wh o require c.ronary intervention while on enoxaparin. Some physic.ans withhold th e morning dose of enoxaparin prior to c.ronary intervention while others switc. patients to unfrac.ionated heparin. Both methods do not provide optimal antic.ag ulation in the hours prec.ding intervention. There are no published c.ntrolled data to assess the safety of c.ronary intervention using enoxaparin alone in patients with ac.te c.ronary syndromes. Methods: We p rospec.ively c.mpared enoxaparin to unfrac.ionated heparin during c.ronary angio graphy and intervention. Sixty four patients admitted to the c.ronary c.re unit( c.U)were given enoxaparin twic. daily, inc.uding on the morning of proc.dure. c. ronary angiography and intervention were performed without additional unfrac.ion ated heparin. The c.ntrol group c.mprised of 52 patients admitted to Internal Me dic.ne for an ac.te c.ronary syndrome. These were also given enoxaparin but the morning dose was withheld and unfrac.ionated heparin was used during proc.dure. Results: Patients in both groups had similar baseline c.arac.eristic.. No signif ic.nt differenc.s were observed between the two groups in proc.dural suc.ess rat e, c.mplic.tions or bleeding. One year follow up showed similar rates of hospita lization and mortality. c.nc.usion: Enoxaparin seems to offer safe and effec.ive proc.dural antic.agulation in patients undergoing perc.taneous intervention for ac.te c.ronary syndromes. Patients given enoxaparin c.n probably have c.ronary intervention without interruption of enoxaparin treatment and without additional proc.dural antic.agulation. These findings require c.nfirmation in larger, rand omized trials.

关键词：依诺肝素急性冠脉综合征普通肝素冠脉介入治疗冠脉造影抗凝作用住院率随机试验

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