Objective To compare the rates of major adverse cardiovascular events(MACE)and bleeding events of three different antiplatelet strategies during temporary withdrawal of antiplatelet therapy for non-cardiac surgery within 1 year after drug-eluting stent (DES)implantation.Methods Retrospectively analyzed 42 patients who had accepted non-cardiac surgery and required temporary withdrawal of antiplatelet therapy within 1 year after drug-eluting stent implantation. The patients were divided into three groups according to the bridging antiplatelet strategies they received.All patients discontinued clopidogrel 5 to 7 days before the non-cardiac surgery. The tirofiban group was treated with intravenous tirofiban 0.4ug/kg·min in the first 30 min followed 0.1μg/(kg·min). The dosage was reduced by half for patients whose Creatinine clearance were less than 30 ml/min.The low molecular weight heparin group was treated with subcutaneous enoxaparin (Clexane 4000 AxaIU, once per day) .The asprin group was given only oral asprin(100 mg, once per day) . Tirofiban and low molecular weight heparin were continued until clopidogrel was resured. Perioperative cardiovascular events and serious bleeding were recorded. Results The rates of major adverse cardiac events in the tirofiban and the low molecular weight heparin group were lower than the aspirin group. Acute myocardial infarction caused by confirmed in-stent thrombosis was diagnosed in one patient in the aspirin group. One case of asymptomatic ST-T changes was found in the low molecular weight the aspirin group. 3 cases in the aspirin group presented ST-T changes on ECG and among them 1 case was STEMI due to LAD thrombosis requiring primary and 2 other cases were agina pectoris.There were no significant differences in bleeding events among the three groups.Conclusions Potential for the perioperative management with tirofiban or low molecular weight heparin is safe and feasible for patients who had recently undergone DES implantation and required noncardiac surgery with the interruption of antiplatelet therapies.%目的 比较三种抗栓策略对药物洗脱支架(DES)置入术1年内需接受非心脏外科手术患者的主要不良心血管事件和出血发生率.方法 回顾性分析因冠心病行DES置入术且正行双联抗血小板药物治疗(氯吡格雷和阿司匹林)并于置入1年内需行非心脏外科手术的患者42例,根据抗栓策略分为三组.替罗非班组和低分子肝素组患者均于术前5～7 d停用双联抗血小板药物治疗.替罗非班组30 min内以0.4μg/(kg﹒min)静脉输注替罗非班,30 min后调整速度为0.1μg/(kg﹒min),继而以0.1μg/(kg﹒min)的速度维持,肌酐清除率下降的患者减量;低分子肝素组给予低分子肝素钠(克塞)4000 AxaIU皮下注射,每日1次;阿司匹林组仅继续使用阿司匹林75 mg,每日1次.三组患者术后根据分组继续使用替罗非班、低分子肝素钠或阿司匹林直至重新恢复双联抗血小板治疗.比较三组患者围术期主要不良心血管事件和出血发生率.结果 替罗非班组和低分子肝素组主要不良心血管事件发生率明显低于阿司匹林组,阿司匹林组有1例支架内血栓形成.三组出血发生率比较,差异无统计学意义(P>0.05).替罗非班组和低分子肝素组围术期均无患者出现心绞痛或心肌梗死,低分子肝素组有1例患者心电图出现ST-T改变,但无自觉症状,考虑与糖尿病导致的心脏交感神经变性有关.阿司匹林组有3例出现心电图ST-T改变,其中2例为心绞痛发作,1例发生急性ST段抬高型心肌梗死,行急诊经皮冠状动脉介入治疗,诊断为前降支支架内血栓形成,给予血栓抽吸等处理后好转.三组患者均无心血管相关性死亡.三组患者围术期出血量比较,差异无统计学意义(P>0.05).替罗非班组有1例股骨头置换术后出现伤口渗血,皮下瘀斑,未特殊处理,自行好转.低分子肝素组1例消化道出血,表现为黑便,未见呕血,给予药物治疗后好转.结论 替罗非班和低分子肝素可作为中断双联抗血小板药物治疗期间的"过渡治疗",可安全有效地用于DES置入术后需接受外科手术的患者.
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