应用血栓弹力图指导PCI术后脑出血抗血小板治疗

摘要

目的 探讨血栓弹力图指导经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后脑出血抗血小板治疗的临床应用.方法 对我院收治的PCI术后脑出血在血栓弹力图指导下行抗血小板治疗1例的临床资料进行回顾性分析.结果 本例因发作性胸闷、胸痛2h收入院.诊断为急性前壁心肌梗死,行急诊PCI,术后予双联抗血小板治疗6d出院.出院3d后出现头痛、视物模糊、步态不稳,自行口服感冒药无效,夜间出现嗜睡、恶心、呕吐,急诊头颅CT检查示脑出血(右侧颞枕顶部).考虑脑出血与PCI术后双联抗血小板治疗相矛盾,予脱水、降颅压、营养神经等治疗,同时利用血栓弹力图指导抗血小板治疗,后病情好转出院.随访4个月,病情稳定.结论 应用血栓弹力图可实现PCI术后脑出血个体化抗血小板治疗.%Objective To study application of thrombelastography (TEG)-guided antiplatelet therapy strategy in a patient with cerebral hemorrhage following percutaneous coronary intervention (PCI).Methods Clinical data of 1 patient with cerebral hemorrhage receiving TEG-guided antiplatelet therapy after PCI were retrospectively analyzed.Results The patient,a 76-year-old male,was admitted to hospital for episodic chest distress and chest pain for 2 hours.On the basis of diagnosis of acute anterior myocardial infarction,he received PCI in emergency.He was discharged from hospital at 6 days postoperatively using dual anti-platelet therapy.He complained of headache,blurred vision and unsteady gait 3d after discharge.Cold medicine taken by himself did not relieve the symptoms,and he had lethargy,nausea,and vomiting at night.An emergency head CT scan showed cerebral hemorrhage (at right temporal-occipital-parietal junction).Cerebral hemorrhage might contradict with dual anti-platelet therapy after PCI,therefore,dehydration,reducing intracranial pressure and nutritional nerves were initiated,coupled with TEG-guided antiplatelet therapy.He was discharged from hospital at 21 days after active treatment.At 4-month follow-up,he reported a stable condition.Conclusion TEG can be used to guide individualized antiplatelet therapy in patient with cerebral hemorrhage after PCI.