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ステントを挿入した後のレステノスを減少させるためのエノキサパリンの局所投与:最初の多センター試験の結果:ポーランド系アメリカ人局所Lovenox NIR評価研究 (POLONIA研究)
R S Kiesz1, P Buszman, J L Martin
1Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, TX 78229-7872, USA.
Circulation
|January 4, 2001
まとめ
冠動脈ステント設置前の局所的なエノキサパリン投与は,デノボ病変におけるレステノシスと遅い光の損失を著しく減少させた. このアプローチは,冠動脈ステント移植後の結果を改善するための有望な戦略です.
科学分野:
- 心臓病学 心臓病学
- 介入性心臓病学 介入性心臓病学
- 薬理学 薬理学とは
背景:
- インティマル・ハイパープラジアは,冠動脈ステントの植え付け後のレステノシスの主要な原因です.
- エノキサパリンは,前臨床研究において,滑らかな筋肉細胞の増殖を抑制する効果を示している.
- レステノスの減少は,冠動脈ステントの長期的な成功に不可欠です.
研究 の 目的:
- デノボ冠動脈病変のステント化後のレステノシスの予防における内腔エノキサパリン投与の有効性を評価する.
- 局所的なエノキサパリン投与と標準的な全身ヘパリニゼーションを比較する.
主な方法:
- 冠動脈ステントを挿入する100人の患者を対象とした予期的なランダム化試験です.
- 患者は,局所的なエノキサパリン投与で,全身ヘパリンを減少させたか,または標準的な全身ヘパリニゼーションのいずれかに割り当てられました.
- プライマリエンドポイントは,遅い発光損失であり,二次エンドポイントは,6ヶ月で主要な不良心事および再発光症を含む.
主要な成果:
- 局所的なエノキサパリン投与は,遅い光の損失 (0.76mm対1.07mm,P<0.001) を著しく減少させた.
- エノキサパリン群では,レステノシス発症率が低かった (10%対24%,P<0.05).
- 標的病変の再血管化は,エノキサパリン群でも減少した (8%対22%,P<0.05).
結論:
- エノキサパリンの局所内静脈投与は,デノボ冠動脈病変のステント化後の遅い光の損失と回復を減らすのに有効です.
- これは,ステント移植後のレステノシスの減少のために局所薬投与の利点を示す最初の予見的なランダム化試験を表しています.
- この発見は,介入性心臓病学の成果を改善するための新しい治療戦略を示唆しています.
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