抗血小板療法とシロリムス放出ステントインプランテーション後のステント血栓症
Takeshi Kimura1, Takeshi Morimoto, Yoshihisa Nakagawa
1Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan. taketaka@kuhp.kyoto-u.ac.jp
Circulation
|February 11, 2009
まとめ
薬剤排出ステントの挿入後,チエノピリジンとアスピリンの投与を中止すると,ステントの血栓形成のリスクが著しく増加します. ティエノピリジンのみを停止すると,このリスクは上昇せず,半年を超える長期的な利益は限られていることを示唆しています.
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:
- 薬剤排出ステント (DES) の移植後に抗血小板治療を中止することはリスクがあります.
- DESの後の長期的なアウトカムとステント血栓症については,さらなる調査が必要です.
研究 の 目的:
- 抗血小板治療の中止がステントの血栓形成および臨床結果に与える影響を調査する.
- DESインプランテーション後のチエノピリジンおよびアスピリンの停止に関連するリスクを評価する.
主な方法:
- 日本でシロリムス放出ステントを投与された患者10,778人を対象とした観察研究.
- フォローアップ中の抗血小板治療の状態の将来的な収集.
- ステントトロンボシスの分析と2年後の臨床結果.
主要な成果:
- ティエノピリジンとアスピリンの投与を中止すると,複数の間隔でステントの血栓形成のリスクが著しく増加します.
- ティエノピリジン単独投与を中止しても,ステント栓塞率が上昇することはありませんでした.
- ティエノピリジン使用者と非使用者の間で24ヶ月で死亡率や心筋梗塞の有意な差はありません (里程碑的な分析).
結論:
- 二重抗血小板治療 (ティエノピリジンとアスピリン) を中止すると,ステントの血栓形成のリスクが増加します.
- ティエノピリジン単独治療の中止は,ステントの血栓症を増加させるようには見えません.
- チエノピリジン療法によるシロリムス放出ステントの埋め込み後の6ヶ月以上の臨床的効果は明らかではない.
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