在不稳定冠状动脉综合征患者干预前对长期抗血栓前治疗 ("冷却"策略) 的评估:随机对照试验
Franz-Josef Neumann1, Adnan Kastrati, Gisela Pogatsa-Murray
1Medizinische Klinik, Technische Universität München, Munich, Germany. Franz-Josef.Neumann@herzzentrum.de
JAMA
|September 25, 2003
概括
在不稳定的冠状动脉综合征中,在导管干预之前进行长时间的抗血栓预治疗并没有改善结果. 通过强烈的抗血小板治疗进行即时干预,显示出更好的结果,心肌梗塞较少,死亡率没有增加.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 血栓形成的原因是血栓形成.
背景情况:
- 不稳定的冠状动脉综合征往往需要导管干预,先进行抗血栓治疗以减轻风险.
- 支持常规抗血栓前治疗的临床试验证据有限.
研究的目的:
- 评估长时间的抗血栓前治疗是否与早期干预相比,改善了急性不稳定冠状动脉综合征的结果.
- 测试推迟预治疗干预对患者有益的假设.
主要方法:
- 一项随机对照试验,涉及410名患有不稳定性胸痛和ST段抑郁或心脏托罗宁T升高的患者.
- 患者被随机分配到3-5天的抗血栓前治疗或早期干预 (<6小时) 用未分离的肝素,阿司匹林,克洛皮多格雷尔和蒂罗菲班.
主要成果:
- 主要终点 (大型非致命性心肌梗塞或死亡的30天发病率) 发生在11.6%的长期预治疗者和5.9%的早期干预者中 (RR, 1.96;P=.04).
- 长期预治疗组的风险增加是由于在导管注射之前发生的事件.
- 透后事件的发生率在各组之间是相似的.
结论:
- 延迟用于长期抗血栓前期治疗的导管干预不会改善不稳定的冠状动脉综合征的结果.
- 通过强烈的抗血小板治疗进行即时干预,与长时间的预治疗策略相比或优越.
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