| Objective:A retrospective study to assess the efficacy and safty of low dose of tirofiban plus routine dose of aspirin and clopidogrel on preventing coronary stent thrombosis (ST)Methods:3063patients with percutaneous coronary intervention (PCI) from December in2003to December in2010were divided into two groups according to the time order.1164patients in control group were not treated with tirofiban, while1899patients in experimental group were treated with low dose of tirofiban. The patients in the two groups were both treated with load quantity of aspirin300mg at admission,then100mg or300mg once a day,and treated with load quantity of clopidogrel300mg or600mg,then75mg once a day,which should be sustained to9-12months at least. Partial patients with left main coronary artery should be added to cilostazol50～100mg twice a day during the two or three days after PCI or treated with clopidogrel150mg once a day.After30days cilostazol should be discontinued, and the dose of clopidogrel should be changed to75mg once a day. When written informed consent was obtained,the patients in experimental group would be treated with tirofiban vein autotransfusion in5-10minutes before PCI.For the patients of emergency PCI (AMI or ACS),were treated with load quantity of tirofiban intravenous4～5μg/kg or5ml/50kg in3minutes firstly,then0.05～0.075μg/kg/min or3～4ml/50kg/h vein autotransfusion sustained to36～48hours;for the patients of selective PCI,be only treated with tirofiban by0.05～0.075μg/kg/min or3-4ml/50kg/h vein autotransfusion sustained to36～48hours; for patients occured to "slow-flow"(TIMI flow0～1grade) during PCI,5～10ml tirofiban was injected in the coronary artery over6-8minutes.When stopped using tirofiban, antiplatelet therapy in triple antiplatelet group was the same as dual antiplatelet group.The incidence of stent thrombosis and adverse effect (bleeding,transfusion and thrombocytopenia) during30days after PCI in the two groups were observed.Results:In contrast with control group,the incidence of stent thrombosis in experimental group was reduced obviously,which ratio was2(0.11%) vs14(1.20%),and was significantly different with control group in statistic (P=0.000).The patients in the two groups didn’t occur major bleeding or blood transfusion,only occurred minor bleeding [experimental group vs control group,8(0.42%) vs4(0.34%),P=0.738]. The incidence of thrombocytopenia in experimental group was higher than control group obviously,but was not different with control group in statistic[9(0.47%) vs1(0.08%),P=0.068].Conclusion:Triple antiplatelet therapy with low dose of tirofiban combined with routine dose of aspirin and clopidogrel:(1) decreased obviously the incidence of stent thrombosis during30days after PCI;(2)didn’t occur major bleeding or blood transfusion;(3) increased the incidence of thrombocytopenia obviously,but was not different with control group in statistic. So triple antiplatelet therapy with low dose of tirofiban combined with routine dose of aspirin and clopidogrel may be the ideal treatment strategy to the patients with PCI at present. |
