Perioperative antithrombotic strategy in coronary intervention therapy for the patients with coronary heart disease treated with long-term warfarin anticoagulation
- VernacularTitle:长期服用华法林冠心病患者冠状动脉介入治疗围术期抗栓策略的探讨
- Author:
Xianhua YI
;
Yaling HAN
;
Yi LI
- Publication Type:Journal Article
- Keywords:
coronary disease;
angioplasty,transluminal,percutaneous coronary;
heparin,low-molecular-weight;
warfarin
- From:
Medical Journal of Chinese People's Liberation Army
2001;0(08):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the perioperative antithrombotic strategy in percutaneous coronary intervention(PCI)for the patients with coronary heart disease(CHD)who were treated with long-term warfarin anticoagulation,and to evaluate the safety of the strategy and short-term efficacy.Methods The clinical data of 76 patients were analyzed,who underwent coronary stenting while treated with long-term warfarin anticoagulation.All of them had unstable angina.The reasons of requiring warfarin anticoagulation were cardiac valve replacement [51(67.1%)],pulmonary embolism within half a year [6(7.9%)],and sustained atrial fibrillation at high risk of stroke [19(25.0%)].Warfarin was withdrawn and low molecular weight heparin(LMWH)was administered as alternative anti-thrombus drugs before PCI.PCI was performed when international normalized ratio(INR)went less than or equal to 1.3.LMWH was administered combined with low dose aspirin(100mg/d)and clopidogrel(75mg/d)post PCI,while warfarin was resumed too.When INR arrived at 1.8,LMWH was withdrawn.Warfarin was administered in a dose adjusted to achieve the target INR of 1.8 to 2.3.Clopidogrel was withdrawn 1 month later.Aspirin(75-100mg/d)was continued,and then warfarin was resumed to the dose before PCI.The data of the incidence of ischemic events,major adverse cardiac events(MACE),subacute instent thrombus(SAT),and hemorrhage events during hospital period were analyzed.Results The incidence of hemorrhage events was 5.3%(4/76),one of them was secondary hemorrhage events.The rate of MACE was 1.3%(1/76).No main hemorrhage events and SAT occurred during hospitalization related to regulating antithrombotic strategy.Conclusions As alternatives of warfarin,LMWH is taken before PCI,and then the low dose of aspirin,clopidogrel,LMWH and warfarin are admitted in a short period after PCI,the dosage of warfarin should be accurately adjusted according INR post PCI,and then the LMWH is taken out of service timely,such a strategy is safe and efficient in peri-percutaneous coronary intervention for the patients with CHD who were treated with maintaining warfarin anticoagulation.
