【摘要】 目的 对经皮冠状动脉介入治疗（PCI）后1个月内意外中断双联抗血小板治疗（DAPT）的45例患者主要不良心血管事件（MACE）发生情况进行分析。方法 以2017年1月1日至2022年12月31日在河北医科大学第三医院成功进行PCI并置入至少1枚支架（除外急性ST段抬高型心肌梗死、单纯药物涂层球囊或非药物球囊治疗以及同时口服抗凝药物治疗）者4 876例为研究对象，对其中术后1个月内意外中断DAPT患者45例进行分析，随访其临床结局。结果 45例患者中男性29例，女性16例，年龄48～80(61.7±15.3)岁。中断DAPT原因包括：出血35例；恶性肿瘤手术3例（含2例出血患者）；创伤5例；血液病2例；自行终止DAPT 2例。停药期间有低分子肝素替代治疗的6例患者均未发生支架内血栓形成或其他MACE；无抗栓替代治疗的39例患者中，5例发生了支架内血栓和急性心肌梗死（11.1%,5/45），除1例为PCI术后2周自行停用DAPT者，其余4例均为PCI术后2周内合并出血患者，停用DAPT时间均在10 d以上，支架内血栓形成分别发生于停用DAPT后第10天、第11天、第11天、第13天，其中2例并发急性左心衰竭，1例死亡；另有1例因脑干出血死亡。结论 PCI术后过早停用DAPT潜在很大风险，停药时间早、停药持续时间长、无替代治疗者风险尤高。更多还原

【Abstract】 Objective To analyze the incidence of major adverse cardiovascular events(MACE) in 45 patients who unexpectedly interrupted dual antiplatelet therapy(DAPT) within one month after percutaneous coronary intervention(PCI). Methods A total of 4 876 patients who successfully underwent PCI and implanted one or more stents(excluding acute ST segment elevation myocardial infarction, drug coated balloon or non-drug coated ballooon only, and oral anticoagulants)between January 1, 2017 and December 31, 2022 were selected as the study subjects. A total of 45 patients with unexpected interruption of DAPT within one month after PCI were analyzed, and their clinical outcomes were followed up. Results Among the 45 patients, there were 29 males and 16 females, aged 48–80(61.7±15.3)years. The reasons for interrupting DAPT include: 35 cases of bleeding; 3 cases of malignant tumor surgery(including 2 bleeding patients); 5 cases of trauma; 2 cases of hematological diseases; 2 cases of self-interruption of DAPT. 6 patients who received low-molecular-weight heparin replacement therapy during the discontinuation period did not experience stent thrombosis or other MACE. Among the 39 patients without antithrombotic replacement therapy, 5 developed stent thrombosis and acute myocardial infarction(5/45,11.1%). Except for 1 patient who voluntarily stopped DAPT 2 weeks after PCI, the remaining 4 cases were those who with concurrent bleeding within 2 weeks after PCI. DAPT was stopped for more than 10 days, and stent thrombosis occurred on the 10th, 11th, 11th, and 13th days after DAPT was stopped. Among the 4 patients, 2 patients developed acute left heart failure and 1 patient died. Another case died due to brainstem hemorrhage. Conclusions Premature interruption of DAPT after PCI has a high potential risk. Patients who stop taking medication earlier, for a longer duration, and without replacement therapy have a higher risk.更多还原