Avtor/Urednik     Šabovič, Mišo; Blinc, Aleš
Naslov     Antritrombotična zaščita pri žilnih opornicah
Prevedeni naslov     Antithrombotic treatment in patients with arterial stents
Tip     članek
Vir     Med Razgl
Vol. in št.     Letnik 38, št. Suppl 3
Leto izdaje     1999
Obseg     str. 121-7
Jezik     slo
Abstrakt     Vascular stents have improved treatment of arterial stenoses and occlusions. The use of coronary stents is rapidly growing, whereas aortic, iliofemoral, carotid and renal stents are not widely used so far. In comparison to balloon angioplasty, stents reduce the rate of acute vessel closure and long-term restenosis, but stenting is limited by thrombotic occlusions. Acute thrombosis occurs in the first 24 hours and subacute thrombosis in the first three weeks after implantation. Anatomic and clinical factors associated with stent thrombosis have been recognised. The most important is incomplete stent dilation, other factors are wall dissection, intraluminal thrombus, longer and narrowed stented segment. The mechanisms and molecular reactions which are involved in the development of thrombosis are not completely known. The main step is activation of platelets and/or the coagulation system. it seems that the activation of platelets has a crucial role. Currently, recommended antighrombotic treatment for coronary stenting is combined antiaggregatory treatment with aspirin (80-325 mg/d) and ticlopidine (250-500 m/d, two to four weeks). Since there is a lack of trials addressing the antithrombotic treatment for aortic, iliofemoral, carotid and renal stents, no clear recommendation exists. Both, combined antiagregatory treatment with aspirin and ticlopidine or solely aspirin have been used in different trials.
Izvleček     Žilne opornice predstavljajo pomemben napredek v zdravljenju arterijskih zožitev in zapor. Največ kliničnih izkušenj je s koronarnimi opornicami, mnogo manj pa z opornicami za aorto, iliofemoralne, ledvične in karotidne arterije. V primerjavi z balonsko razširitvijo so takojšnje zapore in kasne restenoze po vstavitvi opornice redkejše, nov zaplet pa je tromboza opornice. Do tromboze pride v prvih urah (akutna tromboza) ali v prvih treh tednih (subakutna tromboza) po vstavitvi opornice. Anatomski in klinični dejavniki, ki so povezani s pojavom tromboze opornice, so že dobro poznani. Najpomembnejši dejavnik je premalo razpeta opornica. Na pojav tromboze vplivajo tudi disekcija žilne stene, strdek v arteriji, poseg na ozki arteriji in v dolgem segmentu idr. Mehanizmi in molekularne spremembe, ki so vpleteni v razvoj tromboze, še niso natančno proučeni. Ključni korak v razvoju tromboze je aktivacija trombocitov in koagulacijskega sistema. Rezultati kliničnih raziskav kažejo, da je verjetno pomembnejša aktivacija trombocitov. Trenutno priporočeno antitrombotično zdravljenje pri bolnikih s koronarno žilno opornico je kombinirano antiagregacijsko zdravljenje z aspirinom (80 do 325 mg/dan) in tiklopidinom (250 do 500 mg/dan, dva do štiri tedne). Pri bolnikih z aortno, iliakalno, femoralno, ledvično in karotidno arterijsko žilno opornico še ni bilo opravljenih dovolj raziskav za trdna priporočila. Uporabljajo tako zdravljenje z aspirinom in tiklopidinom kot tudi zdravljenje samo z aspirinom.
Deskriptorji     ARTERIAL OCCLUSIVE DISEASES
STENTS
FIBRINOLYTIC AGENTS
ANGIOPLASTY, BALLOON