雙重抗血小板藥物治療(dual anti-platelet therapy) 併用aspirin 及thienopyridine，是急性冠心症及冠狀動脈支架置放術後之標準療法。隨著塗藥支架(drug-eluting stents, DES)之廣泛使用及發生晚期血栓之顧慮，aspirin併用 thienopyridine之治療期間已建議由六個月延長至一年以上。然而，長期使用aspirin併用 thienopyridine，伴隨而來的是病患出血機率的增加，以及因急性出血或面臨其他手術而必須停藥時，造成支架血栓之風險。本文報告一名45歲男性病患，因不穩定心絞痛接受冠狀動脈塗藥支架置放。術後兩個月，病患因泡溫泉時頭部承受強力按摩水柱沖擊，引發硬腦膜下出血(subdural hemorrhage)，因而停用aspirin與clopidogrel治療。病患在接受頭顱切開手術後逐步重新加上aspirin與clopidogrel，在停藥期間並無發生支架血栓之事件且恢復良好。我們藉由文獻回顧，探討長期併用aspirin及thienopyridine及置放支架時應有之安全考量，並提出預防手術前後支架血栓(perioperative stent thrombosis)之方法。

Concomitant use of aspirin and clopidogrel is the cornerstone of treatment for patients with acute coronary syndromes and/or undergoing percutaneous coronary interventions. Notice of the rare but catastrophic occurrence of stent thrombosis - in particular 'late' stent thrombosis - in association with the quick and widespread adoption in drug-eluting stents (DES) has focused attention on the prolonged duration of dual antiplatelet therapy. On the basis of available data it is currently recommended that patients receive at least 12 months of uninterrupted
therapy. However, caution must still be exercised because of the potential for significant bleeding complications resulting from the prolonged dual antiplatelet therapy. In addition, surgery and most invasive procedures increase the risk of stent thrombosis because antiplatelet therapy is often discontinued in the perioperative period. We
report the case of a patient who after the lash of water column of hot spring developed a subdural hematoma requiring craniotomy that likely was precipitated by concomitant use of aspirin and clopidogrel within the
second month after implantation a drug-eluting stent. The dual antiplatelet therapy was discontinued during the perioperative period and was restarted as soon as possible after the surgery. The patient showed improvement in his right-sided weakness after surgery without any evidence of stent thrombosis. We reviewed the literatures and discussed the safety concern about implantation of stents and prolonged dual antiplatelet therapy. We also outlined of different strategies to prevent perioperative stent thrombosis.