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|本期目录/Table of Contents|

比伐芦定对女性PCI患者凝血功能及安全性的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2017年第6期
页码:
672-675
栏目:
临床研究
出版日期:
2017-06-01

文章信息/Info

Title:
Effect of bivalirudin on coagulation function and prognosis in women with coronary artery disease undergoing PCI
作者:
韩兆帅1; 文明洪1; 刘 松2; 纪 阳2
(1.青岛大学医学部，山东 青岛 266021;
2.青岛大学附属医院心内科，山东 青岛 266003）
Author(s):
HAN Zhao-shuai1;  WEN Ming-hong1;  LIU Song2;  JI Yang2
(1.Medical College, Qingdao University, Qingdao 266021, Shandong, China 2.Department of Cardiology, Affiliated Hospital, Medical College, Qingdao University, Qingdao 266003, Shandong, China)
关键词:
比伐芦定; 冠状动脉疾病; 女性; 凝血功能; 经皮冠状动脉介入治疗
Keywords:
bivalirudin;  coronary disease;  women;  coagulation function;  percutaneous coronary intervention
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 探讨比伐芦定对女性拟行经皮冠状动脉介入(PCI)治疗的冠心病患者的凝血功能及安全性的影响。方法 将71例女性拟行PCI的冠心病患者随机分为普通肝素组（n=39）和比伐芦定组（n=32）。分别于PCI术前、用药后5 min、术后即刻、停药后0.5、1和2 h测定激活凝血时间（ACT）。用药前、用药结束后6、24和72 h分别测定凝血酶时间（TT）、活化部分凝血酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（Fib）。分别在用药前、用药后24 h测定血小板计数(PLT)。30 d内主要不良心脑血管事件（MACCE）、术后出血并发症以及支架血栓事件。结果 比伐芦定用药后5 min、术后即刻ACT值显著大于肝素组（P<0.01）；停药后30 min和术前，两组患者ACT差异无统计学意义；停药后1 h、2 h ACT比伐芦定组小于普通肝素组（P<0.01）。两组术后凝血4项及PLT，比较均无统计学意义。两组患者随访30 d，MACCE及支架内血栓发生率差异无统计学意义，术后30 d出血总发生率及美国出血学术研究联合会(BARC) Ⅱ-Ⅴ型出血发生率差异有统计学意义（P<0.05）。结论 与普通肝素相比，比伐芦定对女性行PCI的冠心病患者抗凝治疗中起效更快，半衰期短，更安全有效。
Abstract:
AIM To determine the effects of bivalirudin on coagulation function and prognosis in women with coronary artery disease undergoing percutaneous coronary intervention (PCI). METHODS A total of 71 women with coronary artery disease were assigned to two groups: Bivalirudin group (n=32) and heparin group (n=39). Activated clotting time (ACT) was determined at preoperative, 5 min after medication, immediately after operation, and 30 min, 1 h and 2 h after stopping medication. Before operation, and 6 h, 24 h and 72 h after stopping medication, thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen (FIB) index were detected using automated coagulation analyzer. Before operation and 24 h after operation, a platelet count was performed. Net adverse clinical events (NACE) and stent thrombosis at 30-day were compared. RESULTS At 5 min after medication and immediately after operation, ACT in the bivalirudin group was significantly higher (P<0.01) and no significant difference was found at 30 min after stopping medication and preoperatively between the two groups. At 1 h and 2 h after stopping medication, ACT was significantly lower in the bivalirudin group (P<0.01). No significant difference was found in blood coagulation and platelet count after operation between the two groups and the 30-day follow-up revealed no difference in stent thrombosis and in major adverse cardiac or cerebral event between the two groups. All bleeding at 30 days and BARC types 2 through 5 were significantly reduced by using bivalirudin compared with using heparin (P<0.05). CONCLUSION Compared with heparin, bivalirudin produces better effects and quicker recovery and bivalirudin is thus safer and more efficient for women with coronary artery disease undergoing PCI.

参考文献/References

[1]Lansky AJ,Mehran R,Cristea E,et al.Impact of gender and antithrombin strategy on early and late clinical outcomes in patients with non-st-elevation acute coronary syndromes(from the acuity trial)[J].Am J Cardiol,2009,103(9):1196-1203.
[2]Yu J,Mehran R,Grinfeld L,et al.Sex-based differences in bleeding and long term adverse events after percutaneous coronary intervention for acute myocardial infarction:Three year results from the horizons-ami trial[J].Catheter Cardiovasc Interv,2015,85(3):359-368.
[3]Kim LK,Wong SC,Minutello RM,et al.Efficacy and safety of bivalirudin in patients with diabetes mellitus undergoing percutaneous coronary intervention in current clinical practice[J].J Invasive Cardiol,2010,22(3):94-100.
[4]O’Gara PT,Kushner FG,Ascheim DD,et al.2013 ACCF/AHA guideline for the management of st-elevation myocardial infarction:Executive summary: A report of the american college of cardiology foundation/american heart association task force on practice guidelines[J].J Am Coll Cardiol,2013,61(4):485-510.
[5]Collet JP,Cuisset T,Range G,et al.Bedside monitoring to adjust antiplatelet therapy for coronary stenting[J].N Engl J Med,2012,367(22):2100-2109.
[6]Mehran R,Rao SV,Bhatt DL,et al.Standardized bleeding definitions for cardiovascular clinical trials:A consensus report from the bleeding academic research consortium[J].Circulation,2011,123(23):2736-2747.
[7]Cutlip DE,Windecker S,Mehran R,et al.Clinical end points in coronary stent trials:A case for standardized definitions［J］. Circulation, 2007, 115(17):2344-2351.
[8]Rogers WJ,Frederick PD,Stoehr E,et al.Trends in presenting characteristics and hospital mortality among patients with st elevation and non-st elevation myocardial infarction in the national registry of myocardial infarction from 1990 to 2006[J].Am Heart J,2008,156(6):1026-1034.
[9]Basra SS,Tsai P,Lakkis NM.Safety and efficacy of antiplatelet and antithrombotic therapy in acute coronary syndrome patients with chronic kidney disease[J].J Am Coll Cardiol,2011,58(22):2263-2269.
[10]Bairey Merz CN,Shaw LJ,Reis SE,et al.Insights from the nhlbi-sponsored women's ischemia syndrome evaluation(wise)study:Part ii:Gender differences in presentation,diagnosis,and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease[J].J Am Coll Cardiol,2006,47(3):S21-S29.
[11]Pepine CJ,Kerensky RA,Lambert CR,et al.Some thoughts on the vasculopathy of women with ischemic heart disease[J].J Am Coll Cardiol,2006,47(3):S30-S35.
[12]Wenger NK,Speroff L,Packard B.Cardiovascular health and disease in women[J].N Engl J Med,1993,329(4):247-256.
[13]Han Y,Guo J,Zheng Y,et al.Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: The bright randomized clinical trial[J].JAMA,2015,313(13):1336-1346.

备注/Memo

备注/Memo:
收稿日期：2016-11-14.
通讯作者：刘松，主任医师，主要从事心血管介入研究 Email：liusong@medmail.com.cn
作者简介：韩兆帅，硕士生 Email：hanzhaoshuai66@126.com
更新日期/Last Update: 2017-06-06