磺达肝癸钠联合替罗非班在复杂冠状动脉介入治疗的应用  

The clinical efficacy and safety of fondaparinux combined with tirofiban hydrochloride in patients with acute coronary syndrome undergoing complex percutaneous coronary intervention

作　　者：李牧蔚[1] 赵香梅[1] 饶立新[1] 陈岩[1] 朱中玉[1] 高传玉[1] 

机构地区：[1]河南省人民医院心内科,郑州450003

出　　处：《中华内科杂志》2013年第12期1037-1040,共4页Chinese Journal of Internal Medicine

基　　金：河南省卫生厅科学创新工程项目（201003094）

摘　　要：目的观察磺达肝癸钠联合替罗非班对择期行复杂经皮冠状动脉介入治疗（PCI）患者手术的疗效及安全性。方法389例不稳定性心绞痛（uA）择期行复杂PCI手术患者，术前分别皮下注射磺达肝癸钠（192例）或依诺肝素（197例），术后联合应用盐酸替罗非班，观察术后2、4周的出血、血栓及主要不良心脏事件（MACE）的发生率。结果磺达肝癸钠与依诺肝素抗凝疗效相似，术后未见重度出血发生，轻度及微量出血发生率低（0比1．5％及18．2％比34．5％，P值=0．04和〈0．001），术后2、4周MACE发生率差异无统计学意义（术后死亡、再发心肌梗死、顽固性心肌缺血、靶血管重建术发生率分别0．5％比0．5％、0．5％比1．0％、1．6％比1．0％、2．1％比1．5％；2周时0比0、1．0％比0．5％、1．0％比1．5％、0．5％比1．0％；4周时0．5％比0．5％、0．5％比0．5％、2．6％比2．0％、0比0．5％；P值均〉0．05）。结论磺达肝癸钠联合替罗非班对择期行复杂PCI患者的疗效与依诺肝素联合替罗非班相当，不良事件发生率低，较安全。Objective To explore the efficacy and safety of fondaparinux combined with tirofiban in patients with high risk unstable angina （UA） undergoing complex percutaneous coronary intervention （PCI）. Methods A total of 389 patients were enrolled and randomized into two groups receiving either fondaparinux with tirofiban or enoxaparin with tirofiban. Bleeding, thrombosis and main adverse cardiovascular events （MACE） were compared between the two groups during hospitalization, at week 2 and week 4 after discharge. Results No severe bleeding was observed during hospitalization in the both groups, while lower rate of mild and minor bleeding was shown in the fondaparinux group （0 vs 1.5% and 18.2% vs 34. 5% ,P =0. 04 and P 〈0. 001 respectively）. No difference was found between the two groups in the rate of MACE during hospitalization, at week 2 and week 4 weeks after discharge. The rates of death, recurrent myocardial infarction, refractory myocardial ischemia and target vessel revascularization were 0. 5% vs 1.0%, 0.5% vs 1.0%, 1.6% vs 1.0% and 2. 1% vs 1.5% during hospitalization;0 vs 0, 1.0% vs 0.5%, 1.0% vs 1.5%, 0.5% vs 1.0% at week2 after discharge; 0.5% vs0.5%, 0.5% vs0.5%, 2. 6% vs 2.0%, 0 vs 0.5% at week 4 after discharge （all P values 〉 0.05）. Conclusion The combination therapy of fondaparinux and tirofiban is of good safety and efficacy in high risk UA patients undergoing complex PCI.

关 键 词：血管成形术 经腔 经皮冠状动脉 抗凝药 

分 类 号：R541.4[医药卫生—心血管疾病]