经皮冠状动脉介入治疗术后依诺肝素抗凝治疗对临床事件的影响  

Effect of the strategy with or without enoxaparin on clinical events after percutaneous coronary intervention

作　　者：唐念中[1] 杜贺[2] 陈少萍[2] 石秀英[2] 叶忠[2] 郑兴[2] 

机构地区：[1]解放军第411医院心血管内科,上海200081 [2]第二军医大学长海医院心血管内科

出　　处：《中国介入心脏病学杂志》2015年第3期145-150,共6页Chinese Journal of Interventional Cardiology

基　　金：上海市科委科研计划项目(10411954900)

摘　　要：目的探讨经皮冠状动脉介入治疗(PCI)术后依诺肝素抗凝治疗对临床事件的影响。方法连续入选2011年5月至2013年11月在长海医院、解放军第411医院行PCI术中未发生无复流和冠状动脉夹层等具有血栓高危因素并发症的患者700例,随机分为依诺肝素抗凝组和非抗凝组,对入选患者分别在住院期间、术后1个月、12个月时随访并记录主要不良心脑血管事件(MACCE)的发生情况。结果抗凝组与非抗凝组住院期间(2.0%比2.3%,P=0.790)、术后1个月(3.2%比3.5%,P=0.826)、术后12个月(6.4%比6.7%,P=0.869)MACCE的发生率比较,差异均无统计学意义。两组患者住院期间严重出血的发生率比较,差异无统计学意义(0.6%比0.3%,P=0.565);抗凝组小出血的发生率高于非抗凝组(27.9%比20.4%,P=0.022)。结论 PCI术后非抗凝组与抗凝组相比,未增加MACCE发生率,且降低了住院期间小出血并发症的发生率。PCI术中若未发生无复流和冠状动脉夹层等具有血栓高危因素的并发症时,可无需抗凝治疗。Objective To explore the effect of the strategy with or without enoxaparin on clinical events after percutaneous coronary intervention（ PCI）. Methods We recruited 700 patients consecutively who had undergone percutaneous coronary intervention and without procedure complications in the cardiology department of Changhai Hospital and No. 411 Hospital of PLA from May 2011 to November 2013. The patients were randomly assigned to anticoagulation group treated with enoxaparin and non-anticoagulation group. Clinical follow up was carried out during hospitalization,1 and 12 months after PCI. The primary points were rates of major adverse cardiac and cerebrovascular events（ MACCE）. Results MACCE occurred in 2. 0% in the anticoagulation group versus 2. 3% in the non-anticoagulation group,respectively（ P = 0. 790） during hospitalization. The rates of major bleeding were comparable between the 2 groups（ 0. 6% vs. 0. 3%,P = 0. 565） but minor bleeding rates were higher in the anticoagulation group（ 27. 9%vs. 20. 4%,P = 0. 022）. The MACCE rates after 1 month were 3. 2% in the anticoagulation group vs.3. 5% in the non-anticoagulation group,respectively（ P = 0. 826）; and after 12 month the rates were 6. 4%vs. 6. 7%,respectively（ P = 0. 869）. No significant differences in MACCE were observed between the two groups. Conclusions The MACCE rate after PCI in patients without post operation anticoagulation was not increased as compared with patients received enoxaparin anti-coagulation. The rate of minor bleeding during hospitalization is lower in the non-anticoagulation group than that in the anticoagulation group. The results suggest that routine anticoagulation therapy after PCI is not necessary for patients without procedure complications.

关 键 词：经皮冠状动脉介入治疗 依诺肝素 主要不良心脑血管事件 出血 

分 类 号：R541.4[医药卫生—心血管疾病]