ST段抬高型心肌梗死直接经皮冠状动脉介入术中抗凝治疗:肝素抑或比伐卢定?  

Anticoagulation Therapy in STEMI Patients during Primary PCI:Heparin or Bivalirudin?

作　　者：林星[1] 罗素新[1] 

机构地区：[1]重庆医科大学附属第一医院心血管内科,重庆400016

出　　处：《心血管病学进展》2015年第3期308-311,共4页Advances in Cardiovascular Diseases

基　　金：国家自然科学基金面上项目(81270210);国家临床重点专科建设项目(2011-08);重庆市科委课题(CSTC2012JJA0911)

摘　　要：对于进行经皮冠状动脉介入术治疗的急性冠状动脉综合征患者而言,严重出血事件与患者临床预后息息相关。因此,在抗凝治疗中减少出血并发症与预防缺血事件同等重要。已有大量临床实验证实作为直接凝血酶抑制剂的比伐卢定在降低缺血事件发生的基础上可以进一步减少出血事件,尤其是对于非ST段抬高急性冠状动脉综合征的患者而言,这一优势已经得到广泛认可。但是对于急性ST段抬高型心肌梗死直接经皮冠状动脉介入术治疗的患者而言,术中选择肝素还是比伐卢定抗凝仍然是目前争论的热点问题。现对ST段抬高型心肌梗死患者直接经皮冠状动脉介入术抗凝治疗策略的主要研究进展进行总结,结合目前中国实际情况提供一些可行的抗凝治疗方案的建议。Severe bleeding events are associated with the prognosis in acute coronary syndrome patients after percutaneous coronary in-tervention（PCI）.Therefore, reducing bleeding complications is as important as preventing ischemic events.A large number of clinical trials have proved that bivalirudin （as a direct thrombin inhibitor） can not only reduce ischemic events but also reduce bleeding events, especially for non ST segment elevation acute coronary syndrome patients.This advantage has been widely recognized.But for the acute ST-segment el-evation myocardial infarction （STEMI） patients who will accept primary PCI, it remains to be a hot topic that whether heparin or bivalirudin is better for anticoagulation.This paper summarizes the current progress in research on the treatment strategy of primary PCI in STEMI pa-tients with anticoagulation.Through combining this research with the current clinical situation in China, the article will also attempt to pro-vide feasible suggestions for anticoagulation treatment.

关 键 词：比伐卢定 肝素 ST段抬高型心肌梗死 直接经皮冠状动脉介入术 

分 类 号：R542.22[医药卫生—心血管疾病] R815[医药卫生—内科学]