Effect of bivalirudin on coagulation function and prognosis in patients with coronary artery disease and renal insufficiency undergoing PCI  

作　　者：韩兆帅 纪阳 刘松 文明洪 

机构地区：[1]Qingdao University Medical College [2]Department of Cardiology,Affiliated Hospital of Qingdao University Medical College

出　　处：《South China Journal of Cardiology》2016年第3期147-152,共6页岭南心血管病杂志（英文版）

摘　　要：Background Renal insufficiency is associated with an excess risk of vascular complications and bleeding events in patients who undergo PCI. Heparin is still used commonly for PCI, but the bleeding complications is high. However, Bivalirudin is similar to heparin in ischemic complications and superior to the bleeding complica- tions. Methods A total of 181 patients with coronary artery disease and renal insufficiency were randomly as- signed two treatment groups： Bivalirudin （n = 90）, unfractionated heparin （n = 91）. Activated clotting time （ACT） was determined in patients at 5 min after undergoing PCI at the end of operation immediately （stopping drug im- mediately） , and 30 min,1 h, 2 h after stopping drug. Activated partial thromboplastin time （APTT）, thrombin time （TT）, proth rombin time （PT）, fibrinogen （FIB） index were measured before treatment, 6 h, 24 h and 72 h af- ter the treatment through an automated coagulation analyzer. Platelet count was monitored before treatment and 24 h after treatment. The end points were the proportion of net adverse clinical events （NACE） and stent throm- bosis at 30 days. Results The use of bivalirudin was associated with a statistically significant higher at 5 min af- ter treatment, end of operation immediately （P 〈 0.05）, with statistically significant lower at lh after stopping drug , 2h after stopping drug （P 〈 0.05）. There were no differences between patients at blood coagulation and platelet after operation （P 〉 0.05）, no differences in the 30-day rates of stent thrombosis （0% vs. 0%, P = 1）. Elev- en patients（12.22%） treated with bivalirudin vs. 24 （26.38%） treated with heparin experienced an adverse clinical events at 30 days （relative risk[RR], 0.46; 95%CI, 0.36-0.56; P 〈 0.025）. There were no differences in the major adverse cardiac or cerebral event at the 30-day end point（1.11% vs. 2.20%, P 〉 0.05）. The bleeding at 30 days was abated by using bivalirudin compared with unfracfionated heBackground Renal insufficiency is associated with an excess risk of vascular complications and bleeding events in patients who undergo PCI. Heparin is still used commonly for PCI, but the bleeding complications is high. However, Bivalirudin is similar to heparin in ischemic complications and superior to the bleeding complica- tions. Methods A total of 181 patients with coronary artery disease and renal insufficiency were randomly as- signed two treatment groups： Bivalirudin （n = 90）, unfractionated heparin （n = 91）. Activated clotting time （ACT） was determined in patients at 5 min after undergoing PCI at the end of operation immediately （stopping drug im- mediately） , and 30 min,1 h, 2 h after stopping drug. Activated partial thromboplastin time （APTT）, thrombin time （TT）, proth rombin time （PT）, fibrinogen （FIB） index were measured before treatment, 6 h, 24 h and 72 h af- ter the treatment through an automated coagulation analyzer. Platelet count was monitored before treatment and 24 h after treatment. The end points were the proportion of net adverse clinical events （NACE） and stent throm- bosis at 30 days. Results The use of bivalirudin was associated with a statistically significant higher at 5 min af- ter treatment, end of operation immediately （P 〈 0.05）, with statistically significant lower at lh after stopping drug , 2h after stopping drug （P 〈 0.05）. There were no differences between patients at blood coagulation and platelet after operation （P 〉 0.05）, no differences in the 30-day rates of stent thrombosis （0% vs. 0%, P = 1）. Elev- en patients（12.22%） treated with bivalirudin vs. 24 （26.38%） treated with heparin experienced an adverse clinical events at 30 days （relative risk[RR], 0.46; 95%CI, 0.36-0.56; P 〈 0.025）. There were no differences in the major adverse cardiac or cerebral event at the 30-day end point（1.11% vs. 2.20%, P 〉 0.05）. The bleeding at 30 days was abated by using bivalirudin compared with unfracfionated he

关 键 词：BIVALIRUDIN coronary artery disease renal insufficiency coagulation function percutaneous coronary intervention 

分 类 号：R541.4[医药卫生—心血管疾病]