65岁以上老年急性冠脉综合征患者择期PCI术中比伐芦定减量使用与推荐剂量对比研究  

Comparison of low dose and recommended dose Bivalirudin in patients over 65 years of age with acute coronary syndrome during elective PCI

作　　者：曲小雨 汪倩 周铁楠 张磊 王效增 邹德莉 QU Xiao-yu;WANG Qian;ZHOU Tie-nan;ZHANG Lei;WANG Xiao-zeng;ZOU De-li(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,Liaoning,China)

机构地区：[1]北部战区总医院心血管内科,辽宁沈阳110016

出　　处：《心脏杂志》2022年第6期672-679,共8页Chinese Heart Journal

基　　金：国家十三五重点研发计划项目资助(2016YFC1301303)。

摘　　要：目的探讨65岁以上老年急性冠脉综合征(ACS)患者择期行经皮冠状动脉介入治疗(PCI)术中比伐芦定减量使用(推荐剂量的80%)且术后不持续静脉滴注的疗效和安全性。方法连续性纳入2019年1月至2021年2月行择期PCI且术中使用比伐芦定的65岁以上老年ACS患者854例,推荐剂量组485例,减量组369例。通过倾向性评分匹配(PSM)校正混杂因素。主要研究终点为术后30 d净不良临床事件(NACE),次要终点为主要不良心血管事件(MACE)和出血事件的发生率。结果减量组ST段抬高型心肌梗死、高血压、贫血患者所占比例低于推荐剂量组,差异有统计学意义(P<0.05,P<0.01)。PSM后,两组间上述各项临床资料比较,差异无统计学意义。PSM前或后两组负荷剂量5 min后活化凝血时间(ACT)值和两组患者ACT≥250 s所占比例差异均无显著统计学意义。PSM前或后,两组PCI术后30 d的NACE、MACE和出血发生率,差异均无显著统计学意义。结论65岁以上老年ACS患者择期PCI术中可以应用80%推荐剂量的比伐芦定抗凝,未增加血栓和出血风险。AIM To investigate the efficacy and safety of the low dose Bivalirudin(80%of the recommended dose)without post-procedure intravenous infusion in patients≥65 years of age with acute coronary syndrome(ACS)during elective percutaneous coronary intervention(PCI).METHODS 854 consecutive patients≥65 years of age with ACS who underwent elective PCI and received Bivalirudin from January 2019 to February 2021 were enrolled,485 patients were included in the recommended dose group and 369 patients were included in the low dose group.Using propensity score matching(PSM)to reduce confounding factors.The incidence of net adverse clinical events(NACE),major adverse cardiac events(MACE)and bleeding events at 30 days were observed.RESULTS The incidence of STsegment elevation myocardial infarction,hypertension and anemia in the low dose group was lower than that in the recommended dose group,and the difference was statistically significant(P<0.05).After PSM,there were no statistically significant differences in clinical data between the two groups.Before or after PSM,the activated clotting time(ACT)after 5 min and the proportion of ACT≥250 s in two groups without statistical significance,the incidence of NACE,MACE and bleeding 30 days after PCI in two groups without statistical significance.CONCLUSION The 80%recommended dose of bivalirudin used for anticoagulation in patients over 65 years of age with ACS during elective PCI does not increase the risk of thrombosis or bleeding.

关 键 词：急性冠脉综合征 比伐芦定 老年 经皮冠状动脉介入治疗 

分 类 号：R541[医药卫生—心血管疾病]