优化比伐芦定抗凝方案应用于老年急性心肌梗死急诊经皮冠状动脉介入的临床疗效  

Clinical effectiveness of optimized protocol for anticoagulation with bivalradine in the interventional adjuvant therapy of elderly patients with acute myocardial infarction

作　　者：包恩泽 皮林[1] 贾衍尧 徐世莹[1] 周立辉[1] 齐冰洋 Bao Enze;Pi Lin;Jia Yanyao;Xu Shiying;Zhou Lihui;Qi Bingyang(Department of Cardiology,Beijing Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京市垂杨柳医院心内科,北京100022

出　　处：《中国医刊》2023年第5期503-506,共4页Chinese Journal of Medicine

摘　　要：目的分析老年急性心肌梗死患者行急诊经皮冠状动脉介入时应用优化比伐芦定抗凝方案的临床疗效及安全性。方法选择2020年8月至2021年8月在北京市垂杨柳医院行急诊经皮冠状动脉介入治疗的老年急性心肌梗死患者84例,采用随机数字表法分为普通肝素组和优化比伐芦定组,每组42例。普通肝素组围术期予以普通肝素抗凝方案,优化比伐芦定组予以优化比伐芦定抗凝方案,比较两组凝血功能、主要终点事件及次要终点事件的差异。结果两组术前、术后24h的活化部分凝血活酶时间、纤维蛋白原、凝血酶时间、凝血酶原时间差异无显著性(P>0.05)。两组院内及出院后30d主要心血管不良事件发生率比较差异无显著性(P>0.05)。优化比伐芦定组院内及出院后30d的出血事件发生率低于普通肝素组,差异有显著性(P<0.05)。结论老年急性心肌梗死患者急诊经皮冠状动脉介入治疗中,应用普通肝素与优化比伐芦定抗凝方案均可有效预防术后主要心血管不良事件的发生,但优化比伐芦定抗凝方案出血事件发生率更低,安全性更好。Objective To compare the clinical efficacy and safety of unfractionated heparin and optimized protocol for anticoagulation with bivalradine in emergency intervention of elderly patients with acute myocardial infarction.Method 84 cases of elderly patients with acute myocardial infarction who were underwent interventional therapy in Beijing Chuiyangliu Hospital from August 2020 to August 2021 were selected.According to the random number table method,they were divided into unfractionated heparin group and bivalirudin group,with 42 cases in each group.42 patients in the unfractionated heparin group were anticoagulated with unfractionated heparin,and 42 patients in the bivalirudin group were anticoagulated with bivalirudin to optimize the anticoagulation intensity after surgery,comparative analysis of coagulation function,primary end point events and secondary end point events between the two groups.Result The thromboplastin time(APTT),fibrinogen(FIB),plasma thrombin time(TT),prothrombin time(PT)before and 24h after operation were compared between the two groups,the difference was not statistically significant(P>0.05).There was no significant difference in the incidence of net clinical adverse events(MACE)between the two groups in hospital and 30 days after operation(P>0.05).The bleeding rate in hospital and 30 days after operation in bivalirudin group was lower than that in unfractionated heparin group(P<0.05).Conclusion In the emergency interventional treatment of elderly patients with acute myocardial infarction,the efficacy of unfractionated heparin and optimized protocol for anticoagulation with bivalradine is equivalent,which can effectively prevent the occurrence of adverse cardiovascular events after surgery,but the optimized protocol for anticoagulation with bivalradine has fewer bleeding events and more ideal safety.

关 键 词：普通肝素 比伐芦定 抗凝 老年急性心肌梗死 介入 辅助治疗 

分 类 号：R543.31[医药卫生—心血管疾病]