术前服用利伐沙班急性冠状动脉综合征患者经皮冠状动脉介入治疗围术期应用比伐芦定有效性与安全性分析  

Efficacy and safety of percutaneous coronary intervention with bivarudine in patients with acute coronary syndrome treated with rivaroxaban before operation

作　　者：祁俊仙 王亚松 顾若曦 刘轩泽 张磊 周铁楠 王效增 QI Jun-xian;WANG Ya-song;GU Ruo-xi;LIU Xuan-ze;ZHANG Lei;ZHOU Tie-nan;WANG Xiao-zeng(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,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：《临床军医杂志》2025年第2期129-135,共7页Clinical Journal of Medical Officers

基　　金：辽宁省自然科学基金(2021-MS-045)。

摘　　要：目的分析术前服用利伐沙班的急性冠状动脉综合征(ACS)患者在经皮冠状动脉介入治疗(PCI)围术期中应用50%推荐剂量比伐芦定的有效性和安全性。方法连续筛选北部战区总医院自2019年1月至2024年5月收治的诊断为ACS、已行择期PCI、术中应用比伐芦定的639例患者为研究对象。根据术前是否服用利伐沙班将患者分为常规组(阿司匹林+氯吡格雷,n=488)和利伐沙班组(利伐沙班+氯吡格雷,n=151)。将活化凝血时间(ACT)≥225 s作为达标,将ACT范围250~350 s作为最佳范围。主要终点为PCI术中首次给药5 min后ACT达标率;次要终点为住院期间和随访期间内净不良临床事件(NACE)发生率,包括主要心脑血管不良事件和美国出血学术研究联合会(BARC)定义的出血事件。结果利伐沙班组既往心房颤动比例、N端-B型钠尿肽前体水平均高于常规组,差异有统计学意义(P<0.05)。利伐沙班组5 min后ACT高于常规组,差异有统计学意义(P<0.05)。两组住院期间NACE发生率比较,差异均无统计学意义(P>0.05)。所有患者至少有1次随访记录,中位随访时间243.0(159.0,335.0)d。利伐沙班组随访期间NACE、非靶血管血运重建、BARC 2~5型、BARC 2型发生率高于常规组,差异有统计学意义(P<0.05)。结论服用利伐沙班的ACS患者在PCI围术期中应用50%推荐剂量比伐芦定安全有效,ACT达标率与接受双联抗血小板治疗且在术中应用比伐芦定推荐剂量的患者相当。同时,与阿司匹林联合氯吡格雷比较,利伐沙班联合氯吡格雷的长期NACE和出血事件发生风险增加。Objective To evaluate the efficacy and safety of 50%recommended dose of bivarudine in percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS)who took rivaroxaban before surgery.Methods A total of 639 patients diagnosed with ACS,undergoing elective PCI,and undergoing intraoperative bivarudine admitted to General Hospital of Northern Theater Command from January 2019 to May 2024 were selected as the study objects.Patients were divided into conventional group(aspirin+clopidogrel,n=488)and rivaroxaban group(rivaroxaban+clopidogrel,n=151)according to whether they took rivaroxaban before surgery.The activated clotting time(ACT)≥225 seconds was regarded as the standard,and the ACT range was 250-350 seconds as the optimal range.The primary endpoint was ACT compliance 5 minutes after the first dose of PCI.Secondary endpoints were the incidence of net adverse clinical events(NACE)during hospitalization and follow-up,including major adverse cardiovascular and cerebrovascular events and bleeding events as defined by American Association for Bleeding Academic Research Consortium(BARC).Results The proportion of previous atrial fibrillation and the level of N-terminal natriuretic peptide precursor in rivaroxaban group were higher than those in conventional group,with statistical significance(P<0.05).The ACT after 5 minutes in rivaroxaban group was higher than that in conventional group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of NACE during hospitalization between the two groups(P>0.05).All patients had at least one follow-up,and the median follow-up time was 243.0(159.0,335.0)days.During the follow-up period,the incidence of NACE,non-target vessel revasulation,BARC type 2-5 and BARC type 2 in rivaroxaban group was higher than that in conventional group,and the difference was statistically significant(P<0.05).Conclusion In ACS patients taking rivaroxaban,50%recommended dose is safe and effective compared with varudine during peri

关 键 词：利伐沙班 急性冠状动脉综合征 经皮冠状动脉介入治疗 围术期 比伐芦定 

分 类 号：R541.4[医药卫生—心血管疾病]