达比加群酯在非瓣膜性心房颤动经皮冠状动脉介入治疗术后抗凝治疗中的应用  

Application of dabigatran etexilate in anticoagulation therapy for patients with nonvalvular atrial fibrillation after PCI

作　　者：张乾 张文斌[3] 范静君 杨娟 Zhang Qian;Zhang Wenbin;Fan Jingjun;Yang Juan(Room of Clinical Pharmacy,Department of Pharmacy,Second People's Hospital of Guizhou Province,Guiyang 550004,Guizhou Province,China)

机构地区：[1]贵州省第二人民医院药剂科临床药学室,贵阳550004 [2]贵州省第二人民医院内科,贵阳550004 [3]贵州省人民医院心血管外科 [4]贵州省贵阳市公共卫生救治中心药剂科临床药学室

出　　处：《中华老年心脑血管病杂志》2025年第4期473-477,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：贵州省高层次创新型人才项目[黔科合平台人才(2020)6011]。

摘　　要：目的探究达比加群酯在非瓣膜性心房颤动(atrial fibrillation,AF)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后抗凝的应用效果。方法选取2021年2月至2023年1月贵州省第二人民医院收治的行PCI术的AF患者103例,按照抗凝方法不同分为常规组52例和达比加群酯组51例。比较2组治疗前后凝血功能指标[凝血酶原时间(prothrombin time,PT)、活化的部分凝血活酶时间(activeated partial thromboplasting time,APTT)、凝血酶时间(thrombin time,TT)和纤维蛋白原(fibrinogen,FIB)]、心功能(左心室射血分数、心脏指数、心排血量)、血管内皮功能(一氧化氮、内皮素1)、血清组织型纤溶酶原激活物(tissue-type plasminogen activator,t-PA)、纤溶酶原激活物抑制剂1(plasminogen activator inhibitor-1,PAI-1)、RAC相关蛋白(Rac-related protein,Rac1)水平,术后1年不良心血管事件(急性心肌梗死、心源性猝死、缺血性脑卒中、肺栓塞、下肢深静脉栓塞)和出血事件发生情况。结果与治疗前比较,2组治疗后2个月左心室射血分数、心脏指数、心排血量、PT、APTT、TT、一氧化氮水平明显升高,FIB、内皮素1、t-PA、PAI-1、Rac1水平明显降低,差异有统计学意义(P<0.05);且达比加群酯组治疗后2个月左心室射血分数、心脏指数、心排血量、PT、APTT、TT、一氧化氮水平明显高于常规组,FIB、内皮素1、t-PA、PAI-1、Rac1水平明显低于常规组,差异有统计学意义(P<0.05,P<0.01)。达比加群酯组出血事件发生率明显低于常规组(5.9%vs 19.2%,P<0.05)。结论PCI术后达比加群酯抗凝可有效改善AF患者凝血功能,对血管内皮功能和心功能有一定保护作用,并降低出血风险,为临床抗凝方案的选择提供参考。Objective To explore the application efficacy of dabigatran etexilate in anticoagulation for patients with nonvalvular atrial fibrillation after percutaneous coronary intervention(PCI).Methods A total of 103 AF patients undergoing PCI in our hospital from February 2021 to January 2023 were recruited,and based on different anticoagulation regimens,they were divided into routine group(warfarin,52 cases)and dabigatran etexilate group(dabigatran etexilate,51 cases).The coagulation function indicators[prothrombin time(PT),active partial thromboplasting time(APTT),thrombin time(TT),fibrinogen(FIB)],cardiac function[left ventricular ejection fraction(LVEF),cardiac index,cardiac output],vascular endothelial function[nitric oxide(NO),endothelin-1(ET-1)],serum tissue-type plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1)and Rac-related protein(Rac1)levels before and after treatment,and the incidences of adverse cardiovascular events(acute myocardial infarction,sudden cardiac death,ischemic stroke,pulmonary embolism,lower extremity deep venous thrombosis)and bleeding events in 1 year after surgery were compared between the two groups.Results After 2 months of treatment,LVEF,cardiac index,cardiac output,PT,APTT,TT and NO level were significantly increased while the FIB,ET-1,t-PA,PAI-1 and Rac1 levels were significantly decreased in the two groups(P<0.05).At the moment,the dabigatran etexilate group had obviously higher LVEF,cardiac index,cardiac output,longer PT,APTT and TT,and elevated NO level,while remarkably lower FIB,ET-1,t-PA,PAI-1 and Rac1 levels than the routine group(P<0.05,P<0.01).The incidence of bleeding events was significantly lower in the dabigatran etexilate group than the routine group(5.9%vs 19.2%,P<0.05).Conclusion Dabigatran etexilate can effectively improve the coagulation function of AF patients after PCI,has a certain protective effect on vascular endothelial function and cardiac function,and can reduce the risk of bleeding,which provides a reference for the selection of clinical ant

关 键 词：经皮冠状动脉介入治疗 心房颤动 达比加群 抗凝药 

分 类 号：R54[医药卫生—心血管疾病]