使用依诺肝素48h行冠脉造影的安全性和有效性

The safety and effectiveness of enoxaparin treatment for ≥ 48 hours before coronary angiography

目的低分子量肝素(LMWH)可以有效取代普通肝素(UH)应用于急性冠脉综合征(ACS)的治疗。然而,这些患者行冠脉造影(CAG)的最佳抗凝策略尚不明了。国外有关LMWH在冠脉造影中的应用研究表明,皮下应用低分子肝素至少48h(≥4次)冠脉造影,术中不追加抗凝剂是安全有效的,但此方案不一定适合我国。我科室曾沿用此法入选176例ACS患者,结果显示CAG前肝素抗-Ⅹa因子活性(0.808±0.265)IU/ml,93.2%的患者抗-Ⅹa活性>0.5IU/ml。本研究扩大样本量,试图进一步评价LMWH在心导管室应用的安全性和有效性,探索适合国人的心导管检查抗凝策略。方法与结果入选278例ACS患者。所有患者按照1mg(100IU)/kg每隔12h(7am～7pm)皮下注射依诺肝素(克赛),在接受至少48h(≥4次)的LMWH后进行导管检查。末次注射(7am)距离冠脉造影不超过8h(3pm之前)。穿刺前(≈末次注射的3～5h内)取血测定抗-Ⅹa活性。如病情需要,可行经皮冠脉介入术(PCI),术中追加普通肝素5000IU。结果显示冠脉造影前肝素抗-Ⅹa活性为(0.745±0.304)IU/ml,79.7%的患者抗-Ⅹa活性>0.5IU/ml,5.4%抗-Ⅹa活性>1.2IU/ml。1例在造影过程中,另3例在PCI中出现血栓,无严重出血事件。结论皮下注射依诺肝素至少48h行冠脉造影抗凝强度偏低,可能需要寻找新的抗凝方案。

Objective To further assess the safety and effectiveness of low molecular weight heparin （LMWH） in coronay angiography. Methods and Results A total of 278 patients with acute coronary syndrome were treated for at least 48 h with subcutaneous enoxaparin （1mg[100IU]/kg every 12 h, cycled at 7 am and 7 pm）. Without the interruption of LMWH and without coagulation monitoring, all 278 patients underwent coronary angiography within 8 h after the morning LMWH injection. Anti-X a activity before catheterization was （0. 745 ± 0. 304） IU/ml , 〉0.5IU/ml in 79.7% of patients and 〉1.2IU/ml in 5.4% of patients. Thrombosis/embolism occurred in 1 patient. There was no severe hemorrhage. Conclusion Anticoagulant activity of enoxaparin seems to be low for Chinese. New anticoagulation strategy may need to be found.