急性心肌梗死患者溶栓后不同肝素抗凝疗效分析

Effectiveness of Unfractionated Heparin and a Low—Molecular-Weight Heparin Following rt-PA Thrombolytic Therapy on Patients with Acute Myocardial Infarction

目的比较急性心肌梗死rt-PA溶栓治疗后普通肝素(UFH)和国产低分子肝素(商品名:海普宁Hiparin)不同抗凝辅助治疗方法的疗效和安全性。方法74名入院接受rt-PA溶栓治疗的ST段抬高型急性心肌梗死患者,随机分为常规UFH组和Hiparin组。UFH组溶栓治疗后每小时静脉滴注UFH700～1000U,持续滴注48h,维持活化的部分凝血活酶时间为正常对照的1.5～2.0倍,以后皮下注射UFH7500U,每12h一次,持续一周。Hiparin组予rt-PA溶栓后4h皮下注射Hiparin5000U,每12h一次,持续一周。终点事件:观察住院期间及随访期间(出院后2月内)心绞痛、心肌再梗死及心源性死亡事件。副作用观察指标:观察住院期间脑血管事件,出血事件发生情况。随访时间为60d。结果联合终点事件在Hiparin组明显下降(17.1%vs38.2%,P<0.05),出血事件发生率低于UFH组(5.7%vs26.5%,P<0.05)。结论急性心肌梗死rt-PA溶栓后辅助抗凝治疗Hiparin组观察时间内较UFH组更能减少心脏事件的再发生及出血事件。

Objective To compare the efficacy and safety of unfractionated heparin with a low-molecular - weight heparin（hiparin） in the management of anticoagulation following thrombolytic therapy for acute ST-segment elevation myocardial infarction. Methods 74 patients with acute ST segment elevation myocardial infarction undergoing thrombolytic therapy were randomly assigned to receive either unfractionated heparin （700 - 1000U/h ）continuous infusion for 48 h after thrombolysis to maintain the activated partial thromboplastin time at 1.5 to 2.0 times as normal, then subcutaneous 7500 U every 12 h for 7 days, or Hiparin（5000u subcutaneously every 12 h for 7 days 4h after thrombolysis, ） in conjunction with routine therapy. The patients stayed in hospital for at least 10 days and were followed for 60 days. Results Composite end-point was significantly reduced in patients receiving Hiparin than unfractionated heparin（ 17.1% vs 58.2%, P 〈 0.05）. Compared with unfractionated heparin group, the incidences of hemorrhage were also lower in Hiparin group （26.5% vs 5.7% P 〈0.05）. Conclusion Hiparin is more effective in reducing composite cardiac events, hemorhage as compared with unffractionated heparin during anticoagulation following thrombolytic therapy for acute ST-segment elevation myocardial infarction.