延长使用低分子肝素治疗高原非ST段抬高型急性冠脉综合征的临床观察

Clinical observation of delayed therapy with low molecular weight heparin in patients with non-ST segment elevation acute coronary syndrome at high altitude

目的:观察延长使用低分子肝素治疗高原非ST段抬高型急性冠脉综合征(NSTE-ACS)患者的疗效及安全性。方法:将85例NSTE-ACS患者随机分为常规治疗组(n=42)和延长治疗组(n=43),常规治疗组采用低分子肝素(依诺肝素)皮下注射治疗5～7 d,延长治疗组治疗10～14 d,其余基础治疗相同。观察30 d内心血管事件、出血事件和血小板减少的发生率。结果:常规治疗组30 d内心血管事件的发生率为19%,延长治疗组为5%,两组间有显著差异(P<0.05);常规治疗组30 d内出血事件的发生率为5%,延长治疗组为5%,两组间无显著差异;两组患者中均未观察到血小板减少和APTT延长的发生。结论:延长使用(10～14 d)低分子肝素治疗高原NSTE-ACS可显著降低30 d内心血管事件的发生率,且不增加出血风险和血小板减少事件的发生率。

AIM： To observe the effectiveness and safety of delayed therapy with low molecular weight heparin（LMWH） in patients with non-ST segment elevation acute coronary syndrome（NSTE-ACS） at high altitude.METHODS： Eighty-five patients with NSTE-ACS were randomized into conventional therapy group（n=42） and delayed therapy group（n=43）.Patients in conventional group received LMWH therapy for 5 to 7 days,whereas patients in delayed group received LMWH for 10-14 days.The basic therapy was similar in both groups.The incidences of cardiovascular events,hemorrhage and platelet reduction within 30 days were recorded.RESULTS： The incidence of cardiovascular events within 30 days in conventional group was significantly higher than that in delayed group（19.0% vs.4.7%,P0.05）.The incidence of hemorrhage was similar between groups（4.8% vs.4.7%,P0.05）.No reduction in platelet count and no increase in activated partial thromboplastin time（aPTT） were observed.CONCLUSION： The strategy of delayed therapy with LMWH will significantly decrease the incidence of cardiovascular events in patients with NSTE-ACS at high altitude within 30 days and will not significantly increase hemorrhage risks.