达比加群对冠状动脉支架植入术后行瓣膜置换术患者的抗凝效果

The effect of anticoagulation on PCI patients with valve replacement by using dabigatran instead of warfarin

目的探讨新型抗凝药物达比加群对接受冠状动脉支架植入(PCI)术后行瓣膜置换术患者的抗血栓治疗效果。方法选择66例患者,分为研究组(单独使用达比加群)15例,对照组1(小剂量华法令加阿司匹林)24例,对照组2(常规剂量华法令、波立维加阿司匹林)27例。通过单因素分析分别观察血栓事件和出血事件的发生率。比较目前常规检测的凝血功能指标,观察PCI术后行瓣膜置换术患者应用达比加群替代华法令的抗凝效果。结果研究组与两组对照组相比,患者血栓事件发生率的差异均无统计学意义(均P>0.05),达比加群替代华法令可达到常规抗凝效果。研究组恶性出血事件发生率与对照组1相近(4.6%vs 4.17%,P>0.05),但显著低于对照组2(22.2%,P<0.01)。结论达比加群可以替代华法令用于复杂抗凝要求的PCI术后行瓣膜置换术患者。

Objective To observe anticoagulation effect of dabigatran instead of warfarin on patients undergoing percutaneous coronary intervention（PCI） and valve replacement. Methods Sixty-six patients underwent valve operation as well as PCI . They were randomly divided into 3 groups as dabigatran group （ 15 cases） ,low dose warfarin plus aspirin group （24 cases, ） and ordinary dose warfarin plus aspirin and polivy group （27 cases）. Incidence rate of thrombosis, bleeding events and coagulation function were e- valuated by single factor analysis . Clinical symptom and sign were received. Comparision of findings was made statistically. Results Comparing two control groups, there was no significant difference in inci- dence rate of thrombosis （ both P 〉 0.05 ）, observed for the research group, however there was similar in- cidence rate of bleeding events at discharge for the research group and during follow-up which was com- pared with the control group 1 （4.6% vs 4.17% ,P 〉0.05）, and it was lower than that in the control group 2 （22.2% ,P 〈0.01 ）. That meant in the dabigatran group there was good anticoagulation effect on patients who had complex potential anticoagulation requirement. Conclusion Single usage of dabigatran can get good anticoagulation for patients undergoing PCI and valve replacement to replace combining war- farin with aspirin.