PCI术后是否抗凝治疗的临床疗效比较

Effect of the Strategy with Enoxaparin and without Enoxaparin on Clinical Outcomes after PCI

目的:研究PCI术后是否应用依诺肝素抗凝治疗对患者临床疗效的影响。方法:于2011年5月至2012年1月间,连续入选在我院行冠状动脉造影并置入了支架的患者158例,将符合标准的患者随机分为非抗凝组或抗凝组两组各79名。非抗凝组术后常规应用阿司匹林和氯吡格雷。抗凝组术后加用依诺肝素。对入选患者进行院内随访记录其主要心脏不良事件及出血事件。结果:支架植入成功率100%。术后抗凝组113处病变共置入支架135枚;非抗凝组109处病变置入支架115枚。院内随访:主要心脏不良事件和严重出血差异无统计学意义。小出血事件抗凝组多于非抗凝组(P=0.007)。结论:冠状动脉支架置入术后非抗凝治疗组缺血不良事件发生率较抗凝组无明显增加,小出血并发症明显减少。该研究结果表明,对PCI术无特殊并发症的患者术后无需常规抗凝治疗。

Objective： To evaluate the clinic effect of the treatment with enoxaparin and without enoxaparin after PCI. Methods： We recruied 158 patients who have undergone the percutaneous coronary intervention in cardiology department of Changhai Hospital from May 2011 to January 2012. 158 patients with coronary artery disease underwent intracoronary stent implantation were randomly divided into two groups： anticoagulation group （n=79）, non-anticoagulation group（n = 79）. Non-anticoagulation group was given aspirin and clopidog rel as usual, and anticoagnlation group was given additional enoxaparin. The rates of major adverse cardiac events and bleeding in hospital were observed. Results： The success rate of operation procedure was 100%. 135 stems were implanted at 113 lesions in anticoagnlation group and 115 stents at 109lesions in non-anticoagulation group. Hospital follow-up： There were no significant differences of the major adverse card iac events （MACE） and major bleeding between the two groups. Minor bleeding rate in anticoagulant group was significant higher than that in the non-anticoagulant group （P=0.007）. Conclusion： The frequency of ischemic adverse events after PCI in non-anticoagulation groups is not significant increased as compared with that of anticoagnlation group. However, the rate of minor bleeding is lower significantly in non-anticoagulation group than that in anticoagnlation group. The results surgest that routin anticoagulation therapy after PCI is not necessary for patients without procedure complications.