老年冠心病合并慢性肾功能不全患者介入治疗围术期应用不同剂量依诺肝素抗凝的有效性和安全性

Peri-operative enoxaparin at different patients with renal insufficiency after on its efficiency and safety doses in elderly coronary heart disease interventional therapy： an observation

目的探讨不同剂量依诺肝素抗凝在老年冠心病合并肾功能不全患者介入治疗围术期的安全有效剂量。方法分析2009年1月至2012年12月在我科住院的108例冠心病合并肾功能不全介入治疗围术期应用依诺肝素的患者，按依诺肝素应用剂量共分为3组。A组（n=31）：依诺肝素40mg，皮下注射，每12小时1次。B组（n=35）：依诺肝素40mg，皮下注射，每日1次。C组（n=42）：依诺肝素40mg，皮下注射，每早1次以及依诺肝素20mg，皮下注射，每晚1次。观察各组出血及支架内血栓发生率。结果在服用同样剂量阿司匹林和氯吡格雷的情况下，3组患者均无大出血及支架内血栓发生，但A组患者皮下出血、牙龈出血发生率明显高于其他两组。结论老年冠心病合并肾功能不全患者介入治疗围术期给予依诺肝素，40mg皮下注射，每早1次，20mg皮下注射，每晚1次，共5～7d，是安全和有效的。

Objective To investigate the safe and effective dosage disease and renal insufficiency during interventional operation. Methods of enoxaparin in the elderly patients with coronary heart A total of 108 senile patients with above 2 disorders who received interventional treatment and perioperative enoxaparin for anticoagulation in our department from January 2009 to December 2012 were recruited in this study. They were divided into 3 groups according to the dose of enoxaparin, that is, group A （n = 31, 40mg enoxaparin, subcutaneous injection, once every 12 hour）, group B （n = 35, 40mg enoxaparin, subcutaneous injection, once a day）, and group C （n = 42, 40mg enoxaparin, subcutaneous injection, once every morning, and 20mg once every night）. They all took the same doses of aspirin and clopidogrel. The bleeding and stent thrombosis rate were observed and compared among the 3 groups. Results No massive hemorrhage or stent thrombosis was found in the 3 groups. But the patients from group A had significantly higher prevalence of subcutaneous hemorrhage and gum bleeding than those from the other 2 groups. Conclusion It is quite safe and effective for the elderly coronary heart disease patients accompanied with renal insufficiency to be given 40mg enoxaparin, subcutaneous injection, once every morning, and 20mg once every night, for a total of 5 to 7d during interventional therapy.