比伐卢定在高龄急性冠状动脉综合征患者经皮冠状动脉介入治疗中的应用体会

Evaluation of anticoagulant efficacy and safety for domestic bivalirudin during percutaneous coronary intervention in elderly patients with acute coronary syndrome

目的比较年龄>80岁的急性冠状动脉综合征(ACS)患者在经皮冠状动脉介入治疗(PCI)围手术期应用比伐卢定和普通肝素的安全性和有效性。方法共入选64例患者,按顺序交替分为两组,PCI术中分别应用普通肝素(32例)或比伐卢定(32例),比较两组抗凝效果、PCI成功率、出血不良反应发生率。结果普通肝素组和比伐卢定组术中活化凝血时间(ACT)达标分别为30例(93.8%)和28例(87.5%),PCI成功分别为26例(81.2%)和28例(87.5%),两组差异均无统计学意义;轻度出血分别为4例(12.5%)和1例(3.1%),严重出血分别为2例(6.2%)和0例,总体出血分别为6例(18.8%)和1例(3.1%),两组差异有统计学意义,比伐卢定组优于普通肝素组(P<0.05)。结论比伐卢定在高龄ACS患者PCI术中的抗凝疗效与普通肝素相当,而且出血不良反应发生率显著低于普通肝素。

Objective To evaluate the safety and efficacy of bivalirudin during perioperation of percutaneous coronary intervention （PCI） in patients older than 80 years old with acute coronary syndrome. Methods A total of 64 patients were randomly divided into two groups, respectively received heparin（n=32）, or bivalirudin （n=32）. We compared the activated coagulation time （ACT）, procedural success rate, bleeding rate between two groups. Results The two groups ACT, PCI success rates are not statistically different, No signiifcant difference in the incidence of mild hemorrhage which is 4 （12.5%） for heparin and 1（3.1%） for bivalirudin and severe bleeding which is 2 （6.2%） for heparin and 0 for bivalirudin. However there are signiifcant differences in the overall incidence of bleeding between the two groups with lower incidence of beeding in the bivalirudin group than the heparin group （P〈0.05）. Conclusions Bivalirudin has comparable anticoangulation effect as heparin during perioperation of percutaneous coronary intervention （PCI） among patients older than 80 years of age with acute coronary syndrome with lower bleeding incidence than heparin dose.