急性冠状动脉综合征患者PCI术后使用质子泵抑制剂对华法林抗凝效果的临床观察

Clinical Observation of Proton Pump Inhibitor on Warfarin Anticoagulation Effect in Patients with Acute Coronary Syndrome after PCI

目的观察急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入术(PCI)后使用质子泵抑制剂对华法林抗凝效果的临床疗效。方法选择我院2014年7月至2016年6月收治的ACS患者102例,按照随机数字表法分为对照组(n=51)和观察组(n=51),对照组患者给予基础对症治疗和华法林抗凝治疗,观察组在对照组治疗基础上给予质子泵抑制剂奥美拉唑,比较两组治疗前后凝血酶原时间(PT)、PT与国际标准化比值(INR),消化道出血和主要心血管不良事件发生情况,1年后复查冠状动脉造影情况。结果治疗第4周和治疗第10周,观察组PT和INR值均显著高于对照组(P <0.05);观察组消化道出血总发生率3.92%低于对照组的19.61%(P <0.05),主要心血管不良事件总发生率7.84%与对照组的11.76%无显著差异(P> 0.05);观察组冠状动脉再狭窄发生率、完全闭塞发生率和管腔丢失分别为51.16%、4.65%和(0.28±0.13)mm,与对照组的52.50%、7.50%和(0.26±0.11)mm无明显差异(P> 0.05)。结论 ACS患者PCI术后使用质子泵抑制剂,可提高华法林抗凝效果,有效预防消化道出血。

Objective To observe the clinical efficacy of proton pump inhibitor on warfarin anticoagulation effect in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods 102 cases of ACS patients admitted to our hospital from July 2014 to June 2016 were divided into the control group (n=51) and the observation group (n=51) according to the random number table method. The control group was given basic symptomatic treatment and warfarin anticoagulant therapy, and the observation group was given the proton pump inhibitor omeprazole based on the control group. The prothrombin time (PT), PT and international normalized ratio (INR), the occurrence of gastrointestinal bleeding and major cardiovascular adverse events, and the coronary angiographic after 1-year follow-up were compared between the two groups before and after treatment. Results After 4 weeks and 10 weeks of treatment, the values of PT and INR in the observation group were significantly higher than those in the control group (P <0.05). The total incidence rate of gastrointestinal bleeding in the observation group was lower than that in the control group (3.92% vs 19.61%)(P <0.05). The total incidence rateof major adverse cardiac events was not significantly different from that in the control group (7.84% vs 11.76%)(P >0.05). The incidence rates of coronary artery restenosis and complete occlusion and the luminal loss in the observation group were 51.16%, 4.65% and (0.28±0.13) mm respectively, which were not significantly different from those in the control group with 52.50%, 7.50% and (0.26±0.11) mm (P >0.05). Conclusions Proton pump inhibitor in ACS patients after PCI can improve the warfarin anticoagulant effect and effectively prevent gastrointestinal bleeding.