达比加群酯联合阿司匹林在经皮冠状动脉介入术后的应用效果观察

Observation on Effect of Dabigatran Combined with Aspirin After Percutaneous Coronary Intervention

目的:探讨达比加群酯联合阿司匹林在经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后应用的效果。方法:选取2016年6月至2019年6月西安市第一医院行PCI术的冠心病患者159例为研究对象,采用随机数字表法将患者分为研究组80例与对照组79例。两组患者在术后均给予阿司匹林口服治疗,研究组患者在此基础上给予达比加群酯治疗,两组患者均治疗3个月。比较两组患者治疗前后凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、国际标准化比值(INR)及活化部分凝血酶时间(APTT)]变化、血液流变学指标变化、出血事件及不良心脑血管事件发生情况的差异。结果:治疗前,两组患者凝血功能指标及血液流变学指标水平比较,差异均无统计学意义(P>0.05)。治疗后,两组患者PT、TT及APTT均较治疗前明显延长,INR较治疗前明显升高,血浆黏度、红细胞比容及全血黏度较治疗前明显降低,且研究组患者各指标改善程度明显优于对照组,差异有统计学意义(P<0.05)。研究组患者心肌梗死、心源性猝死、脑梗死、心绞痛复发及支架内血栓等不良心脑血管事件的总发生率明显低于对照组,差异有统计学意义(P<0.05)。研究组、对照组患者出血事件总发生率分别为2.50(2/80)、8.86%(7/79),差异无统计学意义(P>0.05)。结论:冠心病患者PCI术后应用达比加群酯联合阿司匹林进行抗凝治疗,可有效改善凝血功能,降低术后不良心脑血管事件发生率。

OBJECTIVE:To probe into the effect of dabigatran combined with aspirin after percutaneous coronary intervention(PCI).METHODS:Totally 159 patients with coronary disease undergoing PCI admitted into the First Hospital of Xi’an from Jun.2016 to Jun.2019 were selected and divided into research group(80 cases)and control group(79 cases)via random number table.Both groups were given aspirin orally after surgery,on that basis,the research group was treated with dabigatran,both groups were treated continuously for 3 months.Differences in changes of coagulation function indicators[prothrombin time(PT),thrombin time(TT),international normalized ratio(INR)and activated partial thromboplastin time(APTT)]and hemorheological indicators,incidences of bleeding events and adverse cardiovascular and cerebrovascular events between two groups were compared.RESULTS:Before treatment,there were no statistical significance in differences in indicators of coagulation function and hemorheology between two groups(P>0.05).After treatment,the PT,TT and APTT of both groups had been significantly prolonged,the INR level had been significantly increased,the plasma viscosity ratio,hematokrit and whole blood viscosity ratio had been significantly decreased,and the improvements of all those indicators in research group were significantly better than the control group,with statistically significant differences(P<0.05).The total incidence of adverse cardiovascular and cerebrovascular events such as myocardial infarction,sudden cardiac death,cerebral infarction,angina recurrence and stent thrombosis of research group was significantly lower than those of control group,with statistically significant difference(P<0.05).The total incidences of bleeding events of research group and control group were respectively 2.50%(2/80)and 8.86%(7/79),the difference had no statistical significance(P>0.05).CONCLUSIONS:The application of dabigatran combined with aspirin for anticoagulation therapy in patients with coronary heart disease after PCI can effectively improve the coagulation function,reduce the incidence of adverse cardiovascular and cerebrovascular events after surgery.