替格瑞洛联合比伐卢定在急性冠脉综合征围术期的应用

Application of ticagrelor combined with bivalirudin in perioperative period of acute coronary syndrome

目的观察比伐卢定与替格瑞洛联用,对急性冠脉综合征患者PCI围术期应用的疗效及出血风险,以期为临床治疗决策提供理论依据。方法入选350例急性冠脉综合征拟行急诊冠脉介入治疗的患者,将患者分为观察组(替格瑞洛+比伐卢定)120例,对照组1(氯吡格雷+普通肝素)116例,和对照组2(替格瑞洛+普通肝素)114例。观察指标:观察术后24 h、72 h、30 d心脑血管不良事件(MACCE):全因死亡、再发心绞痛、再发心肌梗死和卒中的发生率及出血事件的发生率。结果术后24 h、72 h、30 d 3组患者MACCE发生率:观察组分别为:2.5%、3.33%、4.17%,对照组1分别为:5.17%、10.34%、11.21%,对照组2分别为:2.63%、4.39%、6.14%;术后30 d时观察组较对照组1相比差异有统计学意义(χ^2=4.15,P=0.042),观察组和对照组2相比差异无统计学意义。全因死亡发生事件:观察组分别为:0例、1例、1例,对照组1分别为:3例、3例、3例,对照组2分别为:0例、2例、2例。术后24 h、72 h、30 d 3组患者总出血率:观察组:0、2.5%、2.5%,对照组1:7.77%、9.48%、9.48%,对照组2:9.65%、9.65%、9.65%,术后72 h同30 d时,观察组较对照组1出血率明显降低(χ^2=5.15,P=0.023),观察组较对照组2出血率明显降低(χ^2=5.312,P=0.021)。3组均未出现致死性出血事件。结论在急性冠脉综合征PCI围术期使用替格瑞洛联合比伐卢定安全有效,心脑血管不良事件发生率低,同时出血风险低。

Objective To observe the efficacy and bleeding risk of bivaludine combined with ticagrelor in patients with acute coronary syndrome(ACS)during the perioperative period of PCI,so as to provide evidence for clinical treatment decisions.Methods A total of 350 patients with ACS who had been treated with emergency coronary intervention were enrolled,and the patients were divided into observation group(ticagrelor+bivarudine)with 120 patients,control group 1(clopidogrel+ordinary heparin)with 116 patients,and control group 2(ticagrelor+ordinary heparin)with 114 patients.The incidence of cardiovascular and cerebrovascular adverse events(MACCE:all-cause death,recurrent angina pectoris,recurrent myocardial infarction and stroke)and the incidence of bleeding events were observed at 24 hours,72 hours and 30 days after the operations.Results The incidence of MACCE at the 3 times in the patients of the observation group were 2.5%,3.33%,and 4.17%respectively;those in the control 1 group were 5.17%,10.34%,and 11.21%respectively;those in the control 2 group were 2.63%,4.39%,and 6.14%respectively.At 30 days,the incidence of MACCE in the observation group showed statistical differences compared with the control 1 group(χ^2=4.15,P=0.042).All-cause deaths occurred in the observation group were 0,1 and 1 case respectively;in the control 1 group were 3,3 and 3 cases respectively;in the control 2 group were 0,2 and 2 cases respectively.The total bleeding rate of patients in the observation group were 0,2.5%and 2.5%respectively;in the control 1 group were 7.77%,9.48%and 9.48%respectively;in the control 2 group were 9.65%,9.65%and 9.65%respectively.The observation group was significantly lower than the control 1 group(χ^2=5.15,P=0.023),and the observation group was significantly lower than the control 2 group(χ^2=5.312,P=0.021).Conclusion Ticagrelor combined with bivarudine is safe and effective in the perioperative period of PCI in acute coronary syndrome,with a low incidence of cardiovascular and cerebrovascular adverse events and a low risk of bleeding.