服用新型口服抗凝药合并冠状动脉粥样硬化性心脏病患者冠状动脉介入治疗围术期抗栓策略的探讨

Perioperative antithrombotic strategies in patients undergoing coronary interventional therapy with a new oral anticoagulant combined with coronary atherosclerotic heart disease

目的探讨服用新型抗凝药同时合并冠心病的患者接受经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)围术期的抗栓策略,评价其安全性及近期疗效。方法分析2019年1月~2020年2月在我院住院行PCI术的132例(NOAC组)服用新型口服抗凝药(利伐沙班)和同时期132例(对照组)无口服抗凝药的冠心病患者的临床资料。口服新型抗凝药组患者采用不间断口服抗凝药策略,即PCI术前1天晚上服用最后1次抗凝药,术后6 h重新启动口服抗凝治疗,对照组按照常规方案进行PCI治疗。观察比较两组患者围术期缺血事件、主要不良心脏事件(Major adverse cardiovascular events,MACE)、支架内亚急性血栓形成(Subacute instent thrombus,SAT)及出血的发生率。结果两组患者住院期间总体事件发生例数分别为24(18.2%)、21(15.9%),差异无统计学意义(P=0.623),无缺血事件及SAT发生,无主要出血事件,1例小出血事件,两组MACE(4.8%vs 5.3%)和出血事件(14.4%vs 10.6%)未见明显差别,差异无统计学意义(P>0.05)。结论合并冠心病的患者围术期不间断口服抗凝药利伐沙班的抗凝策略是安全有效的。

Objective To explore the perioperative antithrombotic strategies of patients with a new anticoagulant and coronary heart disease who received percutaneous coronary intervention(PCI),and to evaluate their safety and short-term efficacy.Methods The clinical data of 132 patients with new oral anticoagulant(rivaroxaban)who underwent PCI(NOAC group)and 132 patients in the same period(control group)did not take oral anticoagulant in our hospital were analyzed.The patients in the new oral anticoagulant group adopted an uninterrupted oral anticoagulant strategy,that is,they took the last anticoagulant one night before PCI,and restarted oral anticoagulant therapy 6 hours after surgery.The control group received PCI treatment according to the conventional protocol.The incidences of perioperative ischemic events,major adverse cardiovascular events(MACE),subacute instent thrombus(SAT)and bleeding in the two groups were observed and compared.Results The overall events during the hospitalization of the two groups were 24(18.2%)and 21(15.9%)respectively,which difference was not statistically significant(P=0.623).No ischemic events and SAT occurred,no major bleeding events,1 minor bleeding event.The two groups had no significantly differences in MACE(4.8%vs 5.3%)and bleeding events(14.4%vs 10.6%)(P>0.05).Conclusion The anticoagulation strategy of uninterrupted oral anticoagulant rivaroxaban for patients with coronary heart disease,is safe and effective during the perioperative period.