比伐芦定抗凝治疗在经皮冠状动脉介入术中的应用价值研究

Study on the Application Value of Bivalrudine Anticoagulant Therapy in Percutaneous Coronary Intervention

目的对比分析比伐芦定和普通肝素抗凝治疗在经皮冠状动脉介入术中的应用价值。方法将2017年6月—2019年6月该院收治的冠状动脉慢性完全闭塞(CTO)病变并接受经皮冠状动脉介入术(PCI)治疗的84例老年患者随机分为观察组与对照组,观察组42例接受比伐芦定抗凝治疗,对照组42例接受普通肝素抗凝治疗,比较其PCI情况、围术期不良事件(出血情况、接触性血栓、冠脉无复流/慢血流)和术后1年MACE发生情况(再发心绞痛、靶血管血运重建、心力衰竭、心源性死亡、卒中、非致死性心肌梗死)发生率。结果两组活化凝血时间(ACT)、开通时间、对比剂使用量、置入支架长度等情况差异无统计学意义(P>0.05)。观察组围术期出血和冠脉无复流/慢血流发生率(4.76%、0.00%)低于对照组(23.81%、16.67%),差异有统计学意义(χ^(2)=6.222、7.636,P<0.05),接触性血栓发生率差异无统计学意义(P>0.05)。术后随访12个月两组均无卒中、非致死性心肌梗死和心源性死亡发生,观察组MACE发生率低于对照组,但差异无统计学意义(P>0.05)。结论冠状CTO病变患者在PCI中应用比伐芦定抗凝治疗能减少围术期出血和冠脉无复流/慢血流发生,且不加大术后MACE发生风险。

Objective To compare and analyze the application value of bivalrudine and unfractionated heparin anticoagulant therapy in percutaneous coronary intervention.Methods From June 2017 to June 2019,84 elderly patients with chronic total occlusion(CTO)of coronary artery disease and undergoing percutaneous coronary intervention(PCI)were randomly divided into observation group and control group.42 patients in the observation group received bivalrudine anticoagulant therapy,and 42 patients in the control group received unfractionated heparin anticoagulant therapy.The PCI status and perioperative adverse events(bleeding,contact thrombosis,coronary no-reflow/slow blood)were compared,as well as MACE occured events(recurrent angina pectoris,target vessel revascularization,heart failure,cardiogenic death,stroke,non-fatal myocardial infarction)one year after surgery.Results There were no statistically significant differences in activated coagulation time(ACT),opening time,contrast medium usage,lenth of stents between the two groups(P>0.05).The incidence of perioperative bleeding and coronary no-reflow/slow blood flow in the observation group(4.76%,0.00%)was lower than that in the control group(23.81%,16.67%),and the difference was statistically significant(χ^(2)=6.222,7.636,P<0.05),there was no statistically significant difference in the incidence of contact thrombosis(P>0.05).There was no stroke,non-fatal myocardial infarction,or cardiogenic death in the two groups after 12 months of follow-up.The incidence of MACE in the observation group was lower than that in the control group,but the difference was not statistically significant(P>0.05).Conclusion The application of bivalirudin anticoagulant therapy in patients with coronary CTO lesions during PCI can reduce perioperative bleeding and coronary no-reflow/slow blood flow,and does not increase the risk of MACE after surgery.