普通肝素与比伐芦定对体外膜肺氧合辅助经皮冠状动脉介入治疗术中激活凝血酶时间影响:单中心回顾性分析

A single-center retrospective analysis of the effects of bivalirudin and heparin on activated clotting time during extracorpore-al membrane oxygenation-assisted percutaneous coronary intervention

目的探讨在出血高危患者中应用比伐芦定与普通肝素对体外膜肺氧合(ECMO)辅助经皮冠状动脉介入治疗(PCI)术中激活凝血酶时间(ACT)的影响。方法回顾性分析北部战区总医院心血管内科数据库自2019年6月至2023年6月应用ECMO辅助PCI的56例患者的临床资料,其中,使用普通肝素抗凝38例设为肝素组,使用比伐芦定抗凝18例设为比伐芦定组。所有入选患者均按照ECMO及PCI操作常规进行,普通肝素及比伐芦定均依照治疗指南进行给药,其中,普通肝素70~100 U/kg;比伐芦定0.75 mg/kg静脉负荷剂量,静脉持续1.75 mg/kg/h泵入。主要观察终点:PCI首次、术中、术毕时的ACT数值;次要观察终点:手术前后的血小板数值。结果所有患者ECMO均成功撤机,术毕即刻撤机52例(92.9%),术后延迟撤机4例(7.1%);术后延迟撤机患者的ECMO平均辅助时间约(2.3±0.7)d。比伐芦定组女性比例、体质量、术前血小板计数均低于普通肝素组,年龄、CRUSADE评分均高于普通肝素组,差异均有统计学意义(P<0.05);两组的糖尿病、高血压、卒中史患者比例,以及术前左心室射血分数比较,差异均无统计学意义(P>0.05)。比伐芦定组的PCI首次、术中及术毕ACT均高于普通肝素组,而术后血小板计数及术前术后血小板计数差值均低于普通肝素组,差异均有统计学意义(P<0.05)。结论单中心回顾性分析结果提示,在ECMO辅助PCI术中,不同抗凝药物的ACT数值不同,比伐芦定相较于普通肝素更多应用于出血高危人群且血小板计数更为稳定。比伐芦定在ECMO中的应用未发生明显的管路及膜肺血栓形成。

Objective To investigate the effect of bivarudine and ordinary heparin on activated clotting time(ACT)during extracorpo-real membrane oxygenation(ECMO)assisted percutaneous coronary intervention(PCI)in patients at high risk of bleeding.Methods Clinical data of 56 patients receiving ECMO-assisted PCI from the cardiovascular department database of the General Hospital of Northern Theater Command from June 2019 to June 2023 were retrospectively analyzed.Among them,38 patients receiving ordinary heparin for anticoagulation were assigned to the heparin group and 18 patients receiving bivarudine for anticoagulation were assigned to the bivarudine group.All enrolled patients were administered according to ECMO and PCI procedures,and ordinary heparin and bivarudine were administered according to treatment guidelines,among which ordinary heparin was 70-100 U/kg,the intravenous loading dose was 0.75 mg/kg,and the intravenous pump lasted 1.75 mg/kg/h.Primary outcome points:ACT values at the first PCI,during and after PCI.Secondary outcome:platelet values before and after surgery.Results ECMO was successfully withdrawn in all patients,52 cases(92.9%)immediately after surgery,and 4 cases(7.1%)delayed after surgery.The average auxiliary time of ECMO was about(2.3±0.7)days in the 4 delayed-withdral patients.The female proportion,body weight and preoperative platelet count in bivarudine group were lower than those in ordinary heparin group,and age and CRUSADE score were higher than those in ordinary heparin group,with statistical significance(P<0.05).There was no significant difference in the proportion of patients with diabetes,hyper-tension,stroke history and preoperative left ventricular ejection fraction between the two groups(P>0.05).The initial PCI,intraoperative and post-operative ACT of bivarudine group were higher than those of ordinary heparin group,while the postoperative platelet count and the difference between preoperative and postoperative platelet count were lower than those of ordinary heparin group,with statistical significance(P<0.05).Conclusion The results of single-center retrospective analysis suggest that different anticoagulants have different ACT values during ECMO-assisted PCI.Compared with ordinary heparin,bivaludine is more commonly used in high-risk groups with more stable platelet counts.The application of bivarudine in ECMO did not cause significant pipeline and membrane thrombosis.