抗Xa因子活性测定评价依诺肝素在心导管室中应用的安全性和有效性

Evaluation of the safety and efficacy of enoxaparin administration in the cardiac catheter laboratory by measurement of factor Xa activity

目的 低分子量肝素可以有效的取代普通肝素应用于急性冠状动脉综合征 (ACS)的治疗。然而 ,ACS患者在行心导管检查时最佳的抗凝策略尚不明了。本研究旨在用抗Xa因子活性检测评价低分子量肝素在心导管室中应用的安全性和有效性 ,探索适合国人的心导管检查及经皮冠状动脉介入治疗 (PCI)的抗凝策略。方法 共入选ACS患者 1 76例。在每 1 2h(7:0 0 1 9:0 0 )皮下注射依诺肝素 1mg kg至少 48h后 ,不追加普通肝素或低分子量肝素于心导管室行冠状动脉造影 ,不进行凝血系统监测。 60例 (34 1 % )患者继之行PCI。结果 在心导管检查前的肝素抗Xa因子活性是 (0 81±0 2 7)IU ml,93 2 %的患者抗Xa因子活性 >0 50IU ml,且抗Xa因子活性与从注射到开始导管检查的时间无关 (P =0 0 97)。PCI组术后 30d无死亡、急性冠状动脉再闭塞或急诊血管重建事件。 3例(5 0 % )PCI患者术中出现血栓和 (或 )栓塞事件。单纯冠状动脉造影组有 1例因三支血管病变在术后1 7d等待冠状动脉旁路移植术时发生急性心肌梗死而行急诊PCI;另 1例患者在冠状动脉造影后 2 1d死于十二指肠穿孔。 1 76例入选患者无一例出现严重出血事件 ;PCI组有 3例 (5 0 % )患者出现轻度穿刺部位出血 ,单纯冠状动脉造影组为 5例 (4 3 % )。

Objective To evaluate the safety and efficacy of subcutaneous low molecular weight heparin (LMWH) used in cardiac catheterization, and tried to seek an optimal anticoagulation strategy Methods A total of 176 patients with acute coronary syndrome (ACS) were treated for at least 48 hours with subcutaneous enoxaparin (1 mg/kg every 12 hours, cycled at 7:00 and 19:00) Without additional bolus of LMWH or unfractionated heparin and without coagulation monitoring, all 176 patients underwent coronary angiographies (CAG) within 8 hours after LMWH injection, followed by immediate percutaneous coronary intervention (PCI) in 60 patients (34 1%) Results Anti Xa activity at the time of catheterization was (0 81±0 27) IU/ml. 93 2% of the patients had anti Xa activity >0 50 IU/ml It was not correlated to the LMWH injection to catheterization time ( r =-0 147, P =0 097) There were no in hospital abrupt closures or urgent revascularizations after PCI In the CAG group, one patient with 3 vessels disease was striken by recurrent acute myocardial infarction while waiting for coronary artery bypass grafting(17 days after CAG)and primary PCI was performed successfully. Another patient died of non cardiac cause before coronary artery bypass grafting Thrombosis and/or embolism occurred in 3 patients (5 0%) after PCI Minor hemorrhage was observed in 3 patients (5 0%) of PCI group, and 5 patients (4 3%) in CAG group No major hemorrhage occurred Conclusion PCI within 8 hours of the last dose after≥48 hours enoxaparin subcutaneous injection seems to be safe and effective