摘要
目的探讨国产注射用比伐芦定对择期冠状动脉支架置入(PCI)患者术中凝血功能的影响。方法入选2017年3月至2018年3月201例择期行冠状动脉支架置入术的患者,术中使用国产注射用比伐芦定抗凝,分别在用药前,用药后5 min、15 min、30 min、60min,停药前,停药后30 min及60min测定活化凝血时间(ACT)。结果给予比伐芦定5 min后,ACT值迅速达标,平均为(313.93±42.34)s。在随后的测定中,ACT值稳定,变异小,增加的幅度和持续时间能够满足冠状动脉介入治疗过程中抗凝的需要。停药后ACT值迅速下降,停药60 min时降至(165.12±19.20) s。住院期间仅有1例发生急性支架内血栓,余均无出血及主要心血管不良事件(MACE)发生。结论国产注射用比伐芦定应用于PCI术中抗凝,ACT值可迅速达标,使用过程中相对稳定,可保证手术过程中的充分抗凝效果。停药后代谢迅速,具有易调控的特点。
Objective To evaluate the effects of domestic bivalirudin on coagulation function during percutaneous coronary interventional(PCI)therapy. Methods Totally 201 patients were selected to use domestic bivalirudin during PCI from March 2017 to March 2018.Activated time(ACT)was tested before PCI, 5, 15, 30 and 60 min after bivalirudin infusion, and the end of infusion, 30 and 60 min after stopping infusion. Results ACT was elevated very quickly at 5 min after using bivalirudin. The average of ACT was(313.93±42.34) s.The value of ACT was relatively stable during PCI and decreased rapidly after stopping infusion. At 60 min after infusion,the average of ACT was(165.12±19.20) s.Only one acute thrombus event occurred. There was no blooding or major adverse cardiac events(MACE) events. Conclusions The stable anti-coagulation effects can be obtained by using domestic bivalirudin during selective PCI and recoveries rapidly.
引文
[1]Melandri G, Semprini F, Cervi V, et al. Comparison of efficacy of low molecular weight heparin(parnaparin)with that of unfractionated heparin in the presence of activated platelets in healthy subjects. Am J Cardio, 1993, 72:450-454.
[2]Gao C, Boylan B, Fang J, et al. Heparin promotes platelet responsiveness by potentiatingαIIbβ3-mediated outside-in signaling. Blood, 2011, 117(18):4946.
[3]Day JR, Malik IS, Weerasinghe A, et al. Distinct yet complementary mechanisms of heparin and glycoprotein IIb/IIIa inhibitors on platelet activation and aggregation:implications for restenosis during percutaneous coronary intervention. Heart, 2004, 90(7):794-799.
[4]Warkentin TE, Greinacher A, Koster A, et al. Treatment and Prevention of Heparin-Induced Thrombocytopenia:Antithrombotic Therapy and Prevention of Thrombosis, 9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Chest, 2008, 133(6):340S-380S.
[5]Kimmelstiel C, Zhang P, Kapur NK, et al. Bivalirudin is a Dual Inhibitor of Thrombin and Collagen-Dependent Platelet Activation in Patients Undergoing Percutaneous Coronary Intervention. Circ Cardiovasc Interv, 2011,4(2):171.
[6]Han Y, Guo J, Zheng Y, et al. Bivalirudin vs Heparin With or Without Tirofiban During Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction:The BRIGHT Randomized Clinical Trial. JAMA, 2015, 313(13):1336.
[7]Zucker ML, Koster A, Prats J, et al. Sensitivity of a Modified ACT Test to Levels of Bivalirudin Used During Cardiac Surgery. J Extra Corpor Technol, 2005, 37(4):364-368.
[8]Lehman SJ, Chew DP. Bivalirudin in percutaneous coronary intervention. Vasc Health Risk Manag, 2006, 2(4):357-363.
[9]Chew GP, Bhatt DL, Kimball W, et al. Bivalirudin provides increasing benefit with decreasing renal function:a meta-analysis of randomized trials. Am J Cardiol, 2003, 92:919-923.
