摘要
目的评价注射用比伐芦定在经皮冠状动脉介入治疗（PCI）抗凝应用的有效性和安全性。方法在英文数据库（Pubmed、Medline、ElsevierScience、JAMA、New England Journal of Medicine、Cochran Library）和中文数据库（CNKI、万方数据库、维普数据库）中检索有关比伐芦定随机对照试验（RCT）研究文献，在对文献的质量评价后进行Meta分析。结果经筛选后纳入Meta分析的文献有12篇，其中5篇文献比较了比伐芦定与肝素的临床疗效与安全性，有8篇文献比较了比伐芦定与肝素联合糖蛋白受体抑制剂（GPI）的临床疗效与安全性。比伐芦定组抗凝治疗获得的缺血净效应（30d内死亡、再次心肌梗死）并不优于肝素组，支架内栓塞的发生率差异无统计学意义。但比伐芦定组发生TIMI大出血、小出血发生率明显低于肝素组（艘0．586，95％CI：0．367-0．935，P〈0．026），（RR0．601，95％C1：0．473-0．763，P〈0．015）。应用比伐芦定组抗凝效果与肝素联合GPI的效果相似。比伐芦定组的大出血发生率较低（RR0．562，95％CI：0．463~0．681，P〈0．000），小出血组发生率也低于肝素联合GPI组（艘0．561，95％CI：O．498~0．63l，P〈0．000）。结论在PCI中应用比伐芦定抗凝治疗，在不增加PCI不良事件发生的情况下，能明显降低PCI围术期大出血和小出血的发生率。对于有高出血风险患者，在PCI过程中单独应用比伐芦定替代肝素或者肝素联合营罗非斑进行抗凝治疗是有意义的。
Objective This study sought to investigate the relative safety and efficacy of bivalirudin inhibitting blood coagulation in patients undergoing percutaneous coronary intervention（PCI）.Methods Literature of rand- omized controlled trials about bivalirudin is choosed from the databases including foreign and Chinese databases, after the evaluation of the quality of the literature for meta analysis.Results By screening into the meta analysis of 8 pieces of literature,of which 5 papers are clinical efficacy and safety of Bivalirudin comparing with Unfractionated Heparin,8 pieces are clinical efficacy and safety of of Bivalirudin versus Heparin Plus Glycoprotein lib/Ilia inhibitors. The net effect of Bivalirudin was not superior to heparin in the treatment of anticoagulant therapy, and the incidence of stent embolization was not statistically significant.However, the incidence of TIMI hemorrhage was significantly lower than that of the heparin group（RR O.586,95%CI：0.367-0.935,P〈O.O26）,（RR 0.601,95%C1：0.473-0.763,P〈0.015）. Anticoagulant effect of Bivalirudin and heparin was similar in the application of GPi.The incidence of large hemor- rhage for Bivalirudin was lower than that of the group（RR 0.562,95%C1：0.463-0.681 ,P〈0.000）,The incidence of small hemorrhage was also lower than that of heparin combined with GPI group（RR 0.561,95%C1：0.498-0.631, P〈0.000）.Conclusion The incidence of perioperative hemorrhage and small hemorrhage was significantly decreased by PCI application of PCI and the incidence of PCI in the case of no increase of adverse events.For patients with high risk of bleeding,it was significant to apply Bivalirudin alone in the PCI process or combination of heparin and the non spot.
出处
《中国药物经济学》
2015年第6期13-18,29,共7页
China Journal of Pharmaceutical Economics
基金
深圳信立泰药业有限公司赞助
