摘要
研究背景 低分子肝素(LMWH)可以有效取代普通肝素(UH)应用于急性冠脉综合征(ACS)的治疗。然而,ACS患者冠脉介入治疗(PCI)时最佳的抗凝策略尚不明了。国外有关在ACS患者冠脉介入治疗中应用LMWH的研究表明,在皮下应用低分子肝素至少48h(≥4次)的基础上,仅使用LMWH,术中不追加抗凝药是安全有效的。而我中心曾按上述方法入选278例ACS患者,发现PCI术前仅有79.7％抗-Xa活性>0.5IY/ml,存在抗在抗凝力度偏低的情况。本试验在原有LMWH依诺肝素(克赛)基础上追加UH5000u,通过监测抗-Xa因子活性及APTT值评价低分子肝素联合UH在PCI中的安全性和有效性,探索适合国人的PCI抗凝策略。方法 入选75例ACS患者。所有患者按照1mg[100IU]/kg的剂量每隔12小时皮下注射依诺肝素(克赛)一次(7AM-7PM),至少48h(≥4次)后进行冠脉造影。术前不间断使用LWMH,末次注射时间(7AM)距离造影不超过8h,穿刺前≈末次注射的2～8h内)取血测定抗-Xa活性和APTT。行PCI前术中追加5000u普通肝素,术中不监测凝血活性,术后测定抗Xa活性及APTT。结果 冠脉造影前肝素抗-Xa活性是0.675±0.2594IU/ml,75.7％患者抗-Xa活性>0.5IUml,2.7％患者抗-Xa活性>1.2IU/ml。追加5000u肝素后平均抗-Xa活性1.323±0.294IU/ml,1.4％患者抗-Xa活性<0.5IU/ml,74.
Background Subcutaneous low - molecular - weight heparin(LMWH) can effectively replace unfractionated heparin(UH) in treating ACS.However, the optimal anticoagulation strategy for these patients when they require PCI is still unclear.A foreign study on PCI after subcutaneous enoxaparin pretreatment in UAP/NQMI Patients demonstrated that it is safe and effective for only using LMWH in cardiac catheterization. However, maybe it did not fit ourselves. In the meanwhile, with this methods our center have performed a study of 278 patients, and the results show that Anti - Xa activity was > 0. 5IU/ml in only 19.1% of patients. So we speculated the anticoagulant activity is something low. With the measurement of Anti - Xa activity and APTT, this study aimed at the safety and validity of the combination of LMWH and 5000UH used in PCI, and tried to seek an optimal anticoagulation strategy. Methods and Results A total of 75 patients with ACS were treated for at least 48 hours with subcutaneous enoxaparin(1mg[ 100IU]/kg every 12 hours, cycled 7 AM and 7PM), Without the interruption of LMWH and without coagulation monitoring, all these patients undergone a coronary angiography within 8 hours after the morning LMWH injection. After the additional bolus of UH5000u, they were followed by immediate percutaneous coronary intervention (PCI), Anti -Xa activity before the time of catheterization was 0.675 ± 0.2594IU/ml,was > 0.5IU/ml in 75.7% of patients, was > 1.2IU/ml in 2.7% of patients. After PCI Anti - Xa activity was 1.323 ± 0.294IU/ ml, was < 0. 5IU/ ml in 1.4% , > 1. 2IU/ ml in 74.3 % . There were no in -hospital abrupt closures or urgent revascularizations after PCI. Thrombosis/embolism occurred in 1 patient who only have CAG, no Thrombosis/ embolism or major hemorrhage in bolus UH group. Conclusion With the bolus of UH5000, maybe the anticoagulant activity is something high for PCI within 8 hours of the last dose after≥48 hours enoxaparin subcutaneous injection.
出处
《全科医学临床与教育》
2004年第1期14-17,共4页
Clinical Education of General Practice
