2017 年第 8 期 第 12 卷

复杂冠状动脉病变择期介入手术中小剂量普通肝素加依诺肝素序贯抗凝的临床有效性及安全性

Effectiveness and safety of unfractionated heparin with sequential enoxaparin in patients with complex coronary artery disease undergoing elective percutaneous coronary intervention

作者：侯晓琳黄觊李志忠王苏陶英阴赪茜高玉龙

英文作者：Hou Xiaolin Huang Ji Li Zhizhong Wang Su Tao Ying Yin Chengqian Gao Yulong

单位：100029首都医科大学附属北京安贞医院心内五科北京市心肺血管疾病研究所

英文单位：The 5th Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：复杂冠状动脉病变；经皮冠状动脉介入；抗凝药；依诺肝素

英文关键词：Complexcoronaryarterydisease；Percutaneouscoronaryintervention；Anticoagulants；Enoxaparin

• 摘要：

• 目的  探讨复杂冠状动脉病变择期经皮冠状动脉介入（PCI）术中“小剂量普通肝素-依诺肝素”序贯抗凝的有效性及安全性。方法  连续选取2015年4月至2016年5月于首都医科大学附属北京安贞医院心内五科诊断为复杂冠状动脉病变，并择期行PCI治疗的患者共805例，随机化分组至“小剂量普通肝素-依诺肝素”序贯抗凝组（观察组，405例）和普通肝素组(对照组，400例)。观察组冠状动脉造影前给予导管内推注普通肝素3 000 U，造影后决定行PCI则导管内补充依诺肝素0.75～1.00 mg/kg；对照组冠状动脉造影前于导管内推注普通肝素3 000 U，造影后决定行PCI术则补充普通肝素至总量（含造影时用量）100 U/kg。比较2组给药前后凝血指标和术后肌钙蛋白水平、手术成功率、复杂病变类型及支架相关指标、术后30 d和1年时主要心血管事件（MACE）发生率和住院期间心肌梗死溶栓试验（TIMI）大出血情况。结果  2组术前和给药后24 h活化部分凝血活酶时间、给药后1 h活化凝血时间、术后肌钙蛋白水平比较，差异均无统计学意义(均P＞0.05)。对照组与观察组PCI手术成功率比较［99.0%（396/400）比98.8%（400/405）］，差异无统计学意义（P＞0.05），2组均无支架内血栓发生。2组患者复杂病变类型、平均病变个数、支架数目、支架长度、支架直径比较，差异均无统计学意义（均P＞0.05）。对照组与观察组术后30 d和1年MACE发生率比较，差异均无统计学意义（均P＞0.05）。2组住院期间均无TIMI大出血发生。结论  复杂冠状动脉病变择期PCI术中“小剂量普通肝素-依诺肝素”序贯抗凝方案与经典普通肝素抗凝相比，有效性和安全性均无明显差异。

• Objective  To explore the effectiveness and safety of unfractionated heparin（UFH） with sequential enoxaparin in patients with complex coronary artery disease undergoing elective percutaneous coronary intervention（ePCI）. Methods  A total of 805 patients who were diagnosed with complex coronary artery disease undergoing ePCI from April 2015 to May 2016 in Beijing Anzhen Hospital, Capital Medical University were randomly assigned to have UFH with sequential enoxaparin（observational group, n=405） and routine UFH（control group, n=400）. Patients in both groups were administered 3 000 U UFH before coronary angiography; the observation group was administered enoxaparin 0.75-1.00 mg/kg and the control group was added UFH to a total dose of 100 U/kg before ePCI. Blood coagulation indexes, troponin level, operation success rate, types of complex coronary artery lesion, stent numbers and size were analyzed. Incidences of major adverse cardiac events（MACE） and thrombolysis in myocardial infarction（TIMI） major bleeding were analyzed. Results  There were no significant differences of activated partial thromboplastin time before and 24 h after administration, activated coagulation time 1 h after administration and postoperative troponin level between groups（P＞0.05）. The success rate of operation was 99.0%（396/400） in control group and 98.8%（400/405） in observation group, there was no significant difference between groups（P＞0.05）. There were no significant differences between groups in types of complex coronary artery lesion, the number of lesions, the number, length and diameter of stents（P＞0.05）. The 30 d and 1 year MACE rates showed no significant differences between groups（P＞0.05）. No TIMI major bleeding occurred in both groups. Conclusion  UFH with sequential enoxaparin may be as effective and safe as the standard UFH anticoagulant therapy in treatment of ePCI for complex coronary artery disease.