比伐芦定在冠心病合并终末期肾病患者行经皮冠状动脉介入治疗术中的抗凝效果

Anticoagulant effect of bivalirudin in patients with coronary heart disease and end-stage renal disease during percutaneous coronary intervention

摘要:

目的 回顾性分析比伐芦定与肝素用于冠心病(CHD)合并终末期肾病(ESRD)患者经皮冠状动脉介入治疗(PCI)术中的抗凝效果。方法 选择2015年10月至2018年12月在武汉市普仁医院接受PCI治疗的62例CHD合并ESRD患者为研究对象,根据术中给予抗凝药物的不同,将患者分为对照组(肝素)29例和观察组(比伐芦定)33例。比较2组住院期间造影剂肾病(CIN),术后30d及1年净临床不良事件(NACE)、主要不良心脑血管事件(MACCE)及全部出血事件发生情况；观察2组MACCE分项指标的差异。采用SPSS 25.0统计软件对数据进行分析,根据数据类型,分别采用t检验或χ²检验。结果 住院期间2组各发生CIN 3例,差异无统计学意义(P＞0.05)。术后30 d,观察组NACE与全部出血事件发生率均低于对照组,差异有统计学意义(P＜0.05)；2组MACCE发生率比较,差异无统计学意义(P＞0.05)。术后1年,观察组NACE发生率低于对照组,差异有统计学意义(P＜0.05)；2组MACCE、全部出血事件发生率差异无统计学意义(P＞0.05)。结论 CHD合并ESRD患者行PCI治疗,与肝素相比,比伐芦定能显著减少术后30d NACE 及全部出血事件,抗凝效果良好,且NACE减少优势持续至术后1年。比伐芦定更适合 CHD合并ESRD患者PCI术中抗凝。

Abstract:

Objective To retrospectively analyze anticoagulant effect of bivalirudin and heparin in the patients with coronary heart disease(CHD) and end-stage renal disease(ESRD)during percutaneous coronary intervention(PCI). Methods A total of 62 patients with CHD complicated with ESRD were selected for the study, who received PCI treatment in Wuhan Puren Hospital from October 2015 to December 2018. According to the different anticoagulants administered during operation, they were divided into control group (heparin, n=29) and observation group (bivalirudin, n=33). The two groups were compared in contrast-induced nephropathy (CIN) during hospitalization, net adverse clinical events (NACE) and major adverse cardiac and cerebrovascular events (MACCE) in 30 days and 1 year after operation. The difference of MACCE sub-indexes between the two groups was observed. SPSS statistics 25.0 was used for data analysis, and t-test or Chi-square test was used for comparison between groups. Results During hospitalization, 3 patients developed CIN in both groups without significant difference (P>0.05). At 30 days after the operation, NACE and all bleeding events in the observation group were lower than those in the control group, and the differences were significant (P<0.05). There was no significant difference in MACCE between the two groups (P>0.05). At postoperative 1 year, NACE was significantly lower in the observation group than the control group (P<0.05), and there was no significant difference in MACCE and all bleeding events between the two groups (P>0.05). Conclusion Bivalirudin reduces the NACE and all bleeding events more significantly than heparin within 30 days after PCI in CHD patients with ESRD, showing better anticoagulant effect. The advantage of risk reduction of NACE may last till 1 year after PCI. Bivalirudin is more suitable for anticoagulation in patients with CHD and ESRD during PCI.