Matthai W H
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
Semin Thromb Hemost. 1999;25 Suppl 1:57-60.
Percutaneous coronary revascularization (PTCR) procedures require intense anticoagulation during the procedure to reduce the risk of a thrombotic complication. This anticoagulation is almost always performed with unfractionated heparin. Heparin, however, is far from the ideal anticoagulant for use in PTCR, and its use is contraindicated in patients with known or suspected heparin-induced thrombocytopenia (HIT) or the heparin-induced thrombocytopenia and thrombosis syndrome (HITTS). The incidence of HIT/HITTS in the population undergoing PTCR may be increased due to the widespread use of heparin in cardiovascular patients. Direct thrombin inhibitors such as argatroban do not interact with the antibody that causes HIT/HITTS, and so these agents can be used to provide anticoagulation in patients with this dangerous condition. Argatroban was used in a trial of 50 patients with known or suspected HIT or HITTS who required PTCR. Adequate anticoagulation was achieved in 98% and there was procedural success in 98% with only 1 major bleeding event. These preliminary data suggest that argatroban can be used safely and effectively as an anticoagulant during PTCR in patients with known or suspected HIT or HITTS.
经皮冠状动脉血运重建术（PTCR）操作过程中需要强效抗凝以降低血栓形成并发症的风险。这种抗凝几乎总是使用普通肝素进行。然而，肝素远非PTCR中理想的抗凝剂，已知或疑似肝素诱导的血小板减少症（HIT）或肝素诱导的血小板减少症和血栓形成综合征（HITTS）的患者禁用肝素。由于肝素在心血管疾病患者中的广泛使用，接受PTCR人群中HIT/HITTS的发生率可能会增加。直接凝血酶抑制剂如阿加曲班不会与导致HIT/HITTS的抗体相互作用，因此这些药物可用于为患有这种危险病症的患者提供抗凝作用。阿加曲班用于一项针对50名已知或疑似HIT或HITTS且需要PTCR的患者的试验。98%的患者实现了充分抗凝，98%的患者手术成功，仅发生1例严重出血事件。这些初步数据表明，阿加曲班可作为已知或疑似HIT或HITTS患者PTCR期间的抗凝剂安全有效地使用。
