Bahit M C, Topol E J, Califf R M, Armstrong P W, Criger D A, Hasselblad V, Betriu A, Hirsh J, Ardissino D, Granger C B
Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
J Am Coll Cardiol. 2001 Mar 15;37(4):1001-7. doi: 10.1016/s0735-1097(01)01143-3.
We sought to determine the incidence of and risk factors for thrombotic events early after discontinuing antithrombin therapy in patients with acute coronary syndromes.
Discontinuation of treatment with heparin and other thrombin inhibitors in patients with unstable coronary syndromes has related to clinical and biochemical evidence of early reactivation of thrombosis.
We studied 8,943 of the 12,142 patients with acute coronary syndromes enrolled in the Global Use of Strategies To Open occluded arteries in acute coronary syndromes trial of hirudin versus heparin. We excluded patients who received no study drug, lacked timing data, died or had myocardial (re)infarction [(re)MI] during study-drug infusion, or began heparin treatment within 2 h after treatment with the study drug was stopped. We assessed the incidence and timing of (re)MI by type and timing of antithrombin treatment.
In all, 215 patients (2.4%) suffered (re)MI, 49 within 12 h of antithrombin therapy discontinuation and 166 between hour 12 and hospital discharge. The duration of infusion did not differ between the hirudin and heparin groups. The rate of early re(MI) after drug therapy discontinuation was significantly higher in patients given heparin versus hirudin (0.8% vs. 0.3%, p = 0.002). Patients with (re)MI had higher mortality at 30 days (23.6% vs. 2.4%, p = 0.001) and 1 year (35.2% vs. 6.7%, p = 0.001) compared with patients without (re)MI.
The incidence of (re)MI was clustered within 12 h of heparin therapy discontinuation, with the greatest risk within 4 h. There was no evidence of early reactivation of thrombotic events after hirudin. Patients who had (re)infarction had worse outcomes. Better understanding of the mechanism and possible prevention of recurrent thrombosis is needed.
我们试图确定急性冠状动脉综合征患者停用抗凝血酶治疗后早期血栓形成事件的发生率及危险因素。
不稳定型冠状动脉综合征患者停用肝素和其他凝血酶抑制剂治疗与血栓形成早期再激活的临床和生化证据有关。
我们研究了全球急性冠状动脉综合征应用策略开放闭塞动脉试验（比较水蛭素与肝素）中纳入的12142例急性冠状动脉综合征患者中的8943例。我们排除了未接受研究药物、缺乏时间数据、在研究药物输注期间死亡或发生心肌（再）梗死[(再)MI]，或在研究药物停用后2小时内开始肝素治疗的患者。我们根据抗凝血酶治疗的类型和时间评估（再）MI的发生率和时间。
总共215例患者（2.4%）发生（再）MI，49例在抗凝血酶治疗停用后12小时内，166例在12小时至出院之间。水蛭素组和肝素组的输注持续时间无差异。停用药物治疗后早期再（MI）发生率在接受肝素治疗的患者中显著高于接受水蛭素治疗的患者（0.8%对0.3%，p = 0.002）。与无（再）MI的患者相比，发生（再）MI的患者在30天时死亡率更高（23.6%对2.4%，p = 0.001），在1年时死亡率更高（35.2%对6.7%，p = 0.001）。
（再）MI的发生率集中在肝素治疗停用后的12小时内，4小时内风险最高。没有证据表明水蛭素治疗后血栓形成事件会早期再激活。发生（再）梗死的患者预后较差。需要更好地了解复发性血栓形成的机制及可能的预防措施。
