Rath B, Bennett D H
Regional Cardiac Centre, Wythenshawe Hospital, Manchester.
Br Heart J. 1990 Jan;63(1):18-21. doi: 10.1136/hrt.63.1.18.
The anticoagulant effect of heparin during percutaneous transluminal coronary angioplasty was monitored by measurements of the activated clotting time in two studies that compared the effects of a single bolus of heparin with those of a bolus of heparin combined with a continuous infusion of the drug. In a preliminary study 40 patients received a single heparin bolus of 10,000 units (protocol I) and a further 40 patients received both a heparin bolus of 10,000 and a continuous infusion of heparin at a rate of 2000 units per hour (protocol II). During the first 45 minutes, nine patients (23%) in protocol I but only two patients (5%) in protocol II were found to be inadequately anticoagulated. For 24 hours after angioplasty both groups received an infusion of heparin at the rate of 2000 units per hour which led to consistent anticoagulation in 73 (91%) of patients. In a subsequent randomised study, 40 patients received heparin according to either protocol I or II. Protocol II was again found to lead to a higher rate of adequate anticoagulation. During the first 60 minutes 11 patients (55%) in protocol I but only three patients (15%) in protocol II were inadequately anticoagulated. In addition, the activated clotting time of arterial blood in the first 30 minutes was significantly higher than that of venous blood in 70% of the patients. A bolus of heparin (10,000 units) together with an infusion of 2000 units per hour should be routinely given during coronary angioplasty. The effects of heparin, which can vary considerably from patient to patient, should be monitored by the measurement of the activated clotting time of arterial blood.
在两项研究中，通过测量活化凝血时间来监测经皮腔内冠状动脉成形术期间肝素的抗凝效果，这两项研究比较了单次推注肝素与推注肝素联合持续输注该药的效果。在一项初步研究中，40例患者接受了10000单位的单次肝素推注（方案I），另外40例患者接受了10000单位的肝素推注以及以每小时2000单位的速率持续输注肝素（方案II）。在最初的45分钟内，方案I中有9例患者（23%）但方案II中只有2例患者（5%）被发现抗凝不足。血管成形术后24小时，两组均以每小时2000单位的速率输注肝素，这使得73例（91%）患者实现了持续抗凝。在随后的一项随机研究中，40例患者根据方案I或方案II接受肝素治疗。再次发现方案II导致充分抗凝的比例更高。在最初的60分钟内，方案I中有11例患者（55%）但方案II中只有3例患者（15%）抗凝不足。此外，在70%的患者中，最初30分钟动脉血的活化凝血时间显著高于静脉血。在冠状动脉成形术期间应常规给予10000单位的肝素推注以及每小时2000单位的输注。肝素的效果在患者之间可能有很大差异，应通过测量动脉血的活化凝血时间来监测。
