Gupta Aakriti, Chui Philip, Zhou Shengfan, Spertus John A, Geda Mary, Lorenze Nancy, Lee Ike, D' Onofrio Gail, Lichtman Judith H, Alexander Karen P, Krumholz Harlan M, Curtis Jeptha P
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Department of Internal Medicine, University of California, Irvine, California.
Am J Cardiol. 2015 Jul 1;116(1):1-7. doi: 10.1016/j.amjcard.2015.03.032. Epub 2015 Apr 6.
Excess dosing of anticoagulant agents has been linked to increased risk of bleeding after percutaneous coronary intervention (PCI) for women compared with men, but these studies have largely included older patients. We sought to determine the prevalence and gender-based differences of excess dosing of anticoagulants including glycoprotein IIb/IIIa inhibitors, bivalirudin, and unfractionated heparin in young patients with acute myocardial infarction who underwent PCI and to examine its association with bleeding. Of 2,076 patients enrolled in the Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients study who underwent PCI, we abstracted doses of unfractionated heparin, bivalirudin, and glycoprotein IIb/IIIa inhibitors administered during PCI from the medical records. At least 47.2% received at least 1 excess dose of an anticoagulant, which did not differ by gender. We used logistic regression to determine the predictors of excess dosing and the association of excess dosing with bleeding. In multivariable analysis, only lower body weight and younger age were significant predictors of excess dosing. Bleeding was higher in young women who received excess dosing versus those who did not (9.3% vs 6.0%, p = 0.03) but was comparable among men (5.2% vs 5.9%, p = 0.69) in univariate analysis. In multivariable analysis, there was a trend to an association between excess dosing and bleeding (odds ratio 1.33, 95% confidence interval 0.92 to 1.91) although not statistically significant. In conclusion, approximately half of the patients received excess dosing of anticoagulant drugs during PCI, which did not vary based on gender. There was a trend toward an association between excess dosing and increased bleeding, although not statistically significant.
与男性相比，经皮冠状动脉介入治疗（PCI）后，女性抗凝剂过量使用与出血风险增加有关，但这些研究主要纳入的是老年患者。我们试图确定接受PCI的急性心肌梗死年轻患者中，包括糖蛋白IIb/IIIa抑制剂、比伐卢定和普通肝素在内的抗凝剂过量使用的患病率及性别差异，并研究其与出血的关联。在参与“恢复差异：性别对年轻急性心肌梗死患者结局的作用”研究且接受PCI的2076例患者中，我们从病历中提取了PCI期间使用的普通肝素、比伐卢定和糖蛋白IIb/IIIa抑制剂的剂量。至少47.2%的患者接受了至少1次抗凝剂过量给药，且不存在性别差异。我们使用逻辑回归来确定过量给药的预测因素以及过量给药与出血的关联。在多变量分析中，只有较低的体重和较年轻的年龄是过量给药的显著预测因素。在单变量分析中，接受过量给药的年轻女性出血发生率高于未接受过量给药的女性（9.3%对6.0%，p = 0.03），但男性中两者相当（5.2%对5.9%，p = 0.69）。在多变量分析中，过量给药与出血之间存在关联趋势（比值比1.33，95%置信区间0.92至1.91），尽管无统计学意义。总之，约一半的患者在PCI期间接受了过量的抗凝药物治疗，且不存在性别差异。过量给药与出血增加之间存在关联趋势，尽管无统计学意义。
