Li Chenguang, Shen Yi, Xu Rende, Dai Yuxiang, Chang Shufu, Lu Hao, Ge Lei, Ma Jianying, Qian Juying, Ge Junbo
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases.
Department of Geriatrics, Zhongshan Hospital, Fudan University.
Int Heart J. 2018 Mar 30;59(2):293-299. doi: 10.1536/ihj.17-030. Epub 2018 Mar 20.
The safety and efficacy of bivalirudin during percutaneous coronary intervention (PCI) in high bleeding risk patients with chronic total occlusion lesions (CTO) has not been studied till date. The use of bivalirudin may increase the thrombotic events during CTO-PCI.Between May 2013 and April 2014, a total of 117 high bleeding risk patients with CTOs underwent PCI. Bivalirudin was used in 89 cases with different strategies, including standard usage, combination of heparin, and additional bolus of bivalirudin on the basis of standard usage. The clinical characteristics, procedural details and antithrombotic strategies were assessed, and the bleeding and ischemic events were evaluated. The first 7 of 9 patients with standard application of bivalirudin exhibited acute thrombogenesis in the procedure. Heparin was then added in decreasing amounts in the next 8 patients wherein no thrombosis occurred; however, 2 patients had bleeding complications. The subsequent 72 patients were randomly assigned to the heparin bolus or additional bivalirudin bolus groups before the percutaneous transluminal coronary angioplasty (PTCA) was performed. The baseline clinical characteristics and procedure information were identical in both the groups. There were no ischemic and bleeding events in both the groups during the 6-month follow-up.Monotherapy with bivalirudin in CTO-PCI should be treated with caution, as the potential risk of thrombogenesis may be due to the long procedure time, the frequent change of equipment and temporary blood flow convection. Combination of heparin or an additional bolus of bivalirudin before PTCA was observed to be likely to decrease the incidence of thrombogenesis.
至今尚未研究比伐卢定在慢性完全闭塞病变（CTO）且出血风险高的患者经皮冠状动脉介入治疗（PCI）中的安全性和有效性。在CTO-PCI过程中使用比伐卢定可能会增加血栓形成事件。2013年5月至2014年4月，共有117例CTO且出血风险高的患者接受了PCI。89例患者采用不同策略使用了比伐卢定，包括标准用法、肝素联合使用以及在标准用法基础上额外推注比伐卢定。评估了临床特征、手术细节和抗血栓策略，并评估了出血和缺血事件。9例标准应用比伐卢定的患者中有7例在手术过程中出现急性血栓形成。随后在接下来的8例未发生血栓形成的患者中逐渐减少肝素用量；然而，有2例患者出现出血并发症。随后的72例患者在进行经皮腔内冠状动脉成形术（PTCA）前被随机分为肝素推注组或额外比伐卢定推注组。两组的基线临床特征和手术信息相同。在6个月的随访期间，两组均未发生缺血和出血事件。在CTO-PCI中单独使用比伐卢定应谨慎对待，因为血栓形成的潜在风险可能是由于手术时间长、设备频繁更换和临时血流对流。观察到在PTCA前联合使用肝素或额外推注比伐卢定可能会降低血栓形成的发生率。
