Sorbonne Université-Univ Paris 06 (UPMC), ACTION Study Group, INSERM, UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), 47-83 bld de l'Hôpital, 75013, Paris, France.
Service mobile d'urgence et de reanimation (SMUR), Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6, Paris, France.
Am J Cardiovasc Drugs. 2018 Dec;18(6):503-511. doi: 10.1007/s40256-018-0294-z.
The aim was to compare the peri-procedural biomarkers of coagulation and platelet activation in patients randomly allocated to intravenous enoxaparin or unfractionated heparin (UFH) in the ATOLL randomized trial (NCT00718471).
A total of 129 patients (n = 58 enoxaparin and n = 71 UFH) admitted for ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI) were included in this substudy of the ATOLL trial. Activated partial thromboplastin time ratio, anti-Xa activity, von Willebrand factor antigen, prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complex (TAT), tissue factor pathway inhibitor and soluble CD40 ligand were measured at sheath insertion (T1) and at the end of the PCI (T2) and correlated with 1-month clinical outcomes. Target anticoagulation levels at T2 were more readily achieved in patients receiving enoxaparin compared to those receiving UFH (80.3 vs 18.2%, p < 0.0001). Increased levels of F1 + 2 and TAT measured at T2 were associated with the incidence of the composite ischemic endpoint (p = 0.04 and p = 0.03) and all-cause mortality (p < 0.0001 and p = 0.002). Release of F1 + 2 between T1 and T2 also predicted the composite ischemic endpoint (312 ± 513 vs 37 ± 292, p = 0.04) and net clinical outcome (185 ± 405 vs 3.2 ± 278, p = 0.03).
During primary PCI, enoxaparin achieved therapeutic levels more frequently than UFH. Higher level of thrombin generation measured at the end of the PCI procedure was associated with more frequent ischemic events.
本研究旨在比较接受静脉注射依诺肝素或未分级肝素（UFH）随机分组的患者在围手术期凝血和血小板激活的生物标志物。
本研究纳入了 129 例接受经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者（n=58 例依诺肝素组和 n=71 例 UFH 组），这是 ATOLL 试验的亚组研究。在鞘管插入（T1）和 PCI 结束时（T2）检测激活的部分凝血活酶时间比值、抗 Xa 活性、血管性血友病因子抗原、凝血酶原片段 1+2（F1+2）、凝血酶-抗凝血酶复合物（TAT）、组织因子途径抑制物和可溶性 CD40 配体，并与 1 个月的临床结果相关。与接受 UFH 的患者相比，接受依诺肝素的患者在 T2 时更容易达到目标抗凝水平（80.3% vs 18.2%，p<0.0001）。T2 时 F1+2 和 TAT 水平升高与复合缺血终点（p=0.04 和 p=0.03）和全因死亡率（p<0.0001 和 p=0.002）相关。T1 至 T2 之间 F1+2 的释放也预测了复合缺血终点（312±513 vs 37±292，p=0.04）和净临床结局（185±405 vs 3.2±278，p=0.03）。
在直接 PCI 中，依诺肝素比 UFH 更频繁地达到治疗水平。PCI 结束时检测到的更高水平的凝血酶生成与更频繁的缺血事件相关。
