Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China.
Chin Med J (Engl). 2018 Oct 20;131(20):2417-2423. doi: 10.4103/0366-6999.243559.
Unfractionated heparin (UFH), despite its limitations, has been used as the primary anticoagulant alternative during the percutaneous coronary intervention (PCI). Some studies indicated that intravenous enoxaparin could be an effective and safe option. Our team used enoxaparin alone at one time according to the guidelines (Class IIA) and found a little catheter thrombosis during PCI. We recommend a new anticoagulation strategy using enoxaparin in combination with UFH. Enoxaparin has a more predictable anticoagulant response with no need of repeatedly monitoring anticoagulation during PCI. This retrospective study aimed to evaluate the efficacy and safety of using enoxaparin in combination with UFH in PCI patients with complex coronary artery disease.
Between January 2015 and April 2017, 600 PCI patients who received intravenous UFH at an initial dose of 3000 U plus intravenous enoxaparin at a dose of 0.75 mg/kg (observation group) and 600 PCI patients who received UFH at a dose of 100 U/kg (control group) were consecutively included in this retrospective study. The endpoints were postoperative 48-h thrombolysis in myocardial infarction (TIMI) bleeding and transfusion and 30-day and 1-year major adverse cardio-cerebrovascular events (MACCE).
Baseline clinical, angiographic, and procedural characteristics were similar between groups, except there was less stent implantation per patient in the observation group (2.13 vs. 2.25 in the control group, P = 0.002). TIMI bleeding (3.3% vs. 4.7%) showed no significant difference between the observation group and control group. During the 30-day follow-up, the rate of MACCE was 0.9% in the observation group and 1.5% in the control group. There was no significant difference in the rates of MACCE, death, myocardial infarction, target vessel revascularization, cerebrovascular event, and angina within 30 days and 1 year after PCI between groups as well as in the subgroup analysis of transfemoral approach.
UFH with sequential enoxaparin has similar anticoagulant effect and safety as UFH in PCI of complex coronary artery disease.
尽管普通肝素（UFH）存在局限性，但它仍被用作经皮冠状动脉介入治疗（PCI）的主要抗凝替代药物。一些研究表明，静脉注射依诺肝素可能是一种有效且安全的选择。我们的团队根据指南（IIA 类）一次单独使用依诺肝素，结果在 PCI 过程中发现了一点导管血栓。我们建议采用一种新的抗凝策略，即依诺肝素联合 UFH。依诺肝素的抗凝反应更可预测，在 PCI 期间无需反复监测抗凝。这项回顾性研究旨在评估依诺肝素联合 UFH 在复杂冠状动脉疾病 PCI 患者中的疗效和安全性。
2015 年 1 月至 2017 年 4 月，连续纳入 600 例行 PCI 治疗的患者，一组初始静脉注射 UFH 剂量为 3000U，同时静脉注射依诺肝素剂量为 0.75mg/kg（观察组）；另一组初始静脉注射 UFH 剂量为 100U/kg（对照组）。主要终点为术后 48 小时心肌梗死溶栓治疗（TIMI）出血和输血，次要终点为 30 天和 1 年的主要不良心脑血管事件（MACCE）。
两组患者的基线临床、血管造影和手术特征相似，但观察组的每位患者支架植入数量较少（2.13 个比对照组的 2.25 个，P = 0.002）。观察组和对照组的 TIMI 出血（3.3%比 4.7%）无显著差异。在 30 天随访期间，观察组的 MACCE 发生率为 0.9%，对照组为 1.5%。两组之间以及经股动脉入路的亚组分析中，30 天和 1 年内 MACCE、死亡、心肌梗死、靶血管血运重建、脑血管事件和心绞痛的发生率均无显著差异。
UFH 序贯依诺肝素在复杂冠状动脉疾病 PCI 中的抗凝效果和安全性与 UFH 相似。
