Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy.
Department of Cardiosciences, A. O. San Camillo-Forlanini, Roma, Italy.
Heart Lung Circ. 2021 Oct;30(10):1545-1551. doi: 10.1016/j.hlc.2021.04.012. Epub 2021 May 14.
Although anticoagulation with unfractionated heparin (UFH) is commonly used during intra-aortic balloon pump (IABP) counterpulsation to prevent thromboembolic events, no data or guidelines exist to support this strategy, especially in the setting of acute myocardial infarction (AMI). This study sought to compare the short-term outcome of UFH vs fondaparinux in AMI patients who underwent successful percutaneous coronary intervention (PCI) and IABP insertion.
The anticoagulation therapy of revascularised AMI patients who received IABP counterpulsation and admitted to a tertiary hospital in the last decade was retrospectively evaluated. The primary outcome was the occurrence of all-cause mortality, stroke or transient ischaemic attack, reinfarction, unplanned revascularisation, major or minor limb ischaemia, and any bleeding at 1 month. Propensity score matching was performed to compare the primary outcome between UFH and fondaparinux.
Of 1,355 AMI survivors at 2 days after hospital admission and who underwent successful PCI, an IABP was inserted in 197 (14.5%): 72 (36.5%) were treated with UFH and 125 (63.5%) with fondaparinux (2.5 mg o.d.). At clinical follow-up, completed in 98.5% of cases, the incidence of the primary outcome was 22.5% in UFH and 5.7% in fondaparinux groups (p=0.0009). More than two-thirds of the events included in the primary outcome were related to early bleeding complications. In the matched cohort of 62 patients, the primary outcome occurred in 14 (45.2%) patients in the UFH and two (6.5%) in the fondaparinux group (p=0.01).
This study suggested that fondaparinux is safer, by reducing early bleeding complications at one month, than UFH in the management of IABP.
尽管在主动脉内球囊反搏（IABP）反搏期间使用未分级肝素（UFH）抗凝以预防血栓栓塞事件，但没有数据或指南支持这种策略，尤其是在急性心肌梗死（AMI）的情况下。本研究旨在比较在接受成功经皮冠状动脉介入治疗（PCI）和 IABP 插入的 AMI 患者中，UFH 与磺达肝素的短期结局。
回顾性评估过去十年间在一家三级医院接受 IABP 反搏和接受再血管化 AMI 患者的抗凝治疗。主要结局是 1 个月时全因死亡率、卒中和短暂性脑缺血发作、再梗死、计划性血管重建、大或小肢体缺血以及任何出血。进行倾向评分匹配以比较 UFH 和磺达肝素之间的主要结局。
在住院后 2 天存活且成功接受 PCI 的 1355 名 AMI 幸存者中，197 名（14.5%）插入了 IABP：72 名（36.5%）接受 UFH 治疗，125 名（63.5%）接受磺达肝素（2.5mg 每天）治疗。在完成了 98.5%病例的临床随访中，UFH 组的主要结局发生率为 22.5%，磺达肝素组为 5.7%（p=0.0009）。主要结局中包括的三分之二以上的事件与早期出血并发症有关。在 62 名匹配患者的队列中，UFH 组发生 14 例（45.2%）主要结局，磺达肝素组发生 2 例（6.5%）（p=0.01）。
本研究表明，磺达肝素比 UFH 更安全，可降低 1 个月时的早期出血并发症，用于 IABP 管理。
