Wang Qian, Liu Yan, Yang Lin, Zhou Tienan, Zhang Quanyu, Zhang Zhiqiang, Sun Dongyuan, Wang Xiaozeng
State Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute, Department of Cardiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, China.
BMC Cardiovasc Disord. 2024 Dec 19;24(1):713. doi: 10.1186/s12872-024-04399-5.
In clinical practice, the dose of bivalirudin may not be fully applicable to the Chinese population. Therefore, this study aimed to explore the efficacy and safety of a reduced dose (80% of the recommended dose) of bivalirudin without post-procedure infusion for 3-4 h in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI).
This was a single-center, retrospective study. Patients who met the inclusion criteria and no exclusion criteria were divided into reduced-dose and recommended-dose groups for analysis. Confounders were corrected using propensity score matching. The incidence of net adverse clinical events (NACE), major adverse cardiovascular events (MACE), and Bleeding Academic Research Consortium (BARC) type 2-5 bleeding events were observed 30 days postoperatively.
In total, 1,590 patients (795 per group) were obtained after propensity score matching. The results after propensity score matching were as follows: The activated clotting time (ACT) after 5 min in the reduced-dose group was 349.37 ± 47.59 s, which was statistically lower than that in the recommended-dose group, 353.12 ± 44.98 s (P = 0.024). There was no significant difference in the proportion of ACT values of ≥ 250 s after 5 min between the two groups (P > 0.05). There were no significant differences in NACE, MACE, and BARC type 2-5 bleeding events between the two groups (5.0% vs. 4.5%, P = 0.638; 0.0% vs. 0.1%, P = 1.000; 0.3% vs. 0.5%, P = 0.687). There were no statistically significant differences in cumulative NACE and cumulative bleeding events between the two groups at 30 days (P = 0.635 and P = 0.716, respectively).
In patients with UA and NSTEMI undergoing elective PCI, 80% of the recommended dose of bivalirudin without post-procedure infusion can be used for anticoagulation without increasing the risk of thrombosis and bleeding.
在临床实践中，比伐卢定的剂量可能并不完全适用于中国人群。因此，本研究旨在探讨在接受择期经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者中，使用比伐卢定减少剂量（推荐剂量的80%）且术后不进行3 - 4小时输注的有效性和安全性。
这是一项单中心回顾性研究。将符合纳入标准且无排除标准的患者分为减少剂量组和推荐剂量组进行分析。使用倾向评分匹配法校正混杂因素。术后30天观察净不良临床事件（NACE）、主要不良心血管事件（MACE）和出血学术研究联盟（BARC）2 - 5型出血事件的发生率。
经过倾向评分匹配后，共获得1590例患者（每组795例）。倾向评分匹配后的结果如下：减少剂量组5分钟后的活化凝血时间（ACT）为349.37±47.59秒，在统计学上低于推荐剂量组的353.12±44.98秒（P = 0.024）。两组5分钟后ACT值≥250秒的比例无显著差异（P > 0.05）。两组之间的NACE、MACE和BARC 2 - 5型出血事件无显著差异（5.0%对4.5%，P = 0.638；0.0%对0.1%，P = 1.000；0.3%对0.5%，P = 0.687）。两组在30天时的累积NACE和累积出血事件无统计学显著差异（分别为P = 0.635和P = 0.716）。
在接受择期PCI的不稳定型心绞痛（UA）和非ST段抬高型心肌梗死（NSTEMI）患者中，使用比伐卢定推荐剂量的80%且术后不进行输注可用于抗凝，而不会增加血栓形成和出血风险。
