比伐芦定对女性PCI患者凝血功能及安全性的影响

目的 探讨比伐芦定对女性拟行经皮冠状动脉介入(PCI)治疗的冠心病患者的凝血功能及安全性的影响。方法 将71例女性拟行PCI的冠心病患者随机分为普通肝素组（n=39）和比伐芦定组（n=32）。分别于PCI术前、用药后5 min、术后即刻、停药后0.5、1和2 h测定激活凝血时间（ACT）。用药前、用药结束后6、24和72 h分别测定凝血酶时间（TT）、活化部分凝血酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（Fib）。分别在用药前、用药后24 h测定血小板计数(PLT)。30 d内主要不良心脑血管事件（MACCE）、术后出血并发症以及支架血栓事件。结果 比伐芦定用药后5 min、术后即刻ACT值显著大于肝素组（P<0.01）；停药后30 min和术前，两组患者ACT差异无统计学意义；停药后1 h、2 h ACT比伐芦定组小于普通肝素组（P<0.01）。两组术后凝血4项及PLT，比较均无统计学意义。两组患者随访30 d，MACCE及支架内血栓发生率差异无统计学意义，术后30 d出血总发生率及美国出血学术研究联合会(BARC) Ⅱ-Ⅴ型出血发生率差异有统计学意义（P<0.05）。结论 与普通肝素相比，比伐芦定对女性行PCI的冠心病患者抗凝治疗中起效更快，半衰期短，更安全有效。

Effect of bivalirudin on coagulation function and prognosis in women with coronary artery disease undergoing PCI

AIM To determine the effects of bivalirudin on coagulation function and prognosis in women with coronary artery disease undergoing percutaneous coronary intervention (PCI). METHODS A total of 71 women with coronary artery disease were assigned to two groups: Bivalirudin group (n=32) and heparin group (n=39). Activated clotting time (ACT) was determined at preoperative, 5 min after medication, immediately after operation, and 30 min, 1 h and 2 h after stopping medication. Before operation, and 6 h, 24 h and 72 h after stopping medication, thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen (FIB) index were detected using automated coagulation analyzer. Before operation and 24 h after operation, a platelet count was performed. Net adverse clinical events (NACE) and stent thrombosis at 30-day were compared. RESULTS At 5 min after medication and immediately after operation, ACT in the bivalirudin group was significantly higher (P<0.01) and no significant difference was found at 30 min after stopping medication and preoperatively between the two groups. At 1 h and 2 h after stopping medication, ACT was significantly lower in the bivalirudin group (P<0.01). No significant difference was found in blood coagulation and platelet count after operation between the two groups and the 30-day follow-up revealed no difference in stent thrombosis and in major adverse cardiac or cerebral event between the two groups. All bleeding at 30 days and BARC types 2 through 5 were significantly reduced by using bivalirudin compared with using heparin (P<0.05). CONCLUSION Compared with heparin, bivalirudin produces better effects and quicker recovery and bivalirudin is thus safer and more efficient for women with coronary artery disease undergoing PCI.